SFTYCHEF: A Consultative, Diagnostic Expert System for Trench Excavation Safety Analysis on Light Commercial Construction Projects.

DTIC Science & Technology

1987-03-30

Safe Trench Excavation ...... 2 Applicability to Solution via Expert System. 3 Background: Expert Systems ..................... 4 Definition of an...trench, drownings in the trench, and other mishaps which are the result of a lack of S C- proper consideration for safe construction practices. Although...the problem is not a new one, there is as yet no *" obvious method that will guarantee a safe trench. In addition, the expertise needed to provide case

Space shuttle main engine anomaly data and inductive knowledge based systems: Automated corporate expertise

NASA Technical Reports Server (NTRS)

Modesitt, Kenneth L.

1987-01-01

Progress is reported on the development of SCOTTY, an expert knowledge-based system to automate the analysis procedure following test firings of the Space Shuttle Main Engine (SSME). The integration of a large-scale relational data base system, a computer graphics interface for experts and end-user engineers, potential extension of the system to flight engines, application of the system for training of newly-hired engineers, technology transfer to other engines, and the essential qualities of good software engineering practices for building expert knowledge-based systems are among the topics discussed.

A comprehensive information technology system to support physician learning at the point of care.

PubMed

Cook, David A; Sorensen, Kristi J; Nishimura, Rick A; Ommen, Steve R; Lloyd, Farrell J

2015-01-01

MayoExpert is a multifaceted information system integrated with the electronic medical record (EMR) across Mayo Clinic's multisite health system. It was developed as a technology-based solution to manage information, standardize clinical practice, and promote and document learning in clinical contexts. Features include urgent test result notifications; models illustrating expert-approved care processes; concise, expert-approved answers to frequently asked questions (FAQs); a directory of topic-specific experts; and a portfolio for provider licensure and credentialing. The authors evaluate MayoExpert's reach, effectiveness, adoption, implementation, and maintenance. Evaluation data sources included usage statistics, user surveys, and pilot studies.As of October 2013, MayoExpert was available at 94 clinical sites in 12 states and contained 1,368 clinical topics, answers to 7,640 FAQs, and 92 care process models. In 2012, MayoExpert was accessed at least once by 2,578/3,643 (71%) staff physicians, 900/1,374 (66%) midlevel providers, and 1,728/2,291 (75%) residents and fellows. In a 2013 survey of MayoExpert users with 536 respondents, all features were highly rated (≥67% favorable). More providers reported using MayoExpert to answer questions before/after than during patient visits (68% versus 36%). During November 2012 to April 2013, MayoExpert sent 1,660 notifications of new-onset atrial fibrillation and 1,590 notifications of prolonged QT. MayoExpert has become part of routine clinical and educational operations, and its care process models now define Mayo Clinic best practices. MayoExpert's infrastructure and content will continue to expand with improved templates and content organization, new care process models, additional notifications, better EMR integration, and improved support for credentialing activities.

Nineteenth-Century World's Fairs as Accountability Systems: Scopic Systems, Audit Practices and Educational Data

ERIC Educational Resources Information Center

Sobe, Noah W.; Boven, David T.

2014-01-01

Late-19th century World's Fairs constitute an important chapter in the history of educational accountability. International expositions allowed for educational systems and practices to be "audited" by lay and expert audiences. In this article we examine how World's Fair exhibitors sought to make visible educational practices and…

Expert system verification and validation survey, delivery 4

NASA Technical Reports Server (NTRS)

1990-01-01

The purpose is to determine the state-of-the-practice in Verification and Validation (V and V) of Expert Systems (ESs) on current NASA and Industry applications. This is the first task of a series which has the ultimate purpose of ensuring that adequate ES V and V tools and techniques are available for Space Station Knowledge Based Systems development. The strategy for determining the state-of-the-practice is to check how well each of the known ES V and V issues are being addressed and to what extent they have impacted the development of ESs.

Expert system verification and validation survey. Delivery 2: Survey results

NASA Technical Reports Server (NTRS)

1990-01-01

The purpose is to determine the state-of-the-practice in Verification and Validation (V and V) of Expert Systems (ESs) on current NASA and industry applications. This is the first task of the series which has the ultimate purpose of ensuring that adequate ES V and V tools and techniques are available for Space Station Knowledge Based Systems development. The strategy for determining the state-of-the-practice is to check how well each of the known ES V and V issues are being addressed and to what extent they have impacted the development of ESs.

Expert system verification and validation survey. Delivery 5: Revised

NASA Technical Reports Server (NTRS)

1990-01-01

The purpose is to determine the state-of-the-practice in Verification and Validation (V and V) of Expert Systems (ESs) on current NASA and Industry applications. This is the first task of a series which has the ultimate purpose of ensuring that adequate ES V and V tools and techniques are available for Space Station Knowledge Based Systems development. The strategy for determining the state-of-the-practice is to check how well each of the known ES V and V issues are being addressed and to what extent they have impacted the development of ESs.

Expert system verification and validation survey. Delivery 3: Recommendations

NASA Technical Reports Server (NTRS)

1990-01-01

The purpose is to determine the state-of-the-practice in Verification and Validation (V and V) of Expert Systems (ESs) on current NASA and Industry applications. This is the first task of a series which has the ultimate purpose of ensuring that adequate ES V and V tools and techniques are available for Space Station Knowledge Based Systems development. The strategy for determining the state-of-the-practice is to check how well each of the known ES V and V issues are being addressed and to what extent they have impacted the development of ESs.

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

Gender and the experience of mental health expert witness testimony.

PubMed

Kaempf, Aimee C; Baxter, Prudence; Packer, Ira K; Pinals, Debra A

2015-03-01

Mental health expert witness testimony involves complex tasks, and the capacity to perform under pressure is a fundamental skill of a forensic professional. In this context, it is important to understand the nuances of the provision of expert witness testimony. There have been several efforts to examine gender bias across legal and medical systems. Despite these reviews, little is known about how men and women differ or are similar with regard to performing expert witness functions. The purpose of this pilot study was to examine whether the testimony experiences of psychiatry and psychology experts vary by gender. Differences across certain domains, such as the sense of never experiencing anxiety and the sense of one's impact on case outcome were seen across genders. Few other gender-based differences in the experience of providing expert witness testimony were seen. Although the findings of this study raise further questions, they highlight some of the important subtleties noted in forensic practice and the work of the expert witness. In future studies, researchers should continue to explore these findings on the influence of gender and expand to consider culture and race as additional factors in the experience of expert witness testimony. As forensic professional practice evolves, it is important to understand unique aspects of forensic practice, to improve training of forensic experts, and to assist forensic experts in anticipating what they may experience related to the provision of expert testimony. © 2015 American Academy of Psychiatry and the Law.

Professionalism in court

PubMed Central

Hutchins, John C.

2014-01-01

Summary Serving as an expert witness can be a rewarding experience. It affords the neurologist the opportunity to contribute expertise to the legal system's pursuit of justice and benefits the public interest. However, serving as an expert witness without understanding and incorporating relevant professional and specialty guidelines concerning expert witness testimony can place the neurologist at risk. The American Academy of Neurology has established standards governing expert witness testimony and a disciplinary process to respond to complaints of violation of its standards. Increased understanding of and adherence to these qualifications and guidelines, coupled with an awareness of how the legal system differs from clinical practice, will better equip neurologists serving as expert witnesses and minimize their professional risk when doing so. PMID:25279255

Representation of Nursing Terminologies in UMLS

PubMed Central

Kim, Tae Youn; Coenen, Amy; Hardiker, Nicholas; Bartz, Claudia C.

2011-01-01

There are seven nursing terminologies or classifications that are considered a standard to support nursing practice in the U.S. Harmonizing these terminologies will enhance the interoperability of clinical data documented across nursing practice. As a first step to harmonize the nursing terminologies, the purpose of this study was to examine how nursing problems or diagnostic concepts from select terminologies were cross-mapped in Unified Medical Language System (UMLS). A comparison analysis was conducted by examining whether cross-mappings available in UMLS through concept unique identifiers were consistent with cross-mappings conducted by human experts. Of 423 concepts from three terminologies, 411 (97%) were manually cross-mapped by experts to the International Classification for Nursing Practice. The UMLS semantic mapping among the 411 nursing concepts presented 33.6% accuracy (i.e., 138 of 411 concepts) when compared to expert cross-mappings. Further research and collaboration among experts in this field are needed for future enhancement of UMLS. PMID:22195127

[Expert investigation on food safety standard system framework construction in China].

PubMed

He, Xiang; Yan, Weixing; Fan, Yongxiang; Zeng, Biao; Peng, Zhen; Sun, Zhenqiu

2013-09-01

Through investigating food safety standard framework among food safety experts, to summarize the basic elements and principles of food safety standard system, and provide policy advices for food safety standards framework. A survey was carried out among 415 experts from government, professional institutions and the food industry/enterprises using the National Food Safety Standard System Construction Consultation Questionnaire designed in the name of the Secretariat of National Food Safety Standard Committee. Experts have different advices in each group about the principles of food product standards, food additive product standards, food related product standards, hygienic practice, test methods. According to the results, the best solution not only may reflect experts awareness of the work of food safety standards situation, but also provide advices for setting and revision of food safety standards for the next. Through experts investigation, the framework and guiding principles of food safety standard had been built.

Identifying influenza-like illness presentation from unstructured general practice clinical narrative using a text classifier rule-based expert system versus a clinical expert.

PubMed

MacRae, Jayden; Love, Tom; Baker, Michael G; Dowell, Anthony; Carnachan, Matthew; Stubbe, Maria; McBain, Lynn

2015-10-06

We designed and validated a rule-based expert system to identify influenza like illness (ILI) from routinely recorded general practice clinical narrative to aid a larger retrospective research study into the impact of the 2009 influenza pandemic in New Zealand. Rules were assessed using pattern matching heuristics on routine clinical narrative. The system was trained using data from 623 clinical encounters and validated using a clinical expert as a gold standard against a mutually exclusive set of 901 records. We calculated a 98.2 % specificity and 90.2 % sensitivity across an ILI incidence of 12.4 % measured against clinical expert classification. Peak problem list identification of ILI by clinical coding in any month was 9.2 % of all detected ILI presentations. Our system addressed an unusual problem domain for clinical narrative classification; using notational, unstructured, clinician entered information in a community care setting. It performed well compared with other approaches and domains. It has potential applications in real-time surveillance of disease, and in assisted problem list coding for clinicians. Our system identified ILI presentation with sufficient accuracy for use at a population level in the wider research study. The peak coding of 9.2 % illustrated the need for automated coding of unstructured narrative in our study.

The adversarial court system and the expert medical witness: 'The truth the whole truth and nothing but the truth?'.

PubMed

Ryan, Matthew

2003-06-01

This discussion aims to provide the occasional medical expert witness with background knowledge of the adversarial court system and the role of the medical expert witness within it. The parallel evolution of the adversarial and inquisitorial legal systems has been more out of tradition rather than any systematic review of the effectiveness of one system or the other. Both legal systems have their merits and limitations. Witnesses within the adversarial system are required to present evidence in a structured and highly stylized format consisting of 'evidence in chief' followed by 'cross-examination'. This format is an attempt to exclude unreliable evidence. The medical witness is an 'expert' by means of specialized knowledge not possessed by the general public. This distinction allows the expert medical witness to offer his or her opinion as evidence. There remain several limitations to the expert's evidence and these relate to common knowledge, field of expertise and the 'ultimate issue'. The current practice of selection of expert medical witnesses is seriously flawed with several pressures operating to maximise bias and inaccurate testimony. Doctors should not only anticipate change in this area they should lead reform in this area.

An application of object-oriented knowledge representation to engineering expert systems

NASA Technical Reports Server (NTRS)

Logie, D. S.; Kamil, H.; Umaretiya, J. R.

1990-01-01

The paper describes an object-oriented knowledge representation and its application to engineering expert systems. The object-oriented approach promotes efficient handling of the problem data by allowing knowledge to be encapsulated in objects and organized by defining relationships between the objects. An Object Representation Language (ORL) was implemented as a tool for building and manipulating the object base. Rule-based knowledge representation is then used to simulate engineering design reasoning. Using a common object base, very large expert systems can be developed, comprised of small, individually processed, rule sets. The integration of these two schemes makes it easier to develop practical engineering expert systems. The general approach to applying this technology to the domain of the finite element analysis, design, and optimization of aerospace structures is discussed.

Expert System Approach For Generating And Evaluating Engine Design Alternatives

NASA Astrophysics Data System (ADS)

Shen, Stewart N. T.; Chew, Meng-Sang; Issa, Ghassan F.

1989-03-01

Artificial intelligence is becoming an increasingly important subject of study for computer scientists, engineering designers, as well as professionals in other fields. Even though AI technology is a relatively new discipline, many of its concepts have already found practical applications. Expert systems, in particular, have made significant contributions to technologies in such fields as business, medicine, engineering design, chemistry, and particle physics. This paper describes an expert system developed to aid the mechanical designer with the preliminary design of variable-stroke internal-combustion engines. The expert system accomplished its task by generating and evaluating a large number of design alternatives represented in the form of graphs. Through the application of structural and design rules directly to the graphs, optimal and near optimal preliminary design configurations of engines are deduced.

Using hybrid expert system approaches for engineering applications

NASA Technical Reports Server (NTRS)

Allen, R. H.; Boarnet, M. G.; Culbert, C. J.; Savely, R. T.

1987-01-01

In this paper, the use of hybrid expert system shells and hybrid (i.e., algorithmic and heuristic) approaches for solving engineering problems is reported. Aspects of various engineering problem domains are reviewed for a number of examples with specific applications made to recently developed prototype expert systems. Based on this prototyping experience, critical evaluations of and comparisons between commercially available tools, and some research tools, in the United States and Australia, and their underlying problem-solving paradigms are made. Characteristics of the implementation tool and the engineering domain are compared and practical software engineering issues are discussed with respect to hybrid tools and approaches. Finally, guidelines are offered with the hope that expert system development will be less time consuming, more effective, and more cost-effective than it has been in the past.

Expert Recommender: Designing for a Network Organization

NASA Astrophysics Data System (ADS)

Reichling, Tim; Veith, Michael; Wulf, Volker

Recent knowledge management initiatives focus on expertise sharing within formal organizational units and informal communities of practice. Expert recommender systems seem to be a promising tool in support of these initiatives. This paper presents experiences in designing an expert recommender system for a knowledge- intensive organization, namely the National Industry Association (NIA). Field study results provide a set of specific design requirements. Based on these requirements, we have designed an expert recommender system which is integrated into the specific software infrastructure of the organizational setting. The organizational setting is, as we will show, specific for historical, political, and economic reasons. These particularities influence the employees’ organizational and (inter-)personal needs within this setting. The paper connects empirical findings of a long-term case study with design experiences of an expertise recommender system.

An expert system executive for automated assembly of large space truss structures

NASA Technical Reports Server (NTRS)

Allen, Cheryl L.

1993-01-01

Langley Research Center developed a unique test bed for investigating the practical problems associated with the assembly of large space truss structures using robotic manipulators. The test bed is the result of an interdisciplinary effort that encompasses the full spectrum of assembly problems - from the design of mechanisms to the development of software. The automated structures assembly test bed and its operation are described, the expert system executive and its development are detailed, and the planned system evolution is discussed. Emphasis is on the expert system implementation of the program executive. The executive program must direct and reliably perform complex assembly tasks with the flexibility to recover from realistic system errors. The employment of an expert system permits information that pertains to the operation of the system to be encapsulated concisely within a knowledge base. This consolidation substantially reduced code, increased flexibility, eased software upgrades, and realized a savings in software maintenance costs.

Examing nursing students' understanding of the cardiovascular system in a BSN program

NASA Astrophysics Data System (ADS)

Stuart, Parker Emerson

This study investigated the alignment of important cardiovascular system (CVS) concepts identified by expert nurses with nursing student's knowledge. Specifically, it focused on the prevalence of nursing students' alternative conceptions for these important concepts as a potential reason for a theory-practice gap in nursing (Corlett, 2000; Jordan, 1994). This is the first study to target nursing student alternative conceptions exclusively whereas other studies focused on diverse groups of undergraduates' CVS knowledge (Michael et al., 2002). The study was divided into two phases and used a case study approach with each phase of the study representing a single case. The first phase of the study sought to understand what CVS concepts expert nurses deemed relevant to their daily practice and how these experts used these concepts. The second phase identified nursing student alternative conceptions through the use of open-ended scenarios based on the results of phase I. For the first phase of the study involved four CVS expert nurses practicing in emergency rooms and cardiac intensive care units at two local hospitals. Interviews were used to elicit important CVS concepts. The expert nurses identified five broad concepts as important to their practice. These concepts were a) cardiovascular anatomical concepts; b) cardiovascular physiological concepts; c) homeostasis and diseases of the CVS; d) the interdependence and interaction of the CVS with other organ systems and e) the intersection of the CVS and technology in patient diagnosis and treatment. These finding reinforce concepts already being taught to nursing students but also suggest that instruction should focus more on how the CVS interacts with other organ systems and how technology and the CVS interact. The presence of alternative conceptions in the nursing students was examined through the use of open-ended questions. A total of 17 students fully completed the scenario questions. Results indicate that this group of nursing students hold some CVS alternative conceptions. Overall, the alternative conceptions can be grouped into four categories: a) CVS anatomy, b) blood flow and pressure, c) anthropomorphic views and d) miscellaneous alternative conceptions. These findings suggest there is indeed a misalignment between expert nurses' and nursing students' knowledge of the CVS with this misalignment potentially contributing to the theory-practice gap.

Expert System Development Methodology (ESDM)

NASA Technical Reports Server (NTRS)

Sary, Charisse; Gilstrap, Lewey; Hull, Larry G.

1990-01-01

The Expert System Development Methodology (ESDM) provides an approach to developing expert system software. Because of the uncertainty associated with this process, an element of risk is involved. ESDM is designed to address the issue of risk and to acquire the information needed for this purpose in an evolutionary manner. ESDM presents a life cycle in which a prototype evolves through five stages of development. Each stage consists of five steps, leading to a prototype for that stage. Development may proceed to a conventional development methodology (CDM) at any time if enough has been learned about the problem to write requirements. ESDM produces requirements so that a product may be built with a CDM. ESDM is considered preliminary because is has not yet been applied to actual projects. It has been retrospectively evaluated by comparing the methods used in two ongoing expert system development projects that did not explicitly choose to use this methodology but which provided useful insights into actual expert system development practices and problems.

Computer-based diagnostic expert systems in rheumatology: where do we stand in 2014?

PubMed

Alder, Hannes; Michel, Beat A; Marx, Christian; Tamborrini, Giorgio; Langenegger, Thomas; Bruehlmann, Pius; Steurer, Johann; Wildi, Lukas M

2014-01-01

Background. The early detection of rheumatic diseases and the treatment to target have become of utmost importance to control the disease and improve its prognosis. However, establishing a diagnosis in early stages is challenging as many diseases initially present with similar symptoms and signs. Expert systems are computer programs designed to support the human decision making and have been developed in almost every field of medicine. Methods. This review focuses on the developments in the field of rheumatology to give a comprehensive insight. Medline, Embase, and Cochrane Library were searched. Results. Reports of 25 expert systems with different design and field of application were found. The performance of 19 of the identified expert systems was evaluated. The proportion of correctly diagnosed cases was between 43.1 and 99.9%. Sensitivity and specificity ranged from 62 to 100 and 88 to 98%, respectively. Conclusions. Promising diagnostic expert systems with moderate to excellent performance were identified. The validation process was in general underappreciated. None of the systems, however, seemed to have succeeded in daily practice. This review identifies optimal characteristics to increase the survival rate of expert systems and may serve as valuable information for future developments in the field.

The Health Improvement Network (THIN)

Cancer.gov

The Health Improvement Network is a collaboration between Cegedim Strategic Data EPIC, an expert in the provision of UK primary care patient data that is used for medical research, and In Practice Systems (InPS), who continue to develop and supply the widely-used Vision general practice computer system.

Workflow Agents vs. Expert Systems: Problem Solving Methods in Work Systems Design

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten; Seah, Chin

2009-01-01

During the 1980s, a community of artificial intelligence researchers became interested in formalizing problem solving methods as part of an effort called "second generation expert systems" (2nd GES). How do the motivations and results of this research relate to building tools for the workplace today? We provide an historical review of how the theory of expertise has developed, a progress report on a tool for designing and implementing model-based automation (Brahms), and a concrete example how we apply 2nd GES concepts today in an agent-based system for space flight operations (OCAMS). Brahms incorporates an ontology for modeling work practices, what people are doing in the course of a day, characterized as "activities." OCAMS was developed using a simulation-to-implementation methodology, in which a prototype tool was embedded in a simulation of future work practices. OCAMS uses model-based methods to interactively plan its actions and keep track of the work to be done. The problem solving methods of practice are interactive, employing reasoning for and through action in the real world. Analogously, it is as if a medical expert system were charged not just with interpreting culture results, but actually interacting with a patient. Our perspective shifts from building a "problem solving" (expert) system to building an actor in the world. The reusable components in work system designs include entire "problem solvers" (e.g., a planning subsystem), interoperability frameworks, and workflow agents that use and revise models dynamically in a network of people and tools. Consequently, the research focus shifts so "problem solving methods" include ways of knowing that models do not fit the world, and ways of interacting with other agents and people to gain or verify information and (ultimately) adapt rules and procedures to resolve problematic situations.

ClassCompass: A Software Design Mentoring System

ERIC Educational Resources Information Center

Coelho, Wesley; Murphy, Gail

2007-01-01

Becoming a quality software developer requires practice under the guidance of an expert mentor. Unfortunately, in most academic environments, there are not enough experts to provide any significant design mentoring for software engineering students. To address this problem, we present a collaborative software design tool intended to maximize an…

Expert system for skin problem consultation in Thai traditional medicine.

PubMed

Nopparatkiat, Pornchai; na Nagara, Byaporn; Chansa-ngavej, Chuvej

2014-01-01

This paper aimed to demonstrate the research and development of a rule-based expert system for skin problem consulting in the areas of acne, melasma, freckle, wrinkle, and uneven skin tone, with recommended treatments from Thai traditional medicine knowledge. The tool selected for developing the expert system is a software program written in the PHP language. MySQL database is used to work together with PHP for building database of the expert system. The system is web-based and can be reached from anywhere with Internet access. The developed expert system gave recommendations on the skin problem treatment with Thai herbal recipes and Thai herbal cosmetics based on 416 rules derived from primary and secondary sources. The system had been tested by 50 users consisting of dermatologists, Thai traditional medicine doctors, and general users. The developed system was considered good for learning and consultation. The present work showed how such a scattered body of traditional knowledge as Thai traditional medicine and herbal recipes could be collected, organised and made accessible to users and interested parties. The expert system developed herein should contribute in a meaningful way towards preserving the knowledge and helping promote the use of Thai traditional medicine as a practical alternative medicine for the treatment of illnesses.

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2011-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: procedure for adoption of International Chemical Reference Substances; WHO good practices for pharmaceutical microbiology laboratories; good manufacturing practices: main principles for pharmaceutical products; good manufacturing practices for blood establishments (jointly with the Expert Committee on Biological Standardization); guidelines on good manufacturing practices for heating, ventilation and air-conditioning systems for non-sterile pharmaceutical dosage forms; good manufacturing practices for sterile pharmaceutical products; guidelines on transfer of technology in pharmaceutical manufacturing; good pharmacy practice: standards for quality of pharmacy services (joint FIP/WHO); model guidance for the storage and transport of time- and temperature-sensitive pharmaceutical products (jointly with the Expert Committee on Biological Standardization); procedure for prequalification of pharmaceutical products; guide on submission of documentation for prequalification of innovator finished pharmaceutical products approved by stringent regulatory authorities; prequalification of quality control laboratories: procedure for assessing the acceptability, in principle, of quality control laboratories for use by United Nations agencies; guidelines for preparing a laboratory information file; guidelines for drafting a site master file; guidelines on submission of documentation for a multisource (generic) finished product: general format: preparation of product dossiers in common technical document format.

Elicitation of neurological knowledge with argument-based machine learning.

PubMed

Groznik, Vida; Guid, Matej; Sadikov, Aleksander; Možina, Martin; Georgiev, Dejan; Kragelj, Veronika; Ribarič, Samo; Pirtošek, Zvezdan; Bratko, Ivan

2013-02-01

The paper describes the use of expert's knowledge in practice and the efficiency of a recently developed technique called argument-based machine learning (ABML) in the knowledge elicitation process. We are developing a neurological decision support system to help the neurologists differentiate between three types of tremors: Parkinsonian, essential, and mixed tremor (comorbidity). The system is intended to act as a second opinion for the neurologists, and most importantly to help them reduce the number of patients in the "gray area" that require a very costly further examination (DaTSCAN). We strive to elicit comprehensible and medically meaningful knowledge in such a way that it does not come at the cost of diagnostic accuracy. To alleviate the difficult problem of knowledge elicitation from data and domain experts, we used ABML. ABML guides the expert to explain critical special cases which cannot be handled automatically by machine learning. This very efficiently reduces the expert's workload, and combines expert's knowledge with learning data. 122 patients were enrolled into the study. The classification accuracy of the final model was 91%. Equally important, the initial and the final models were also evaluated for their comprehensibility by the neurologists. All 13 rules of the final model were deemed as appropriate to be able to support its decisions with good explanations. The paper demonstrates ABML's advantage in combining machine learning and expert knowledge. The accuracy of the system is very high with respect to the current state-of-the-art in clinical practice, and the system's knowledge base is assessed to be very consistent from a medical point of view. This opens up the possibility to use the system also as a teaching tool. Copyright © 2012 Elsevier B.V. All rights reserved.

Replication of clinical innovations in multiple medical practices.

PubMed

Henley, N S; Pearce, J; Phillips, L A; Weir, S

1998-11-01

Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

Information technology from novice to expert: implementation implications.

PubMed

Courtney, Karen L; Alexander, Gregory L; Demiris, George

2008-09-01

This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. Organizational policies and CDSS design affect implementation and user adoption. Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.

Assessing experience in the deliberate practice of running using a fuzzy decision-support system

PubMed Central

Roveri, Maria Isabel; Manoel, Edison de Jesus; Onodera, Andrea Naomi; Ortega, Neli R. S.; Tessutti, Vitor Daniel; Vilela, Emerson; Evêncio, Nelson

2017-01-01

The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches’ knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p<0.001) and also with five other expert running coaches (r>0.86, p<0.001). From the expert’s knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency) and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings. PMID:28817655

WHO expert committee on specifications for pharmaceutical preparations. Fortieth report.

PubMed

2006-01-01

This report presents the recommendations of an international group of experts convened by the World Health Organization to consider matters concerning the quality assurance of pharmaceuticals and specifications for drug substances and dosage forms. The report is complemented by a number of annexes. These include: a list of available International Chemical Reference Substances and International Infrared Spectra; supplementary guidelines on good manufacturing practices for heating, ventilation and air-conditioning systems for non-sterile pharmaceutical dosage forms; updated supplementary guidelines on good manufacturing practices for the manufacture of herbal medicines; supplementary guidelines on good manufacturing practices for validation; good distribution practices for pharmaceutical products; a model quality assurance system for procurement agencies (recommendations for quality assurance systems focusing on prequalification of products and manufacturers, purchasing, storage and distribution of pharmaceutical products); multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability; a proposal to waive in vivo bioequivalence requirements for WHO Model List of Essential Medicines immediate-release, solid oral dosage forms; and additional guidance for organizations performing in vivo bioequivalence studies.

Priorities for implementing nutritional science into practice to optimize military performance.

PubMed

Elfenbaum, Pamela; Crawford, Cindy; Enslein, Viviane; Berry, Kevin

2017-06-01

The Metabolically Optimized Brain study explores nutritional science believed to be ready to place into practice to help improve US service member mission-readiness and performance. To this end, an implementation expert panel considered how the US Department of Defense Subsistence Food Service Program, which is operated by each branch of the military in dining facilities within the continental United States, could apply the best nutritional science in a cost-effective manner. The work of this panel was facilitated through a series of thematic conversations guided by evidence generated through systematic reviews, which were performed to identify systems and process gaps and propose possible solutions. The expert panel used a Delphi method of multiple voting, and ultimately proposed 11 systems changes, of which 6 were ranked as highest priority. The proposed highest priority changes were then discussed by the participants with additional stakeholders. The process described here highlights how experts from different sectors operating in a complex system of subsystems can come together to cross talk, identify gaps, and propose mutually beneficial system and process changes to improve the alignment of nutritional science and institutional food-service practice. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The expert surgical assistant. An intelligent virtual environment with multimodal input.

PubMed

Billinghurst, M; Savage, J; Oppenheimer, P; Edmond, C

1996-01-01

Virtual Reality has made computer interfaces more intuitive but not more intelligent. This paper shows how an expert system can be coupled with multimodal input in a virtual environment to provide an intelligent simulation tool or surgical assistant. This is accomplished in three steps. First, voice and gestural input is interpreted and represented in a common semantic form. Second, a rule-based expert system is used to infer context and user actions from this semantic representation. Finally, the inferred user actions are matched against steps in a surgical procedure to monitor the user's progress and provide automatic feedback. In addition, the system can respond immediately to multimodal commands for navigational assistance and/or identification of critical anatomical structures. To show how these methods are used we present a prototype sinus surgery interface. The approach described here may easily be extended to a wide variety of medical and non-medical training applications by making simple changes to the expert system database and virtual environment models. Successful implementation of an expert system in both simulated and real surgery has enormous potential for the surgeon both in training and clinical practice.

Evaluating neural networks and artificial intelligence systems

NASA Astrophysics Data System (ADS)

Alberts, David S.

1994-02-01

Systems have no intrinsic value in and of themselves, but rather derive value from the contributions they make to the missions, decisions, and tasks they are intended to support. The estimation of the cost-effectiveness of systems is a prerequisite for rational planning, budgeting, and investment documents. Neural network and expert system applications, although similar in their incorporation of a significant amount of decision-making capability, differ from each other in ways that affect the manner in which they can be evaluated. Both these types of systems are, by definition, evolutionary systems, which also impacts their evaluation. This paper discusses key aspects of neural network and expert system applications and their impact on the evaluation process. A practical approach or methodology for evaluating a certain class of expert systems that are particularly difficult to measure using traditional evaluation approaches is presented.

Acute asthma severity identification of expert system flow in emergency department

NASA Astrophysics Data System (ADS)

Sharif, Nurul Atikah Mohd; Ahmad, Norazura; Ahmad, Nazihah; Desa, Wan Laailatul Hanim Mat

2017-11-01

Integration of computerized system in healthcare management help in smoothening the documentation of patient records, highly accesses of knowledge and clinical practices guideline, and advice on decision making. Exploit the advancement of artificial intelligent such as fuzzy logic and rule-based reasoning may improve the management of emergency department in terms of uncertainty condition and medical practices adherence towards clinical guideline. This paper presenting details of the emergency department flow for acute asthma severity identification with the embedding of acute asthma severity identification expert system (AASIES). Currently, AASIES is still in preliminary stage of system validation. However, the implementation of AASIES in asthma bay management is hope can reduce the usage of paper for manual documentation and be a pioneer for the development of a more complex decision support system to smoothen the ED management and more systematic.

Esophageal cancer screening in achalasia: is there a consensus?

PubMed

Ravi, K; Geno, D M; Katzka, D A

2015-04-01

Achalasia is an important but relatively uncommon disorder. While highly effective therapeutic options exist, esophageal cancer remains a long-term potential complication. The risk of esophageal cancer in achalasia remains unclear, with current guidelines recommending against routine endoscopic screening. However, given limited data and conflicting opinion, it is unknown whether consensus regarding screening practices in achalasia among experts exists. A 10-question survey to assess screening practices in achalasia was created and distributed to 28 experts in the area of achalasia. Experts were identified based on publications and meeting presentations in the field. Survey responses were received from 17 of 28 (61%) experts. Wide geographic distribution was seen among respondents, with eight (47%) from Europe or Australia, seven (41%) from the United States, and two (12%) from Asia. Screening for esophageal cancer was inconsistent, with nine (53%) experts endorsing the practice and eight (47%) not. Screening practices did not differ among geographic regions. No consensus regarding the risk for esophageal cancer in achalasia was seen, with three experts reporting no increased risk compared with the general population, eight experts a lifetime risk of 0.1-0.5%, three experts a 0.5-1% risk, two experts a 1-2% risk, and one expert a 3-5% risk. However, these differences in perception of risk did not influence screening practices. Upper endoscopy was utilized among all experts who endorsed screening. However, practices still varied with screening commencing at or within 1 year of diagnosis in two practices compared with 5 and 10 years in three respective practices each. Surveillance intervals also varied, performed every 2 years in four practices, every 3 years in four practices, and every 5 years in one practice. Practice variation in the management of achalasia itself was also seen, with initial treatment with Heller myotomy endorsed by eight experts, pneumatic dilation by five experts, and two each endorsing peroral endoscopic myotomy or no specific preference. In addition, while 82% (14/17) of experts endorsed long-term follow up of patients, no consensus regarding long-term follow up existed, with annual follow up in eight practices, every 3-6 months in three practices, and every 2 years in three practices. Large practice variation in the long-term management of achalasia exists among experts in the field. Only a slight majority of experts endorse screening for esophageal cancer in achalasia, and no consensus exists regarding how surveillance should be structured even among this group. Interestingly, the lack of consensus on cancer screening parallels a lack of agreement on initial treatment of achalasia. These findings suggest a need for greater homogeneity in the management of longstanding achalasia and cancer screening. Further, this study highlights the need for more data on this topic to foster greater agreement. © 2014 International Society for Diseases of the Esophagus.

Survey of expert practice and perceptions of the supporting clinical evidence for the management of uveitis-related cataract and cystoid macular oedema.

PubMed

Sreekantam, Sreekanth; Denniston, Alastair K O; Murray, Philip I

2011-10-01

To survey the practice of uveitis experts in the management of uveitic cataract and cystoid macular oedema (CMO). A structured questionnaire containing two clinical scenarios was sent to members of the International Uveitis Study Group (IUSG). The questionnaire surveyed both respondents' current practice and their perception of the supporting clinical evidence. For uveitic cataract, 70% required a 3-month inflammation-free period before surgery, and 76% gave a prophylactic preoperative systemic corticosteroid. For uveitic CMO, 87% gave corticosteroids, usually orally. Preferred second-line agents were methotrexate (39%), cyclosporin (24%), azathioprine (17%), and mycophenolate (7%). Respondents suggested the evidence underlying their decisions was either absent or relatively weak (levels III or IV), and in most cases personal experience was a factor. This survey highlights areas of consensus and variation among uveitis experts in managing uveitic cataract and CMO, and emphasizes the need for further clinical trials to establish the best practice.

Experts speak: advice from key informants to small, rural hospitals on implementing the electronic health record system.

PubMed

Craven, Catherine K; Sievert, MaryEllen C; Hicks, Lanis L; Alexander, Gregory L; Hearne, Leonard B; Holmes, John H

2013-01-01

The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.

[Prevention of infections in adults and adolescents with systemic lupus erythematosus: Guidelines for the clinical practice based on the literature and expert opinion].

PubMed

Mathian, A; Arnaud, L; Adoue, D; Agard, C; Bader-Meunier, B; Baudouin, V; Belizna, C; Bonnotte, B; Boumedine, F; Chaib, A; Chauchard, M; Chiche, L; Daugas, E; Ghali, A; Gobert, P; Gondran, G; Guettrot-Imbert, G; Hachulla, E; Hamidou, M; Haroche, J; Hervier, B; Hummel, A; Jourde-Chiche, N; Korganow, A-S; Kwon, T; Le Guern, V; Le Quellec, A; Limal, N; Magy-Bertrand, N; Marianetti-Guingel, P; Martin, T; Martin Silva, N; Meyer, O; Miyara, M; Morell-Dubois, S; Ninet, J; Pennaforte, J-L; Polomat, K; Pourrat, J; Queyrel, V; Raymond, I; Remy, P; Sacre, K; Sibilia, J; Viallard, J-F; Viau Brabant, A; Hanslik, T; Amoura, Z

2016-05-01

To develop French recommendations about the management of vaccinations, the screening of cervical cancer and the prevention of pneumocystis pneumonia in systemic lupus erythematosus (SLE). Thirty-seven experts qualified in internal medicine, rheumatology, dermatology, nephrology and pediatrics have selected recommendations from a list of proposition based on available data from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. Inactivated vaccines do not cause significant harm in SLE patients. Experts recommend that lupus patient should receive vaccinations accordingly to the recommendations and the schedules for the general public. Pneumococcal vaccination is recommended for all SLE patients. Influenza vaccination is recommended for immunosuppressed SLE patients. Live attenuated vaccines should be avoided in immunosuppressed patients. Yet, recent works suggest that they can be considered in mildly immunosuppressed patients. Experts have recommended a cervical cytology every year for immunosuppressed patients. No consensus was obtained for the prevention of pneumocystis pneumonia. These recommendations can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients. Copyright © 2016 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Student Teaching: Problems and Promising Practices.

ERIC Educational Resources Information Center

Griffin, Gary A., Ed.; Edwards, Sara, Ed.

The working conference "Student Teaching: Problems and Promising Practices" brought together experts representing three different role orientations: cooperating teachers, school system representatives, and teacher educators. Under discussion was the student teaching process and the nature of research that might contribute to its better…

Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis.

PubMed

Avouac, Jérôme; Huscher, Dörte; Furst, Daniel E; Opitz, Christian F; Distler, Oliver; Allanore, Yannick

2014-01-01

To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide <50% without pulmonary fibrosis). Among experts in pulmonary arterial hypertension-SSc, a core set of criteria for clinical practice to refer SSc patients for RHC has been defined by Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

Understanding the role of knowledge in the practice of expert nephrology nurses in Australia.

PubMed

Bonner, Ann

2007-09-01

This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the role of knowledge in expert practice. Using grounded theory methodology, the study involved 17 registered nurses who were practicing in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participants' observations and interviews. Having extensive nephrology nursing knowledge was a striking characteristic of a nursing expert. Expert nurses clearly relied on and utilized extensive nephrology nursing knowledge to practice. Of importance for nursing, the results of this study indicate that domain-specific knowledge is a crucial feature of expert practice.

Learning from the Experts: Gaining Insights into Best Practice during the Acquisition of Three Novel Motor Skills

ERIC Educational Resources Information Center

Hodges, Nicola J.; Edwards, Christopher; Luttin, Shaun; Bowcock, Alison

2011-01-01

The amount and quality of practice predicts expertise, yet optimal conditions of practice have primarily been explored with novice learners. Ten expert musicians and ten novices practiced disc-throwing skills under self-regulated conditions. A third novice group practiced with the same schedule as the music experts (yoked). The groups did not…

Pediatric regional examination of the musculoskeletal system: a practice- and consensus-based approach.

PubMed

Foster, Helen; Kay, Lesley; May, Carl; Rapley, Tim

2011-11-01

Competent examination of the pediatric musculoskeletal (MSK) system is a vital component of clinical assessment of children with MSK presentations. The aim was to develop a regional MSK examination for school-age children that is age appropriate and reflects clinical practice. Qualitative and quantitative analyses involving video observation of clinical examination technique, systematic review, and expert consensus were employed to reveal descriptions, frequencies, and variations in technique for joint regions in various clinical scenarios. Systematic review and data from clinical observation were combined with feedback from a group of pediatric MSK experts through a web-based survey. All results were collated and discussed by consensus development groups to derive the pediatric Regional Examination of the Musculoskeletal System (pREMS). A total of 48 pediatric MSK expert clinicians were involved to derive pREMS. Systematic review revealed a paucity of evidence about regional pediatric MSK examination. Video observations of MSK examinations (a total of 2,901 maneuvers) performed by pediatric MSK experts (n = 11 doctors and 8 therapists) of 89 school-age children attending outpatient clinics in 7 UK pediatric rheumatology centers were followed by semistructured interviews with 14 of 19 clinicians. Video observation showed variation in examination techniques, most frequently at the hip and knee in the context of mechanical and inflammatory clinical scenarios. pREMS is the first practice- and consensus-based regional pediatric MSK examination for school-age children. The structured approach is an important step toward improved pediatric MSK clinical skills relevant to clinical training. Copyright © 2011 by the American College of Rheumatology.

Modelling a Complex System: Using Novice-Expert Analysis for Developing an Effective Technology-Enhanced Learning Environment

ERIC Educational Resources Information Center

Wu, Hsin-Kai

2010-01-01

The purposes of this article are to present the design of a technology-enhanced learning environment (Air Pollution Modeling Environment [APoME]) that was informed by a novice-expert analysis and to discuss high school students' development of modelling practices in the learning environment. APoME was designed to help high school students…

Academy of Nutrition and Dietetics: Standards of professional performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems.

PubMed

Tagtow, Angie; Robien, Kim; Bergquist, Erin; Bruening, Meg; Dierks, Lisa; Hartman, Barbara E; Robinson-O'Brien, Ramona; Steinitz, Tamara; Tahsin, Bettina; Underwood, Teri; Wilkins, Jennifer

2014-03-01

Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Polyp morphology: an interobserver evaluation for the Paris classification among international experts.

PubMed

van Doorn, Sascha C; Hazewinkel, Y; East, James E; van Leerdam, Monique E; Rastogi, Amit; Pellisé, Maria; Sanduleanu-Dascalescu, Silvia; Bastiaansen, Barbara A J; Fockens, Paul; Dekker, Evelien

2015-01-01

The Paris classification is an international classification system for describing polyp morphology. Thus far, the validity and reproducibility of this classification have not been assessed. We aimed to determine the interobserver agreement for the Paris classification among seven Western expert endoscopists. A total of 85 short endoscopic video clips depicting polyps were created and assessed by seven expert endoscopists according to the Paris classification. After a digital training module, the same 85 polyps were assessed again. We calculated the interobserver agreement with a Fleiss kappa and as the proportion of pairwise agreement. The interobserver agreement of the Paris classification among seven experts was moderate with a Fleiss kappa of 0.42 and a mean pairwise agreement of 67%. The proportion of lesions assessed as "flat" by the experts ranged between 13 and 40% (P<0.001). After the digital training, the interobserver agreement did not change (kappa 0.38, pairwise agreement 60%). Our study is the first to validate the Paris classification for polyp morphology. We demonstrated only a moderate interobserver agreement among international Western experts for this classification system. Our data suggest that, in its current version, the use of this classification system in daily practice is questionable and it is unsuitable for comparative endoscopic research. We therefore suggest introduction of a simplification of the classification system.

Forensic neuropsychology and expert witness testimony: An overview of forensic practice.

PubMed

Leonard, Elizabeth L

2015-01-01

Neuropsychologists are frequently asked to serve as expert witnesses in an increasing number of legal contexts for civil and criminal proceedings. The skills required to practice forensic neuropsychology expand upon the knowledge, skills, and abilities developed by clinical neuropsychologists. Forensic neuropsychologists acquire expertise in understanding the roles and various functions of the legal system, as well as their role in addressing psycholegal questions to assist fact finders in making legal decisions. The required skills and the unique circumstances for clinical neuropsychologists pursing forensic work are reviewed. Copyright © 2015 Elsevier Ltd. All rights reserved.

An expert system-based approach to prediction of year-to-year climatic variations in the North Atlantic region

NASA Astrophysics Data System (ADS)

Rodionov, S. N.; Martin, J. H.

1999-07-01

A novel approach to climate forecasting on an interannual time scale is described. The approach is based on concepts and techniques from artificial intelligence and expert systems. The suitability of this approach to climate diagnostics and forecasting problems and its advantages compared with conventional forecasting techniques are discussed. The article highlights some practical aspects of the development of climatic expert systems (CESs) and describes an implementation of such a system for the North Atlantic (CESNA). Particular attention is paid to the content of CESNA's knowledge base and those conditions that make climatic forecasts one to several years in advance possible. A detailed evaluation of the quality of the experimental real-time forecasts made by CESNA for the winters of 1995-1996, 1996-1997 and 1997-1998 are presented.

CE: Original Research: Creating an Evidence-Based Progression for Clinical Advancement Programs.

PubMed

Burke, Kathleen G; Johnson, Tonya; Sites, Christine; Barnsteiner, Jane

2017-05-01

: Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice. The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program. Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical advancement programs then participated in Delphi rounds aimed at reaching consensus on the developmental progression of the 186 KSAs through four levels of clinical advancement. Two Delphi rounds resulted in consensus by the expert participants. All eight competency domains were determined to be essential at all four levels of clinical practice. At the novice level of practice, the experts identified a greater number of KSAs in the domains of safety and patient- and family-centered care. At more advanced practice levels, the experts identified a greater number of KSAs in the domains of professionalism, teamwork, technology and informatics, and continuous quality improvement. Incorporating the eight competency domains and the 186 KSAs into a framework for clinical advancement programs will likely result in more clearly defined role expectations; enhance accountability; and elevate and promote nursing practice, thereby improving clinical outcomes and quality of care. With their emphasis on quality and safety, the eight competency domains also offer a framework for enhancing position descriptions, performance evaluations, clinical recognition, initial and ongoing competency assessment programs, and orientation and residency programs.

Knowledge Engineering as a Component of the Curriculum for Medical Cybernetists.

PubMed

Karas, Sergey; Konev, Arthur

2017-01-01

According to a new state educational standard, students who have chosen medical cybernetics as their major must develop a knowledge engineering competency. Previously, in the course "Clinical cybernetics" while practicing project-based learning students were designing automated workstations for medical personnel using client-server technology. The purpose of the article is to give insight into the project of a new educational module "Knowledge engineering". Students will acquire expert knowledge by holding interviews and conducting surveys, and then they will formalize it. After that, students will form declarative expert knowledge in a network model and analyze the knowledge graph. Expert decision making methods will be applied in software on the basis of a production model of knowledge. Project implementation will result not only in the development of analytical competencies among students, but also creation of a practically useful expert system based on student models to support medical decisions. Nowadays, this module is being tested in the educational process.

Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning.

PubMed

Chung, Younjin; Salvador-Carulla, Luis; Salinas-Pérez, José A; Uriarte-Uriarte, Jose J; Iruin-Sanz, Alvaro; García-Alonso, Carlos R

2018-04-25

Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice.

Modeling the Delivery Physiology of Distributed Learning Systems.

ERIC Educational Resources Information Center

Paquette, Gilbert; Rosca, Ioan

2003-01-01

Discusses instructional delivery models and their physiology in distributed learning systems. Highlights include building delivery models; types of delivery models, including distributed classroom, self-training on the Web, online training, communities of practice, and performance support systems; and actors (users) involved, including experts,…

Robot path planning using expert systems and machine vision

NASA Astrophysics Data System (ADS)

Malone, Denis E.; Friedrich, Werner E.

1992-02-01

This paper describes a system developed for the robotic processing of naturally variable products. In order to plan the robot motion path it was necessary to use a sensor system, in this case a machine vision system, to observe the variations occurring in workpieces and interpret this with a knowledge based expert system. The knowledge base was acquired by carrying out an in-depth study of the product using examination procedures not available in the robotic workplace and relates the nature of the required path to the information obtainable from the machine vision system. The practical application of this system to the processing of fish fillets is described and used to illustrate the techniques.

Review of Massachusetts Child Care Subsidy Eligibility Policies and Practices: A Report for the Assessment of the Massachusetts Subsidized Child Care System. Research Report

ERIC Educational Resources Information Center

Adams, Gina; Katz, Michael

2015-01-01

This report summarizes findings from a review of Massachusetts' child care subsidy eligibility policies and implementation practices. The review included interviews and focus groups with approximately 60 experts and stakeholders with a broad range of perspectives on the system. It identifies several important issues that, if addressed, could…

A histological ontology of the human cardiovascular system.

PubMed

Mazo, Claudia; Salazar, Liliana; Corcho, Oscar; Trujillo, Maria; Alegre, Enrique

2017-10-02

In this paper, we describe a histological ontology of the human cardiovascular system developed in collaboration among histology experts and computer scientists. The histological ontology is developed following an existing methodology using Conceptual Models (CMs) and validated using OOPS!, expert evaluation with CMs, and how accurately the ontology can answer the Competency Questions (CQ). It is publicly available at http://bioportal.bioontology.org/ontologies/HO and https://w3id.org/def/System . The histological ontology is developed to support complex tasks, such as supporting teaching activities, medical practices, and bio-medical research or having natural language interactions.

Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline.

PubMed

Ramakrishna, Naren; Temin, Sarah; Chandarlapaty, Sarat; Crews, Jennie R; Davidson, Nancy E; Esteva, Francisco J; Giordano, Sharon H; Gonzalez-Angulo, Ana M; Kirshner, Jeffrey J; Krop, Ian; Levinson, Jennifer; Modi, Shanu; Patt, Debra A; Perez, Edith A; Perlmutter, Jane; Winer, Eric P; Lin, Nancy U

2014-07-01

To provide formal expert consensus-based recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2) -positive advanced breast cancer. The American Society of Clinical Oncology (ASCO) convened a panel of medical oncology, radiation oncology, guideline implementation, and advocacy experts and conducted a systematic review of the literature. When that failed to yield sufficiently strong quality evidence, the Expert Panel undertook a formal expert consensus-based process to produce these recommendations. ASCO used a modified Delphi process. The panel members drafted recommendations, and a group of other experts joined them for two rounds of formal ratings of the recommendations. No studies or existing guidelines met the systematic review criteria; therefore, ASCO conducted a formal expert consensus-based process. Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. Clinicians should not perform routine magnetic resonance imaging (MRI) to screen for brain metastases, but rather should have a low threshold for MRI of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer. © 2014 by American Society of Clinical Oncology.

Expert opinion on best practice guidelines and competency framework for visual screening in children.

PubMed

Lança, Carla

2013-09-01

Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

Use of expert systems for the selection and the design of solar domestic hot water systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Panteliou, S.; Dentsoras, A.; Daskalopoulos, E.

1996-07-01

The aim of this article is the study of the application of expert systems to a mechanical engineering research domain with practical and commercial interest, such as design and manufacturing of Solar Domestic Hot Water (SDHW) Systems. The issues studied were the selection and the design of SDHW systems. The application of an expert system was explored. Frame and class formalism was used for knowledge representation together with forward and backward chaining techniques for drawing conclusions and utilizing the accumulated information present. The appropriate computer program was developed to yield the selection of SDHW systems using the software tool LEONARDOmore » 3.0 (1989), an integrated environment for the development of expert systems. The developed program was tested with data according to the Greek standard ELOT corresponding to the ISO/DIS 9459-2 and it performed successfully for 21 SDHW systems available on the Greek market. Apart from the possibility of selection of a SDHW system, the program also supports the facility for updating its knowledge based with new data so that it can be adapted to changes appearing on the market. The program proved to be functional and user friendly to a high degree. 8 refs., 9 figs.« less

Expert system for on-board satellite scheduling and control

NASA Technical Reports Server (NTRS)

Barry, John M.; Sary, Charisse

1988-01-01

An Expert System is described which Rockwell Satellite and Space Electronics Division (S&SED) is developing to dynamically schedule the allocation of on-board satellite resources and activities. This expert system is the Satellite Controller. The resources to be scheduled include power, propellant and recording tape. The activities controlled include scheduling satellite functions such as sensor checkout and operation. The scheduling of these resources and activities is presently a labor intensive and time consuming ground operations task. Developing a schedule requires extensive knowledge of the system and subsystems operations, operational constraints, and satellite design and configuration. This scheduling process requires highly trained experts anywhere from several hours to several weeks to accomplish. The process is done through brute force, that is examining cryptic mnemonic data off line to interpret the health and status of the satellite. Then schedules are formulated either as the result of practical operator experience or heuristics - that is rules of thumb. Orbital operations must become more productive in the future to reduce life cycle costs and decrease dependence on ground control. This reduction is required to increase autonomy and survivability of future systems. The design of future satellites require that the scheduling function be transferred from ground to on board systems.

Improving patient safety incident reporting systems by focusing upon feedback - lessons from English and Welsh trusts.

PubMed

Wallace, Louise M; Spurgeon, Peter; Benn, Jonathan; Koutantji, Maria; Vincent, Charles

2009-08-01

This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide.

Expert Knowledge-Based Automatic Sleep Stage Determination by Multi-Valued Decision Making Method

NASA Astrophysics Data System (ADS)

Wang, Bei; Sugi, Takenao; Kawana, Fusae; Wang, Xingyu; Nakamura, Masatoshi

In this study, an expert knowledge-based automatic sleep stage determination system working on a multi-valued decision making method is developed. Visual inspection by a qualified clinician is adopted to obtain the expert knowledge database. The expert knowledge database consists of probability density functions of parameters for various sleep stages. Sleep stages are determined automatically according to the conditional probability. Totally, four subjects were participated. The automatic sleep stage determination results showed close agreements with the visual inspection on sleep stages of awake, REM (rapid eye movement), light sleep and deep sleep. The constructed expert knowledge database reflects the distributions of characteristic parameters which can be adaptive to variable sleep data in hospitals. The developed automatic determination technique based on expert knowledge of visual inspection can be an assistant tool enabling further inspection of sleep disorder cases for clinical practice.

ICE System: Interruptible control expert system. M.S. Thesis

NASA Technical Reports Server (NTRS)

Vezina, James M.

1990-01-01

The Interruptible Control Expert (ICE) System is based on an architecture designed to provide a strong foundation for real-time production rule expert systems. Three principles are adopted to guide the development of ICE. A practical delivery platform must be provided, no specialized hardware can be used to solve deficiencies in the software design. Knowledge of the environment and the rule-base is exploited to improve the performance of a delivered system. The third principle of ICE is to respond to the most critical event, at the expense of the more trivial tasks. Minimal time is spent on classifying the potential importance of environmental events with the majority of the time used for finding the responses. A feature of the system, derived from all three principles, is the lack of working memory. By using a priori information, a fixed amount of memory can be specified for the hardware platform. The absence of working memory removes the dangers of garbage collection during the continuous operation of the controller.

Decision Support System (DSS) for MSMA Integrated Stormwater Management Ecohydrology for Sustainable Green Infrastructure

NASA Astrophysics Data System (ADS)

Sidek, L. M.; Mohiyaden, H. A.; Haris, H.; Basri, H.; Muda, Z. C.; Roseli, Z. A.; Norlida, M. D.

2016-03-01

Rapid urbanization has known to have several adverse impacts towards hydrological cycle due to increasing impervious surface and degradation of water quality in stormwater runoff. In the past, urban waterways have been confined to narrow river corridors with the channels canalised and concrete and other synthetic materials forming the bed and banks of the river. Apart from that, stormwater pollutants such as litter, debris and sediments in drainage system are common problems that can lead to flooding and the degradation of water quality. To solve this problem, implementing stormwater Best Management Practices (BMPs) proves very promising due to its near natural characteristics and multiple effects on the drainage of stormwater runoff in urban areas. This judgment of using BMPs depends on not only relevant theoretical considerations, but also a large amount of practical experience and the availability of relevant data, as well. To fulfil this task, the so-called Decision Support System (DSS) in MSMA Design Aid and Database system are able to assist engineers and developers in management and improvement of water quantity and quality entering urban rivers from urban regions. This system is also helpful when an expert level judgment procure some repetitive and large amount of cases, like in the planning of stormwater BMPs systems for an entire city catchment. One of the advantages of an expert system is that it provides automation of expert-level judgement using availability of checking tools system.

Expert and non-expert knowledge in medical practice.

PubMed

Nordin, I

2000-01-01

One problematic aspect of the rationality of medical practice concerns the relation between expert knowledge and non-expert knowledge. In medical practice it is important to match medical knowledge with the self-knowledge of the individual patient. This paper tries to study the problem of such matching by describing a model for technological paradigms and comparing it with an ideal of technological rationality. The professionalised experts tend to base their decisions and actions mostly on medical knowledge while the rationality of medicine also involves just as important elements of the personal evaluation and knowledge of the patients. Since both types of knowledge are necessary for rational decisions, the gap between the expert and the non-expert has to be bridged in some way. A solution to the problem is suggested in terms of pluralism, with the patient as ultimate decision-maker.

Examining the practice of generalist expertise: a qualitative study identifying constraints and solutions

PubMed Central

Reeve, Joanne; Dowrick, Christopher F; Freeman, George K; Gunn, Jane; Mair, Frances; May, Carl; Mercer, Stewart; Palmer, Victoria; Howe, Amanda; Irving, Greg; Shiner, Alice; Watson, Jessica

2013-01-01

Objectives Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Design Qualitative study in General Practice. Setting UK primary care. Main outcome measures A qualitative study – interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Design and setting Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory. Participants UK based GPs (interview and surveys); European GP trainees (focus groups). Results Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP. Conclusions We describe four areas for change: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role. PMID:24475347

WHO Expert Committee on Specifications for Pharmaceutical Preparations.

PubMed

2014-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use, in addition to 20 monographs and general texts for inclusion in The International Pharmacopoeia and 11 new International Chemical Reference Substances. The International Pharmacopoeia--updating mechanism for the section on radiopharmaceuticals; WHO good manufacturing practices for pharmaceutical products: main principles; Model quality assurance system for procurement agencies; Assessment tool based on the model quality assurance system for procurement agencies: aide-memoire for inspection; Guidelines on submission of documentation for prequalification of finished pharmaceutical products approved by stringent regulatory authorities; and Guidelines on submission of documentation for a multisource (generic) finished pharmaceutical product: quality part.

Experience of High School Cooperation with Manufacturing Enterprise While Training Rocket and Space Industry Experts

NASA Astrophysics Data System (ADS)

Novykov, O.; Dzhur, Y.; Perlyk, V.

2002-01-01

Cooperation between Yuzhnoye SDO and Dniepropetrovsk National University (Physical and Engineering Institute) constitutes an example for the efficient practical realization of the idea of integration of science, industry and education, i.e. scientists and industrial experts take an active part in educational process while teachers and students participate in resolution of vital scientific and technical problems. The report is devoted to a summary analysis of such cooperation, which during the creation of Dniepropetrovsk Rocket Center, the largest in the former USSR, helped solving the relevant employment issues and contributed to foundation of Dniepropetrovsk scientific rocket school in the shortest possible time. Later, the cooperation was of avail in adequate reinforcement of the rocket and space industry with highly skilled experts (more than 20 thousand experts have graduated during 50 years). The University department branches representative of principal schools, i.e. rocket and spacecraft design and manufacture, engine design, automated control systems, production practice etc. established at the company's premises resolve vital issues related to improvement of expert training reliability. The department branches successfully resolve the tasks associated with prompt adaptation of the experts by comprehensively accounting both for the needs of the industry and the company's development outlook as well as by involving up-to-date manufacturing equipment in educational process, during researches, etc. Recently a new entity has been established playing an important role in building a continuous aerospace education system. This entity is called the National Center for aerospace education of Ukrainian youth, which unites high and higher school students, young scientists, and allows resolving different tasks ranging from searching and selecting gifted youth to training of highly skilled scientists.

An expert system for the selection of building elements during architectural design

NASA Astrophysics Data System (ADS)

Alibaba, Halil Zafer

This thesis explains the development stages of an expert system for the evaluation and selection of building elements during the early stages of architectural design. This expert system is called BES. It is produced after two prototypes were established. Testing of BES is made on professional architects who are from both academia and the practical construction market of Northern Cyprus. BES is intended to be used by experienced and inexperienced architects. The model includes selection of all kinds of main building elements that are available like retaining walls, foundations, external walls, internal walls, floors, external stairs, internal stairs, roofs, external chimneys, internal chimneys, windows and external doors and internal doors and their sub-type building elements. The selection is achieved via SMART Methodology depending on the performance requirements and an expert system shell Exsys Corvid version 1.2.14 is used to structure the expert system. The use of computers in today's world is very important with its advantages in handling vast amount of data. The use of the model through Internet makes the model international, and a useful design aid for architects. In addition, the decision-making feature of this model provides a suitable selection among numerous alternatives. The thesis also explains the development and the experience gained through use of the BES. It discusses the further development of the model.

Bioethics governance in Israel: an expert regime.

PubMed

Shalev, Carmel; Hashiloni-Dolev, Yael

2011-01-01

This paper provides an overview of bioethics governance in Israel through an analytical description of the legal framework for the interface between individuals and biomedical practices. There is no national agency with general oversight of bioethics policy and decision making, and the rules that apply to individual usage of biomedical technologies are laid down in a multitude of different statutes, regulations and administrative directives. Expert committees play a central role in this regulatory system in two capacities: as governmental advisory bodies that recommend policy; and as decision-making bodies that resolve conflicts around patients' rights or grant individual access to biomedical technologies. This decentralised system of governance through expert committees allows for adaptation to dynamic technological developments and flexibility in accommodating creative societal usage. At the same time the experts are the agents of the state's bio-power at the expense of personal autonomy and open public deliberation. The paper is part of a larger study investigating Israel's bioethics governance and its regime of experts, which includes an examination of the normative level of regulation, and an analysis of the composition of the expert committees. Our findings suggest that Israel has a decentralised system of governance with piecemeal regulation that has established a bioethics technocracy, governed by the ministry of health and dominated by the medical profession. The present paper is confined to a description and discussion of the legal framework of Israel's expert bioethics regime. Here, our major conclusion is that Israel has established a technocracy of official expert ethics committees, which controls life and death decisions.

Ask the experts how to treat individuals with spatial neglect: a survey study.

PubMed

Chen, Peii; Pitteri, Marco; Gillen, Glen; Ayyala, Harsha

2017-07-11

Spatial neglect (SN) impedes rehabilitation success and leaves long-term consequences. We asked experts to provide their opinions in addressing SN by scenario (ideal vs. reality) and by recovery phase (earliest, acute, subacute, and chronic). Experts were individuals who have assessed or treated patients with SN clinically. This study was conducted using an anonymous survey on the Internet with 189 responders over 3 months. Located in 23 different countries, 127 experts of seven disciplines were included (occupational therapy, physical therapy, nursing, speech and language pathology or therapy, neurology, physical medicine and rehabilitation, and psychology or neuropsychology). Comparing the two scenarios, more treatments were selected in the ideal than in the reality scenario for all recovery phases except for the chronic phase. In both scenarios, (1) more treatments were selected in acute and subacute phases than in earliest or chronic phases, (2) less experienced experts selected diverse treatment options more often, and (3) highly experienced experts were more likely to provide their reasons of treatment selection, suggestions of treatment delivery methods, and other insights. Finally, 83.7% reported obstacles in treating SN. Experts' treatment selections are consistent with current evidence and practice guidelines. Recognizing the limitation of evidence, their opinions may help generate ideas in various topics (e.g., dosing, integrative intervention, and treatment implementation) to be examined in future studies. Implications for Rehabilitation Clinicians with experience in treating people with spatial neglect (i.e., experts as defined in the present study) recognized the limitation of evidence but nonetheless suggested specific treatments by recovery phase. In both the reality and ideal scenarios, experts included visual scanning, active limb activation, and sustained attention training in the top-five selections. Prism adaptation was in the top-five selections in the ideal scenario, while in the reality scenario, it was in the top-five in all phases except for the earliest phase where it was the sixth most selected. They also shared their valuable opinions in when to use which treatment to address spatial neglect and how to deliver certain interventions, which may help to generate ideas in various topics (e.g., dosing, integrative intervention, knowledge dissemination, and treatment implementation) that can be examined in future studies. We suggest that (1) clinicians consider collective expert opinions reported here to enhance their clinical judgment and practices, (2) researchers develop studies focused on treatments with limited evidence but selected here by experts, and (3) funding agencies provide the means to research and implementation projects that will generate rich information for improving practice guidelines and rehabilitation outcomes for patients with spatial neglect. The majority of the experts reported some obstacles in providing treatment for spatial neglect, and time and equipment shortages were the most common barriers, which should be addressed at the system level to determine whether removing those barriers have long-term beneficial impacts on both patients and healthcare systems.

Expert system for generating initial layouts of zoom systems with multiple moving lens groups

NASA Astrophysics Data System (ADS)

Cheng, Xuemin; Wang, Yongtian; Hao, Qun; Sasián, José M.

2005-01-01

An expert system is developed for the automatic generation of initial layouts for the design of zoom systems with multiple moving lens groups. The Gaussian parameters of the zoom system are optimized using the damped-least-squares method to achieve smooth zoom cam curves, with the f-number of each lens group in the zoom system constrained to a rational value. Then each lens group is selected automatically from a database according to its range of f-number, field of view, and magnification ratio as it is used in the zoom system. The lens group database is established from the results of analyzing thousands of zoom lens patents. Design examples are given, which show that the scheme is a practical approach to generate starting points for zoom lens design.

Advanced Technology Training System on Motor-Operated Valves

NASA Technical Reports Server (NTRS)

Wiederholt, Bradley J.; Widjaja, T. Kiki; Yasutake, Joseph Y.; Isoda, Hachiro

1993-01-01

This paper describes how features from the field of Intelligent Tutoring Systems are applied to the Motor-Operated Valve (MOV) Advanced Technology Training System (ATTS). The MOV ATTS is a training system developed at Galaxy Scientific Corporation for the Central Research Institute of Electric Power Industry in Japan and the Electric Power Research Institute in the United States. The MOV ATTS combines traditional computer-based training approaches with system simulation, integrated expert systems, and student and expert modeling. The primary goal of the MOV ATTS is to reduce human errors that occur during MOV overhaul and repair. The MOV ATTS addresses this goal by providing basic operational information of the MOV, simulating MOV operation, providing troubleshooting practice of MOV failures, and tailoring this training to the needs of each individual student. The MOV ATTS integrates multiple expert models (functional and procedural) to provide advice and feedback to students. The integration also provides expert model validation support to developers. Student modeling is supported by two separate student models: one model registers and updates the student's current knowledge of basic MOV information, while another model logs the student's actions and errors during troubleshooting exercises. These two models are used to provide tailored feedback to the student during the MOV course.

Visualising probabilistic flood forecast information: expert preferences and perceptions of best practice in uncertainty communication

NASA Astrophysics Data System (ADS)

Pappenberger, F.; Stephens, E. M.; Thielen, J.; Salomon, P.; Demeritt, D.; van Andel, S.; Wetterhall, F.; Alfieri, L.

2011-12-01

The aim of this paper is to understand and to contribute to improved communication of the probabilistic flood forecasts generated by Hydrological Ensemble Prediction Systems (HEPS) with particular focus on the inter expert communication. Different users are likely to require different kinds of information from HEPS and thus different visualizations. The perceptions of this expert group are important both because they are the designers and primary users of existing HEPS. Nevertheless, they have sometimes resisted the release of uncertainty information to the general public because of doubts about whether it can be successfully communicated in ways that would be readily understood to non-experts. In this paper we explore the strengths and weaknesses of existing HEPS visualization methods and thereby formulate some wider recommendations about best practice for HEPS visualization and communication. We suggest that specific training on probabilistic forecasting would foster use of probabilistic forecasts with a wider range of applications. The result of a case study exercise showed that there is no overarching agreement between experts on how to display probabilistic forecasts and what they consider essential information that should accompany plots and diagrams. In this paper we propose a list of minimum properties that, if consistently displayed with probabilistic forecasts, would make the products more easily understandable.

Practical problems in aggregating expert opinions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Booker, J.M.; Picard, R.R.; Meyer, M.A.

1993-11-01

Expert opinion is data given by a qualified person in response to a technical question. In these analyses, expert opinion provides information where other data are either sparse or non-existent. Improvements in forecasting result from the advantageous addition of expert opinion to observed data in many areas, such as meteorology and econometrics. More generally, analyses of large, complex systems often involve experts on various components of the system supplying input to a decision process; applications include such wide-ranging areas as nuclear reactor safety, management science, and seismology. For large or complex applications, no single expert may be knowledgeable enough aboutmore » the entire application. In other problems, decision makers may find it comforting that a consensus or aggregation of opinions is usually better than a single opinion. Many risk and reliability studies require a single estimate for modeling, analysis, reporting, and decision making purposes. For problems with large uncertainties, the strategy of combining as diverse a set of experts as possible hedges against underestimation of that uncertainty. Decision makers are frequently faced with the task of selecting the experts and combining their opinions. However, the aggregation is often the responsibility of an analyst. Whether the decision maker or the analyst does the aggregation, the input for it, such as providing weights for experts or estimating other parameters, is imperfect owing to a lack of omniscience. Aggregation methods for expert opinions have existed for over thirty years; yet many of the difficulties with their use remain unresolved. The bulk of these problem areas are summarized in the sections that follow: sensitivities of results to assumptions, weights for experts, correlation of experts, and handling uncertainties. The purpose of this paper is to discuss the sources of these problems and describe their effects on aggregation.« less

Development of a scale for the evaluation of patients’ rights prerequisites at educational hospitals in Iran: a study using the Delphi technique

PubMed Central

Aazami, Sanaz; Mozafari, Mosayeb

2015-01-01

The patients’ rights status is one of the essential elements in defining norms related to the concept of clinical governance system. In addition, the patients’ rights status is an important index for quality of care offered in the health care system. However, the lack of a coherent instrument makes it difficult to evaluate patients’ rights status in hospitals and clinics. The aim of this study was to develop an instrument for the evaluation of patients’ rights prerequisites at educational hospitals in Iran. This study was conducted using the modified Delphi technique. In this study, 36 experts in the fields of law, medicine, and professional ethics were participated. The panel of experts participated in 3 rounds. First, experts were asked to judge some pre-identified items, and then, excluded items were judged again in the second round. At the end of the third round, all of the agreed items were included in the final list to form an evaluative scale on practice of patients’ rights. Experts were asked to judge a total 171 items in 3 rounds. Around 31% (n = 53) of items obtained the panel’s approval to be included in the final version of the scale. The experts’ opinions were collected using face-to-face interviews and electronic email during a 6-month period of data collection from October 2013 to February 2014. This study developed a 53-item scale for evaluation of patients’ rights prerequisites in educational hospitals in Iran. This scale was developed in 7 areas of commitments including university education, research, supervision, process management, physical structure, organizational policy, and human resources management. This study developed an evaluative scale to assess the practice of patients’ rights in educational hospitals. The items in the final version of this scale were obtained from a consensus of experts and the instrument can be used to evaluate the context and prerequisites for practice of patients’ rights in Iranian educational hospitals. PMID:27354900

Management of immune thrombocytopenia: Korean experts recommendation in 2017.

PubMed

Jang, Jun Ho; Kim, Ji Yoon; Mun, Yeung-Chul; Bang, Soo-Mee; Lim, Yeon Jung; Shin, Dong-Yeop; Choi, Young Bae; Yhim, Ho-Young; Lee, Jong Wook; Kook, Hoon

2017-12-01

Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.

Abstract for 1999 Rational Software User Conference

NASA Technical Reports Server (NTRS)

Dunphy, Julia; Rouquette, Nicolas; Feather, Martin; Tung, Yu-Wen

1999-01-01

We develop spacecraft fault-protection software at NASA/JPL. Challenges exemplified by our task: 1) high-quality systems - need for extensive validation & verification; 2) multi-disciplinary context - involves experts from diverse areas; 3) embedded systems - must adapt to external practices, notations, etc.; and 4) development pressures - NASA's mandate of "better, faster, cheaper".

The Redesign of Urban School Systems: Case Studies in District Governance

ERIC Educational Resources Information Center

McAdams, Donald R., Ed.; Katzir, Dan, Ed.

2013-01-01

"The Redesign of Urban School Systems" provides a uniquely valuable resource for anyone involved in preparing education leaders for the political and practical realities of district-based school reform. Edited by two leading experts in education reform, this absorbing volume brings together twelve teaching cases on urban school…

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

16 CFR 3.31A - Expert discovery.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Expert discovery. 3.31A Section 3.31A... PRACTICE FOR ADJUDICATIVE PROCEEDINGS Discovery; Compulsory Process § 3.31A Expert discovery. (a) The... later than 1 day after the close of fact discovery, meaning the close of discovery except for...

16 CFR 3.31A - Expert discovery.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Expert discovery. 3.31A Section 3.31A... PRACTICE FOR ADJUDICATIVE PROCEEDINGS Discovery; Compulsory Process § 3.31A Expert discovery. (a) The... later than 1 day after the close of fact discovery, meaning the close of discovery except for...

16 CFR 3.31A - Expert discovery.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Expert discovery. 3.31A Section 3.31A... PRACTICE FOR ADJUDICATIVE PROCEEDINGS Discovery; Compulsory Process § 3.31A Expert discovery. (a) The... later than 1 day after the close of fact discovery, meaning the close of discovery except for...

A knowledge creation info-structure to acquire and crystallize the tacit knowledge of health-care experts.

PubMed

Abidi, Syed Sibte Raza; Cheah, Yu-N; Curran, Janet

2005-06-01

Tacit knowledge of health-care experts is an important source of experiential know-how, yet due to various operational and technical reasons, such health-care knowledge is not entirely harnessed and put into professional practice. Emerging knowledge-management (KM) solutions suggest strategies to acquire the seemingly intractable and nonarticulated tacit knowledge of health-care experts. This paper presents a KM methodology, together with its computational implementation, to 1) acquire the tacit knowledge possessed by health-care experts; 2) represent the acquired tacit health-care knowledge in a computational formalism--i.e., clinical scenarios--that allows the reuse of stored knowledge to acquire tacit knowledge; and 3) crystallize the acquired tacit knowledge so that it is validated for health-care decision-support and medical education systems.

The Vanderbilt Professional Nursing Practice Program: part 1: Growing and supporting professional nursing practice.

PubMed

Robinson, Karen; Eck, Carol; Keck, Becky; Wells, Nancy

2003-09-01

Professional practice programs are designed to attract, retain, and reward nurses. This three-part series will describe Vanderbilt's performance-based career advancement system, the Vanderbilt Professional Nursing Practice Program (VPNPP). Part 1 outlines the overall program's foundation, philosophical background, and basic structure. The VPNPP is built upon Benner's work, distinguishing among four levels of practice: novice, competent, proficient, and expert. Work by many in the organization identified the expected behaviors for nurses at each level, which were then used to develop clear process evaluation criteria. Part 2 will examine the performance measurement and evaluation system created to support the program. The process of advancing within the program will be described in part 3.

How Experts Practice: A Novel Test of Deliberate Practice Theory

ERIC Educational Resources Information Center

Coughlan, Edward K.; Williams, A. Mark; McRobert, Allistair P.; Ford, Paul R.

2014-01-01

Performance improvement is thought to occur through engagement in deliberate practice. Deliberate practice is predicted to be challenging, effortful, and not inherently enjoyable. Expert and intermediate level Gaelic football players executed two types of kicks during an acquisition phase and pre-, post-, and retention tests. During acquisition,…

The tacit dimension of clinical judgment.

PubMed Central

Goldman, G. M.

1990-01-01

Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered. PMID:2356625

Real-time application of knowledge-based systems

NASA Technical Reports Server (NTRS)

Brumbaugh, Randal W.; Duke, Eugene L.

1989-01-01

The Rapid Prototyping Facility (RPF) was developed to meet a need for a facility which allows flight systems concepts to be prototyped in a manner which allows for real-time flight test experience with a prototype system. This need was focused during the development and demonstration of the expert system flight status monitor (ESFSM). The ESFSM was a prototype system developed on a LISP machine, but lack of a method for progressive testing and problem identification led to an impractical system. The RPF concept was developed, and the ATMS designed to exercise its capabilities. The ATMS Phase 1 demonstration provided a practical vehicle for testing the RPF, as well as a useful tool. ATMS Phase 2 development continues. A dedicated F-18 is expected to be assigned for facility use in late 1988, with RAV modifications. A knowledge-based autopilot is being developed using the RPF. This is a system which provides elementary autopilot functions and is intended as a vehicle for testing expert system verification and validation methods. An expert system propulsion monitor is being prototyped. This system provides real-time assistance to an engineer monitoring a propulsion system during a flight.

Methods for optimizing solutions when considering group arguments by team of experts

NASA Astrophysics Data System (ADS)

Chernyi, Sergei; Budnik, Vlad

2017-11-01

The article is devoted to methods of expert evaluation. The technology of expert evaluation is presented from the standpoint of precedent structures. In this paper, an aspect of the mathematical basis for constructing a component of decision analysis is considered. In fact, this approach leaves out any identification of their knowledge and skills of simulating organizational and manufacturing situations and taking efficient managerial decisions; it doesn't enable any identification and assessment of their knowledge on the basis of multi-informational and least loss-making methods and information technologies. Hence the problem is to research and develop a methodology for systemic identification of professional problem-focused knowledge acquired by employees operating adaptive automated systems of training management (AASTM operators), which shall also further the theory and practice of the intelligence-related aspects thereof.

Health care for immigrants in Europe: Is there still consensus among country experts about principles of good practice? A Delphi study

PubMed Central

2011-01-01

Background European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Conclusions Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate. PMID:21914194

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

PubMed

Hansen, Dominique; Dendale, Paul; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Niebauer, Josef; Cornelissen, Veronique; Pedretti, Roberto; Geurts, Eva; Ruiz, Gustavo R; Corrà, Ugo; Schmid, Jean-Paul; Greco, Eugenio; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona S; Barna, Olga; Beckers, Paul; Bussotti, Maurizio; Fagard, Robert; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Neunhäuserer, Daniel; Reibis, Rona; Spruit, Martijn A; Stettler, Christoph; Takken, Tim; Tonoli, Cajsa; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick

2017-07-01

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

Determining clinical practice of expert physiotherapy for patients undergoing lumbar spinal fusion: a cross-sectional survey study.

PubMed

Janssen, Esther R C; Scheijen, Elle E M; van Meeteren, Nico L U; de Bie, Rob A; Lenssen, Anton F; Willems, Paul C; Hoogeboom, Thomas J

2016-05-01

To determine the content of current Dutch expert hospital physiotherapy practice for patients undergoing lumbar spinal fusion (LSF), to gain insight into expert-based clinical practice. At each hospital where LSF is performed, one expert physiotherapist received an e-mailed questionnaire, about pre- and postoperative physiotherapy and discharge after LSF. The level of uniformity in goals and interventions was graded on a scale from no uniformity (50-60 %) to very strong uniformity (91-100 %). LSF was performed at 34 of the 67 contacted hospitals. From those 34 hospitals, 28 (82 %) expert physiotherapists completed the survey. Twenty-one percent of the respondents saw patients preoperatively, generally to provide information. Stated postoperative goals and administered interventions focused mainly on performing transfers safely and keeping the patient informed. Outcome measures were scarcely used. There was no uniformity regarding advice on the activities of daily living. Dutch perioperative expert physiotherapy for patients undergoing LSF is variable and lacks structural outcome assessment. Studies evaluating the effectiveness of best-practice physiotherapy are warranted.

Inductive knowledge acquisition experience with commercial tools for space shuttle main engine testing

NASA Technical Reports Server (NTRS)

Modesitt, Kenneth L.

1990-01-01

Since 1984, an effort has been underway at Rocketdyne, manufacturer of the Space Shuttle Main Engine (SSME), to automate much of the analysis procedure conducted after engine test firings. Previously published articles at national and international conferences have contained the context of and justification for this effort. Here, progress is reported in building the full system, including the extensions of integrating large databases with the system, known as Scotty. Inductive knowledge acquisition has proven itself to be a key factor in the success of Scotty. The combination of a powerful inductive expert system building tool (ExTran), a relational data base management system (Reliance), and software engineering principles and Computer-Assisted Software Engineering (CASE) tools makes for a practical, useful and state-of-the-art application of an expert system.

The Good Buy.

ERIC Educational Resources Information Center

Newsom, John

2002-01-01

Describes school purchasing process, examples of illegal or wasteful purchasing activities, a concise ethical guide to school purchasing excerpted from the Texas Agency's Financial Accountability System Resource Guide, and suggestions from experts on how schools can ensure legal and ethical purchasing practices. (PKP)

Who does it better? The corporate versus the nonprofit governance model.

PubMed

Larson, Laurie

2005-05-01

Weighing the corporate against the nonprofit governance model, the answer may be "neither." Both systems can learn from each other, experts say, and best practices in public companies do not automatically translate to health care boards.

Alarm rationalization: practical experience rationalizing alarm configuration for an accelerator subsystem

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kasemir, Kay; Hartman, Steven M

2009-01-01

A new alarm system toolkit has been implemented at SNS. The toolkit handles the Central Control Room (CCR) 'annunciator', or audio alarms. For the new alarm system to be effective, the alarms must be meaningful and properly configured. Along with the implementation of the new alarm toolkit, a thorough documentation and rationalization of the alarm configuration is taking place. Requirements and maintenance of a robust alarm configuration have been gathered from system and operations experts. In this paper we present our practical experience with the vacuum system alarm handling configuration of the alarm toolkit.

Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions

PubMed Central

Correa-de-Araujo, Rosaly

2016-01-01

Scientific literature demonstrates that advances in evidence-based nursing have improved systems of care and women’s health outcomes. Experts agree that nurses worldwide can play a key role in building such evidence and working with interdisciplinary health care teams and systems to accelerate its implementation. PMID:26473771

Coordination Dynamics of the Horse~Rider System

PubMed Central

Lagarde, J.; Peham, C.; Licka, T.; Kelso, J. A. S.

2007-01-01

The authors studied the interaction between rider and horse by measuring their ensemble motions in a trot sequence, comparing 1 expert and 1 novice rider. Whereas the novice’s movements displayed transient departures from phase synchrony, the expert’s motions were continuously phase-matched with those of the horse. The tight ensemble synchrony between the expert and the horse was accompanied by an increase in the temporal regularity of the oscillations of the trunk of the horse. Observed differences between expert and novice riders indicated that phase synchronization is by no means perfect but requires extended practice. Points of contact between horse and rider may haptically convey effective communication between them. PMID:16280312

Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

PubMed

Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

2016-01-27

Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality and process improvement. Michigan uses quality experts from the manufacturing industry who are educated regarding the health care environment, which enables them to perform as quality-improvement coaches (QICs) in primary-care practices. In this case study, ninety-six quality experts were trained to coach primary-care practices, with 53 currently assigned to offices, and others assisting as needed. Practice teams and QICs identify gaps in care and office practices with the use of assorted quality-improvement tools. Reports are made monthly to describe clinical and process measures and methods used. Michigan has 33 practices engaged, involving 205 physicians and 40 midlevel providers. The teaming of quality experts from the manufacturing industry with primary-care office providers and staff resulted in office efficiency, improved care provided, and progress toward attainment of a patient-centered medical home (PCMH). Quality experts from manufacturing volunteered to coach for improvements in primary care. The efforts of QICs have been successful. Because the QICs are volunteers, sustainability of the Michigan Improving Performance in Practice program is a challenge.

The assessment of expert testimony relevance and admissibility in medical malpractice cases in the Czech Republic. Can American judicial practice help us?

PubMed

Zakharov, Sergey

2011-03-01

The relevance and admissibility of expert medical testimony in relation to medical malpractice suits requires a more successful development of formal criteria and a more intentional compliance with efficient judicial procedures. The American judicial system provides an excellent model for implementation of a critical approach to knowledge collection, the evaluation of the validity of scientifically sound information, and the examination of expert's testimony on the basis of a sound methodology. An analysis of the assessment and application of reliability yields evidence that assuring standards to improve the quality of expert medical testimony will increase the overall probability of a fair outcome during the judicial process. Applying these beneficial strategies in medical malpractice cases will continue to support further considerations of promoting justice and solving problems through sufficient scientific means.

Creating a physician network can pay off--with the right tools.

PubMed

1997-09-01

Putting together a physician practice group and then creating the management and administrative structure for that practice to financially succeed is one of the greatest challenges health systems face today. The marriage can work, experts tell Managed Care Strategies, but only with innovation and careful attention to details such as physician compensation design, governance issues, and methods for resolving conflict resolution.

Knowledge based systems: A preliminary survey of selected issues and techniques

NASA Technical Reports Server (NTRS)

Dominick, Wayne D. (Editor); Kavi, Srinu

1984-01-01

It is only recently that research in Artificial Intelligence (AI) is accomplishing practical results. Most of these results can be attributed to the design and use of expert systems (or Knowledge-Based Systems, KBS) - problem-solving computer programs that can reach a level of performance comparable to that of a human expert in some specialized problem domain. But many computer systems designed to see images, hear sounds, and recognize speech are still in a fairly early stage of development. In this report, a preliminary survey of recent work in the KBS is reported, explaining KBS concepts and issues and techniques used to construct them. Application considerations to construct the KBS and potential KBS research areas are identified. A case study (MYCIN) of a KBS is also provided.

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input.

PubMed

O'Connor, Teresia M; Mâsse, Louise C; Tu, Andrew W; Watts, Allison W; Hughes, Sheryl O; Beauchamp, Mark R; Baranowski, Tom; Pham, Truc; Berge, Jerica M; Fiese, Barbara; Golley, Rebecca; Hingle, Melanie; Kremers, Stef P J; Rhee, Kyung E; Skouteris, Helen; Vaughn, Amber

2017-09-11

Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

Fostering Meaning-Oriented Learning and Deliberate Practice in Teacher Education

ERIC Educational Resources Information Center

Bronkhorst, Larike H.; Meijer, Paulien C.; Koster, Bob; Vermunt, Jan D.

2011-01-01

Meaning-oriented learning and deliberate practice may be expected to promote student teachers' continuous professional development. We interviewed twelve expert teacher educators to explore their understanding of these concepts, as well as pedagogies to stimulate them in teacher education. The experts understood deliberate practice in two ways: an…

Risk Evaluation of Bogie System Based on Extension Theory and Entropy Weight Method

PubMed Central

Du, Yanping; Zhang, Yuan; Zhao, Xiaogang; Wang, Xiaohui

2014-01-01

A bogie system is the key equipment of railway vehicles. Rigorous practical evaluation of bogies is still a challenge. Presently, there is overreliance on part-specific experiments in practice. In the present work, a risk evaluation index system of a bogie system has been established based on the inspection data and experts' evaluation. Then, considering quantitative and qualitative aspects, the risk state of a bogie system has been evaluated using an extension theory and an entropy weight method. Finally, the method has been used to assess the bogie system of four different samples. Results show that this method can assess the risk state of a bogie system exactly. PMID:25574159

Risk evaluation of bogie system based on extension theory and entropy weight method.

PubMed

Du, Yanping; Zhang, Yuan; Zhao, Xiaogang; Wang, Xiaohui

2014-01-01

A bogie system is the key equipment of railway vehicles. Rigorous practical evaluation of bogies is still a challenge. Presently, there is overreliance on part-specific experiments in practice. In the present work, a risk evaluation index system of a bogie system has been established based on the inspection data and experts' evaluation. Then, considering quantitative and qualitative aspects, the risk state of a bogie system has been evaluated using an extension theory and an entropy weight method. Finally, the method has been used to assess the bogie system of four different samples. Results show that this method can assess the risk state of a bogie system exactly.

Selecting Health Care Improvement Projects: A Methodology Integrating Cause-and-Effect Diagram and Analytical Hierarchy Process.

PubMed

Testik, Özlem Müge; Shaygan, Amir; Dasdemir, Erdi; Soydan, Guray

It is often vital to identify, prioritize, and select quality improvement projects in a hospital. Yet, a methodology, which utilizes experts' opinions with different points of view, is needed for better decision making. The proposed methodology utilizes the cause-and-effect diagram to identify improvement projects and construct a project hierarchy for a problem. The right improvement projects are then prioritized and selected using a weighting scheme of analytical hierarchy process by aggregating experts' opinions. An approach for collecting data from experts and a graphical display for summarizing the obtained information are also provided. The methodology is implemented for improving a hospital appointment system. The top-ranked 2 major project categories for improvements were identified to be system- and accessibility-related causes (45%) and capacity-related causes (28%), respectively. For each of the major project category, subprojects were then ranked for selecting the improvement needs. The methodology is useful in cases where an aggregate decision based on experts' opinions is expected. Some suggestions for practical implementations are provided.

Here's How to Keep Your Music Program Humming.

ERIC Educational Resources Information Center

McCormick, Kathleen

1985-01-01

Some school systems are finding practical ways to enhance music programs. Experts suggest ways for schools to (1) build a marketing plan, (2) make it easier for children to participate in the music program, (3) provide reinforcement, and (4) publicize the program. (MLF)

What Is Applied Linguistics?

ERIC Educational Resources Information Center

James, Carl

1993-01-01

Ostensive and expository definitions of applied linguistics are assessed. It is suggested that the key to a meaningful definition lies in the dual articulation of applied linguistics: it is an interface between linguistics and practicality. Its role as an "expert system" is suggested. (45 references) (Author/LB)

Inter-expert agreement and similarity analysis of traditional diagnoses and acupuncture prescriptions in textbook- and pragmatic-based practices.

PubMed

Alvim, Danielle Terra; Ferreira, Arthur Sá

2018-02-01

This study examined (1) the agreement of acupuncture experts with textbook prescriptions and among themselves, and (2) the association between similar traditional diagnoses and textbook acupuncture prescriptions, examining whether pragmatic practice (i.e., modifying prescriptions according to personal clinical practice) alters such an association. A computational analysis quantified the diagnosis-prescription association from a textbook. Eight acupuncture experts were independently interviewed. Experts modified the textbook prescriptions according to their pragmatic practice. Experts mostly agreed (19-90%) or strongly agreed (0-29%) with the textbook prescriptions, with no-better-than-chance agreement on their ratings (Light's κ = 0.036, CI 95%  = [0.003; 0.081]). The number of manifestations in traditional diagnoses weakly explains the variability (Spearman's ρ = 0.260, p = 0.038) of the number of acupoints in prescriptions. The association between similar traditional diagnoses and acupuncture prescriptions is strong in the textbook (γ = 0.720, CI 95%  = [0.658, 0.783]), whereas pragmatic practice had little effect on this association (γ = 0.724-0.769). Copyright © 2017 Elsevier Ltd. All rights reserved.

Developing a physics expert identity in a biophysics research group

NASA Astrophysics Data System (ADS)

Rodriguez, Idaykis; Goertzen, Renee Michelle; Brewe, Eric; Kramer, Laird H.

2015-06-01

We investigate the development of expert identities through the use of the sociocultural perspective of learning as participating in a community of practice. An ethnographic case study of biophysics graduate students focuses on the experiences the students have in their research group meetings. The analysis illustrates how the communities of practice-based identity constructs of competencies characterize student expert membership. A microanalysis of speech, sound, tones, and gestures in video data characterize students' social competencies in the physics community of practice. Results provide evidence that students at different stages of their individual projects have opportunities to develop social competencies such as mutual engagement, negotiability of the repertoire, and accountability to the enterprises as they interact with group members. The biophysics research group purposefully designed a learning trajectory including conducting research and writing it for publication in the larger community of practice as a pathway to expertise. The students of the research group learn to become socially competent as specific experts of their project topic and methodology, ensuring acceptance, agency, and membership in their community of practice. This work expands research on physics expertise beyond the cognitive realm and has implications for how to design graduate learning experiences to promote expert identity development.

Essential Nutrition and Food Systems Components for School Curricula: Views from Experts in Iran

PubMed Central

SADEGHOLVAD, Sanaz; YEATMAN, Heather; OMIDVAR, Nasrin; PARRISH, Anne-Maree; WORSLEY, Anthony

2017-01-01

Background: This study aimed to investigate food experts’ views on important nutrition and food systems knowledge issues for education purposes at schools in Iran. Methods: In 2012, semi-structured, face-to-face or telephone interviews were conducted with twenty-eight acknowledged Iranian experts in food and nutrition fields. Participants were selected from four major provinces in Iran (Tehran, Isfahan, Fars and Gilan). Open-ended interview questions were used to identify nutrition and food systems knowledge issues, which experts considered as important to be included in school education programs. Qualitative interviews were analyzed thematically using NVivo. Results: A framework of knowledge that would assist Iranian students and school-leavers to make informed decisions in food-related areas was developed, comprising five major clusters and several sub-clusters. Major knowledge clusters included nutrition basics; food production; every day food-related practices; prevalent nutritional health problems in Iran and improvement of students’ ethical attitudes in the food domain. Conclusion: These findings provide a guide to curriculum developers and policy makers to assess current education curricula in order to optimize students’ knowledge of nutrition and food systems. PMID:28845405

Creating a test blueprint for a progress testing program: A paired-comparisons approach.

PubMed

von Bergmann, HsingChi; Childs, Ruth A

2018-03-01

Creating a new testing program requires the development of a test blueprint that will determine how the items on each test form are distributed across possible content areas and practice domains. To achieve validity, categories of a blueprint are typically based on the judgments of content experts. How experts judgments are elicited and combined is important to the quality of resulting test blueprints. Content experts in dentistry participated in a day-long faculty-wide workshop to discuss, refine, and confirm the categories and their relative weights. After reaching agreement on categories and their definitions, experts judged the relative importance between category pairs, registering their judgments anonymously using iClicker, an audience response system. Judgments were combined in two ways: a simple calculation that could be performed during the workshop and a multidimensional scaling of the judgments performed later. Content experts were able to produce a set of relative weights using this approach. The multidimensional scaling yielded a three-dimensional model with the potential to provide deeper insights into the basis of the experts' judgments. The approach developed and demonstrated in this study can be applied across academic disciplines to elicit and combine content experts judgments for the development of test blueprints.

Vaccine Rejecting Parents' Engagement With Expert Systems That Inform Vaccination Programs.

PubMed

Attwell, Katie; Leask, Julie; Meyer, Samantha B; Rokkas, Philippa; Ward, Paul

2017-03-01

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and "the system" underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents-and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust-as arising from the internalization of countering views, which facilitates nuance.

Developing and piloting an expert system for better routine voluntary HIV counseling and testing in China: preliminary results and lessons.

PubMed

Chai, Jing; Wang, DeBin; Zhou, Meng; Xu, WangQuan; Liang, Guojun; Shen, Yi Fang

2012-01-01

This study aims at developing and testing a pragmatic expert system for HIV voluntary counseling (VCT-ES) that leverages best practices. The VCT-ES was developed via evolutionary prototyping and piloted in 10 voluntary HIV counseling and testing (VCT) clinics from Anhui and Beijing representative of prefecture and county level VCT clinics in China. All counselors with the clinics and the clients to the clinics within selected two weeks at baseline and the end of study were invited to participate. Assessment measures included essential counseling procedures (ECPs); clients' satisfaction, knowledge, and behavior efficacy. VCT-ES was developed which tries to model and facilitate standard VCT operation procedures and best practices. One hundred and eighty-two (96 at baseline vs. 86 after intervention) cases recordings, 172 (96 vs. 76) client questionnaires, 10 counselor, and 2 expert rating instruments were collected; and 17 clients and 8 counselors participated in qualitative interviews. VCT-ES increased delivery of ECPs from 18.94% to 66.39% on average; increased clients' knowledge from 40.51% to 86.34% and self-efficacy by 22.42%. The VCT-ES applications listed were rated 9.1 on average (maximum = 10). The VCT-ES could be an easy and effective solution to better routine VCT and merits further research.

GERIREX - growing a second generation medical expert system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kocur, J. Jr.; Suh, S.C.

This article describes GERIREX, a medical expert system as the core module of an integrated system for total management of a medical practice. GERIREX is currently a first-generation consultant in the domain of prescribing for the geriatric patient with multiple ailments. Employing rule and objective probabilistic knowledge representations, the system performs at the near-expert level, correctly ranking single and multiple drug therapy for hypertension and/or congestive heart failure in the presence of between two and seven of 18 common accompanying or underlying conditions. GERIREX creates permanent consultation records and can access patient information from existing databases. System requirements are metmore » by very modest PCs, yet power, speed, flexibility, and ease of use rival or exceed those of many other systems. GERIREX interfaces with a variety of configurations and applications, including text, spreadsheets, databases, and executables, to fit in with current plans to upgrade to a second generation system, providing a degree of self-maintenance through intelligent parsing of a drug data source such as the Physicians` Desk Reference (PDR - CDROM version). Another option under consideration is developing neural networks to both replace the current knowledge base, and to embody the rationale employed by the medical expert in evaluating drug data for treatment selection. In this version, the current drug database would be used as warning data for the network tasked with adding new drugs to the drug database, imitating the process whereby a physician determines their personal arsenal from among the wide range of available options.« less

Effective Literacy and English Language Instruction for English Learners in the Elementary Grades. IES Practice Guide. NCEE 2007-4011

ERIC Educational Resources Information Center

Gersten, Russell; Baker, Scott K.; Shanahan, Timothy; Linan-Thompson, Sylvia; Collins, Penny; Scarcella, Robin

2007-01-01

This Practice Guide is the first in a series of the Institute of Education Sciences (IES) guides in education that are developed by a panel of experts. The guides are intended to bring the best available evidence and expertise to bear on the types of systemic challenges that cannot currently be addressed by single intervention or programs. This…

Choose and Book: a sociological analysis of 'resistance' to an expert system.

PubMed

Greenhalgh, Trisha; Stones, Rob; Swinglehurst, Deborah

2014-03-01

In 2004, the English Department of Health introduced a technology (Choose and Book) designed to help general practitioners and patients book hospital outpatient appointments. It was anticipated that remote booking would become standard practice once technical challenges were overcome. But despite political pressure and financial incentives, Choose and Book remained unpopular and was generally used reluctantly if at all. Policymakers framed this as a problem of 'clinician resistance'. We considered Choose and Book from a sociological perspective. Our dataset, drawn from a qualitative study of computer use in general practice, comprised background documents, field notes, interviews, clinical consultations (directly observed and videotaped) and naturally occurring talk relating to referral to hospital in four general practices. We used strong structuration theory, Giddens' conceptualisation of expert systems, and sensitivity to other sociological perspectives on technology, institutions and professional values to examine the relationship between the external environment, the evolving technology and actions of human agents (GPs, administrators, managers and patients). Choose and Book had the characteristics of an expert system. It served to 'empty out' the content of the consultation as the abstract knowledge it contained was assumed to have universal validity and to over-ride the clinician's application of local knowledge and practical wisdom. Sick patients were incorrectly assumed to behave as rational choosers, able and willing to decide between potential options using abstracted codified information. Our analysis revealed four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology's socio-material constraints; to interference with doctors' contextual judgements; and to adjusting to the altered social relations consequent on its use. We conclude that 'resistance' is a complex phenomenon with socio-material and normative components; it is unlikely to be overcome using the behaviourist techniques recommended in some health informatics and policy literature. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

"Let Your Data Tell a Story:" Climate Change Experts and Students Navigating Disciplinary Argumentation in the Classroom

ERIC Educational Resources Information Center

Walsh, Elizabeth Mary; McGowan, Veronica Cassone

2017-01-01

Science education trends promote student engagement in authentic knowledge in practice to tackle personally consequential problems. This study explored how partnering scientists and students on a social media platform supported students' development of disciplinary practice knowledge through practice-based learning with experts during two pilot…

The Significance of Practical Training in Linking Theoretical Studies with Practice

ERIC Educational Resources Information Center

Katajavuori, Nina; Lindblom-Ylanne, Sari; Hirvonen, Jouni

2006-01-01

Today's experts must continuously reconstruct their expertise and be able to apply their theoretical knowledge in actual work. The development of expertise is a long process, during which theoretical, practical and metacognitive elements of expert knowledge are integrated into a coherent whole. It is important to foster student's learning and…

Medical expert system for assessment of coronary heart disease destabilization based on the analysis of the level of soluble vascular adhesion molecules

NASA Astrophysics Data System (ADS)

Serkova, Valentina K.; Pavlov, Sergey V.; Romanava, Valentina A.; Monastyrskiy, Yuriy I.; Ziepko, Sergey M.; Kuzminova, Nanaliya V.; Wójcik, Waldemar; DzierŻak, RóŻa; Kalizhanova, Aliya; Kashaganova, Gulzhan

2017-08-01

Theoretical and practical substantiation of the possibility of the using the level of soluble vascular adhesion molecules (sVCAM) is performed. Expert system for the assessment of coronary heart disease (CHD) destabilization on the base of the analysis of soluble vascular adhesion molecules level is developed. Correlation between the increase of VCAM level and C-reactive protein (CRP) in patients with different variants of CHD progression is established. Association of chronic nonspecific vascular inflammation activation and CHD destabilization is shown. The expedience of parallel determination of sVCAM and CRP levels for diagnostics of CHD destabilization and forecast elaboration is noted.

Systemic accident analysis: examining the gap between research and practice.

PubMed

Underwood, Peter; Waterson, Patrick

2013-06-01

The systems approach is arguably the dominant concept within accident analysis research. Viewing accidents as a result of uncontrolled system interactions, it forms the theoretical basis of various systemic accident analysis (SAA) models and methods. Despite the proposed benefits of SAA, such as an improved description of accident causation, evidence within the scientific literature suggests that these techniques are not being used in practice and that a research-practice gap exists. The aim of this study was to explore the issues stemming from research and practice which could hinder the awareness, adoption and usage of SAA. To achieve this, semi-structured interviews were conducted with 42 safety experts from ten countries and a variety of industries, including rail, aviation and maritime. This study suggests that the research-practice gap should be closed and efforts to bridge the gap should focus on ensuring that systemic methods meet the needs of practitioners and improving the communication of SAA research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Building a case-based diet recommendation system without a knowledge engineer.

PubMed

Khan, Abdus Salam; Hoffmann, Achim

2003-02-01

We present a new approach to the effective development of menu construction systems that allow to automatically construct a menu that is strongly tailored to the individual requirements and food preferences of a client. In hospitals and other health care institutions dietitians develop diets for clients which need to change their eating habits. Many clients have special needs in regards to their medical conditions, cultural backgrounds, or special levels of nutrient requirements for better recovery from diseases or surgery, etc. Existing computer support for this task is insufficient-many diets are not specifically tailored for the client's needs or require substantial time of a dietitian to be manually developed. Our approach is based on case-based reasoning, an artificial intelligence technique that finds increasing entry into industrial practice. Our approach goes beyond the traditional case-based reasoning (CBR) approach by allowing an incremental improvement of the system's competency during routine use of the system. The improvement of the system takes place through a direct expert user-system interaction while the expert is accomplishing their tasks of constructing a diet for a given client. Whenever the system performs unsatisfactorily, the expert will need to modify the system-produced diet 'manually', i.e. by entering the desired modifications into the system. Our implemented system, menu construction using an incremental knowledge acquisition system (MIKAS), asks the expert for simple explanations for each of the manual actions he/she takes and incorporates the explanations automatically into its knowledge base (KB) so that the system will perform these manually conducted actions automatically at the next occasion. We present MIKAS and discuss the results of our case study. While still being a prototype, the senior clinical dietitian involved in our evaluation studies judges the approach to have considerable potential to improve the daily routine of hospital dietitians as well as to improve the average quality of the dietary advice given to patients within the limited available time for dietary consultations. Our approach opens up a new avenue towards building highly specialised CBR systems in a more cost-effective way. Hence, our approach promises to allow a significantly more widespread development and practical deployment of CBR systems in a large variety of application domains including many medical applications.

History and structures of telecommunication in pathology, focusing on open access platforms.

PubMed

Kayser, Klaus; Borkenfeld, Stephan; Djenouni, Amina; Kayser, Gian

2011-11-07

Telecommunication has matured to a broadly applied tool in diagnostic pathology. Contemporary with the development of fast electronic communication lines (Integrated digital network services (ISDN), broad band connections, and fibre optics, as well as the digital imaging technology (digital camera), telecommunication in tissue--based diagnosis (telepathology) has matured. Open access (internet) and server--based communication have induced the development of specific medical information platforms, such as iPATH, UICC-TPCC (telepathology consultation centre of the Union International against Cancer), or the Armed Forces Institute of Pathology (AFIP) teleconsultation system. They have been closed, and are subject to be replaced by specific open access forums (Medical Electronic Expert Communication System (MECES) with embedded virtual slide (VS) technology). MECES uses php language, data base driven mySqL architecture, X/L-AMPP infrastructure, and browser friendly W3C conform standards. The server--based medical communication systems (AFIP, iPATH, UICC-TPCC) have been reported to be a useful and easy to handle tool for expert consultation. Correct sampling and evaluation of transmitted still images by experts reported revealed no or only minor differences to the original images and good practice of the involved experts. β tests with the new generation medical expert consultation systems (MECES) revealed superior results in terms of performance, still image viewing, and system handling, especially as this is closely related to the use of so--called social forums (facebook, youtube, etc.). In addition to the acknowledged advantages of the former established systems (assistance of pathologists working in developing countries, diagnosis confirmation, international information exchange, etc.), the new generation offers additional benefits such as acoustic information transfer, assistance in image screening, VS technology, and teaching in diagnostic sampling, judgement, and verification.

Systems survivor: a program for house staff in systems-based practice.

PubMed

Turley, Christine B; Roach, Richard; Marx, Marilyn

2007-01-01

The Systems-Based Practice competency expanded the scope of graduate medical education. Innovative approaches are needed to teach this material. We have designed and implemented a rotation in Systems-Based Practice focused on the interrelationships of patient care, clinical revenue, and the physician's role within health care systems. Experiential learning occurs during a 5-day rotation through 26 areas encompassing the clinical revenue cycle, guided by "expert" staff. Using a reversal of the TV show Survivor, house staff begin conceptually "alone" and discover they are members of a large, dedicated team. Assessment results, including a system knowledge test and course evaluations, are presented. Twenty-five residents from four clinical departments participated in Year 1. An increase in pretest to posttest knowledge scores of 14.8% (p

The current theoretical assumptions of the Bobath concept as determined by the members of BBTA.

PubMed

Raine, Sue

2007-01-01

The Bobath concept is a problem-solving approach to the assessment and treatment of individuals following a lesion of the central nervous system that offers therapists a framework for their clinical practice. The aim of this study was to facilitate a group of experts in determining the current theoretical assumptions underpinning the Bobath concept.A four-round Delphi study was used. The expert sample included all 15 members of the British Bobath Tutors Association. Initial statements were identified from the literature with respondents generating additional statements. Level of agreement was determined by using a five-point Likert scale. Level of consensus was set at 80%. Eighty-five statements were rated from the literature along with 115 generated by the group. Ninety-three statements were identified as representing the theoretical underpinning of the Bobath concept. The Bobath experts agreed that therapists need to be aware of the principles of motor learning such as active participation, opportunities for practice and meaningful goals. They emphasized that therapy is an interactive process between individual, therapist, and the environment and aims to promote efficiency of movement to the individual's maximum potential rather than normal movement. Treatment was identified by the experts as having "change of functional outcome" at its center.

Program and Project Management Framework

NASA Technical Reports Server (NTRS)

Butler, Cassandra D.

2002-01-01

The primary objective of this project was to develop a framework and system architecture for integrating program and project management tools that may be applied consistently throughout Kennedy Space Center (KSC) to optimize planning, cost estimating, risk management, and project control. Project management methodology used in building interactive systems to accommodate the needs of the project managers is applied as a key component in assessing the usefulness and applicability of the framework and tools developed. Research for the project included investigation and analysis of industrial practices, KSC standards, policies, and techniques, Systems Management Office (SMO) personnel, and other documented experiences of project management experts. In addition, this project documents best practices derived from the literature as well as new or developing project management models, practices, and techniques.

Diagnosis and Management of Low-Grade Dysplasia in Barrett's Esophagus: Expert Review From the Clinical Practice Updates Committee of the American Gastroenterological Association.

PubMed

Wani, Sachin; Rubenstein, Joel H; Vieth, Michael; Bergman, Jacques

2016-11-01

The purpose of this clinical practice update expert review is to define the key principles in the diagnosis and management of low-grade dysplasia (LGD) in Barrett's esophagus patients. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Practice Advice 1: The extent of Barrett's esophagus should be defined using a standardized grading system documenting the circumferential and maximal extent of the columnar lined esophagus (Prague classification) with a clear description of landmarks and visible lesions (nodularity, ulceration) when present. Practice Advice 2: Given the significant interobserver variability among pathologists, the diagnosis of Barrett's esophagus with LGD should be confirmed by an expert gastrointestinal pathologist (defined as a pathologist with a special interest in Barrett's esophagus-related neoplasia who is recognized as an expert in this field by his/her peers). Practice Advice 3: Expert pathologists should report audits of their diagnosed cases of LGD, such as the frequency of LGD diagnosed among surveillance patients and/or the difference in incidence of neoplastic progression among patients diagnosed with LGD vs nondysplastic Barrett's esophagus. Practice Advice 4: Patients in whom the diagnosis of LGD is downgraded to nondysplastic Barrett's esophagus should be managed as nondysplastic Barrett's esophagus. Practice Advice 5: In Barrett's esophagus patients with confirmed LGD (based on expert gastrointestinal pathology review), repeat upper endoscopy using high-definition/high-resolution white-light endoscopy should be performed under maximal acid suppression (twice daily dosing of proton pump inhibitor therapy) in 8-12 weeks. Practice Advice 6: Under ideal circumstances, surveillance biopsies should not be performed in the presence of active inflammation (erosive esophagitis, Los Angeles grade C and D). Pathologists should be informed if biopsies are obtained in the setting of erosive esophagitis and if pathology findings suggest LGD, or if no biopsies are obtained, surveillance biopsies should be repeated after the anti-reflux regimen has been further intensified. Practice Advice 7: Surveillance biopsies should be performed in a four-quadrant fashion every 1-2 cm with target biopsies obtained from visible lesions taken first. Practice Advice 8: Patients with a confirmed histologic diagnosis of LGD should be referred to an endoscopist with expertise in managing Barrett's esophagus-related neoplasia practicing at centers equipped with high-definition endoscopy and capable of performing endoscopic resection and ablation. Practice Advice 9: Endoscopic resection should be performed in Barrett's esophagus patients with LGD with endoscopically visible abnormalities (no matter how subtle) in order to accurately assess the grade of dysplasia. Practice Advice 10: In patients with confirmed Barrett's esophagus with LGD by expert GI pathology review that persists on a second endoscopy, despite intensification of acid-suppressive therapy, risks and benefits of management options of endoscopic eradication therapy (specifically adverse events associated with endoscopic resection and ablation), and ongoing surveillance should be discussed and documented. Practice Advice 11: Endoscopic eradication therapy should be considered in patients with confirmed and persistent LGD with the goal of achieving complete eradication of intestinal metaplasia. Practice Advice 12: Patients with LGD undergoing surveillance rather than endoscopic eradication therapy should undergo surveillance every 6 months times 2, then annually unless there is reversion to nondysplastic Barrett's esophagus. Biopsies should be obtained in 4-quadrants every 1-2 cm and of any visible lesions. Practice Advice 13: In patients with Barrett's esophagus-related LGD undergoing ablative therapy, radiofrequency ablation should be used. Practice Advice 14: Patients completing endoscopic eradication therapy should be enrolled in an endoscopic surveillance program. Patients who have achieved complete eradication of intestinal metaplasia should undergo surveillance every year for 2 years and then every 3 years thereafter to detect recurrent intestinal metaplasia and dysplasia. Patients who have not achieved complete eradication of intestinal metaplasia should undergo surveillance every 6 months for 1 year after the last endoscopy, then annually for 2 years, then every 3 years thereafter. Practice Advice 15: Following endoscopic eradication therapy, the biopsy protocol of obtaining biopsies in 4 quadrants every 2 cm throughout the length of the original Barrett's esophagus segment and any visible columnar mucosa is suggested. Practice Advice 16: Endoscopists performing endoscopic eradication therapy should report audits of their rates of complete eradication of dysplasia and intestinal metaplasia and adverse events in clinical practice. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

An expert system for integrated structural analysis and design optimization for aerospace structures

NASA Technical Reports Server (NTRS)

1992-01-01

The results of a research study on the development of an expert system for integrated structural analysis and design optimization is presented. An Object Representation Language (ORL) was developed first in conjunction with a rule-based system. This ORL/AI shell was then used to develop expert systems to provide assistance with a variety of structural analysis and design optimization tasks, in conjunction with procedural modules for finite element structural analysis and design optimization. The main goal of the research study was to provide expertise, judgment, and reasoning capabilities in the aerospace structural design process. This will allow engineers performing structural analysis and design, even without extensive experience in the field, to develop error-free, efficient and reliable structural designs very rapidly and cost-effectively. This would not only improve the productivity of design engineers and analysts, but also significantly reduce time to completion of structural design. An extensive literature survey in the field of structural analysis, design optimization, artificial intelligence, and database management systems and their application to the structural design process was first performed. A feasibility study was then performed, and the architecture and the conceptual design for the integrated 'intelligent' structural analysis and design optimization software was then developed. An Object Representation Language (ORL), in conjunction with a rule-based system, was then developed using C++. Such an approach would improve the expressiveness for knowledge representation (especially for structural analysis and design applications), provide ability to build very large and practical expert systems, and provide an efficient way for storing knowledge. Functional specifications for the expert systems were then developed. The ORL/AI shell was then used to develop a variety of modules of expert systems for a variety of modeling, finite element analysis, and design optimization tasks in the integrated aerospace structural design process. These expert systems were developed to work in conjunction with procedural finite element structural analysis and design optimization modules (developed in-house at SAT, Inc.). The complete software, AutoDesign, so developed, can be used for integrated 'intelligent' structural analysis and design optimization. The software was beta-tested at a variety of companies, used by a range of engineers with different levels of background and expertise. Based on the feedback obtained by such users, conclusions were developed and are provided.

An expert system for integrated structural analysis and design optimization for aerospace structures

NASA Astrophysics Data System (ADS)

1992-04-01

The results of a research study on the development of an expert system for integrated structural analysis and design optimization is presented. An Object Representation Language (ORL) was developed first in conjunction with a rule-based system. This ORL/AI shell was then used to develop expert systems to provide assistance with a variety of structural analysis and design optimization tasks, in conjunction with procedural modules for finite element structural analysis and design optimization. The main goal of the research study was to provide expertise, judgment, and reasoning capabilities in the aerospace structural design process. This will allow engineers performing structural analysis and design, even without extensive experience in the field, to develop error-free, efficient and reliable structural designs very rapidly and cost-effectively. This would not only improve the productivity of design engineers and analysts, but also significantly reduce time to completion of structural design. An extensive literature survey in the field of structural analysis, design optimization, artificial intelligence, and database management systems and their application to the structural design process was first performed. A feasibility study was then performed, and the architecture and the conceptual design for the integrated 'intelligent' structural analysis and design optimization software was then developed. An Object Representation Language (ORL), in conjunction with a rule-based system, was then developed using C++. Such an approach would improve the expressiveness for knowledge representation (especially for structural analysis and design applications), provide ability to build very large and practical expert systems, and provide an efficient way for storing knowledge. Functional specifications for the expert systems were then developed. The ORL/AI shell was then used to develop a variety of modules of expert systems for a variety of modeling, finite element analysis, and design optimization tasks in the integrated aerospace structural design process. These expert systems were developed to work in conjunction with procedural finite element structural analysis and design optimization modules (developed in-house at SAT, Inc.). The complete software, AutoDesign, so developed, can be used for integrated 'intelligent' structural analysis and design optimization. The software was beta-tested at a variety of companies, used by a range of engineers with different levels of background and expertise. Based on the feedback obtained by such users, conclusions were developed and are provided.

An expert system to advise astronauts during experiments: The protocol manager module

NASA Technical Reports Server (NTRS)

Haymann-Haber, Guido; Colombano, Silvano P.; Groleau, Nicolas; Rosenthal, Don; Szolovits, Peter; Young, Laurence R.

1990-01-01

Perhaps the scarcest resource for manned flight experiments - on Spacelab or on the Space Station Freedom - will continue to be crew time. To maximize the efficiency of the crew and to make use of their abilities to work as scientist collaborators as well as equipment operators, normally requires more training in a wide variety of disciplines than is practical. The successful application of on-board expert systems, as envisioned by the Principal Investigator in a Box program, should alleviate the training bottleneck and provide the astronaut with the guidance and coaching needed to permit him or her to operate an experiment according to the desires and knowledge of the PI, despite changes in conditions. The Protocol Manager module of the system is discussed. The Protocol Manager receives experiment data that has been summarized and categorized by the other modules. The Protocol Manager acts on the data in real-time, by employing expert system techniques. Its recommendations are based on heuristics provided by the Principal Investigator in charge of the experiment. This prototype was developed on a Macintosh II by employing CLIPS, a forward-chaining rule-based system, and HyperCard as an object-oriented user interface builder.

Design and Usability Assessment of a Dialogue-Based Cognitive Tutoring System to Model Expert Problem Solving in Research Design

ERIC Educational Resources Information Center

Hung, Wei-Chen; Smith, Thomas J.; Smith, M. Cecil

2015-01-01

Technology provides the means to create useful learning and practice environments for learners. Well-designed cognitive tutor systems, for example, can provide appropriate learning environments that feature cognitive supports (ie, scaffolding) for students to increase their procedural knowledge. The purpose of this study was to conduct a series of…

A new voice rating tool for clinical practice.

PubMed

Gould, James; Waugh, Jessica; Carding, Paul; Drinnan, Michael

2012-07-01

Perceptual rating of voice quality is a key component in the comprehensive assessment of voice, but there are practical difficulties in making reliable measurements. We have developed the Newcastle Audio Ranking (NeAR) test, a new referential system for the rating of voice parameters. In this article, we present our first results using NeAR. We asked five experts and 11 naive raters to assess 15 male and 15 female voices using the NeAR test. We assessed: validity with respect to the GRBAS scale; interrater reliability; sensitivity to subtle voice differences; and the performance of expert versus naïve raters. There was a uniformly excellent agreement with GRBAS (r=0.87) and interrater agreement (intraclass correlation coefficient=0.86). Considering each GRBAS grade of voice separately, there was still good interrater agreement in NeAR, implying it has good sensitivity to subtle changes. All these results were equally true for expert and naive raters. The NeAR test is a promising new tool in the assessment of voice disorders. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

`Let your data tell a story:' climate change experts and students navigating disciplinary argumentation in the classroom

NASA Astrophysics Data System (ADS)

Walsh, Elizabeth Mary; McGowan, Veronica Cassone

2017-01-01

Science education trends promote student engagement in authentic knowledge in practice to tackle personally consequential problems. This study explored how partnering scientists and students on a social media platform supported students' development of disciplinary practice knowledge through practice-based learning with experts during two pilot enactments of a project-based curriculum focusing on the ecological impacts of climate change. Through the online platform, scientists provided feedback on students' infographics, visual argumentation artifacts that use data to communicate about climate change science. We conceptualize the infographics and professional data sets as boundary objects that supported authentic argumentation practices across classroom and professional contexts, but found that student generated data was not robust enough to cross these boundaries. Analysis of the structure and content of the scientists' feedback revealed that when critiquing argumentation, scientists initiated engagement in multiple scientific practices, supporting a holistic rather than discrete model of practice-based learning. While traditional classroom inquiry has emphasized student experimentation, we found that engagement with existing professional data sets provided students with a platform for developing expertise in systemic scientific practices during argument construction. We further found that many students increased the complexity and improved the visual presentation of their arguments after feedback.

International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process.

PubMed

Howell, Ann-Marie; Burns, Elaine M; Hull, Louise; Mayer, Erik; Sevdalis, Nick; Darzi, Ara

2017-02-01

Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care. To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role. After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised. Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally. We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Good practice statements on safe laboratory testing: A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

PubMed

Bowie, Paul; Forrest, Eleanor; Price, Julie; Verstappen, Wim; Cunningham, David; Halley, Lyn; Grant, Suzanne; Kelly, Moya; Mckay, John

2015-09-01

The systems-based management of laboratory test ordering and results handling is a known source of error in primary care settings worldwide. The consequences are wide-ranging for patients (e.g. avoidable harm or poor care experience), general practitioners (e.g. delayed clinical decision making and potential medico-legal implications) and the primary care organization (e.g. increased allocation of resources to problem-solve and dealing with complaints). Guidance is required to assist care teams to minimize associated risks and improve patient safety. To identify, develop and build expert consensus on 'good practice' guidance statements to inform the implementation of safe systems for ordering laboratory tests and managing results in European primary care settings. Mixed methods studies were undertaken in the UK and Ireland, and the findings were triangulated to develop 'good practice' statements. Expert consensus was then sought on the findings at the wider European level via a Delphi group meeting during 2013. We based consensus on 10 safety domains and developed 77 related 'good practice' statements (≥ 80% agreement levels) judged to be essential to creating safety and minimizing risks in laboratory test ordering and subsequent results handling systems in international primary care. Guidance was developed for improving patient safety in this important area of primary care practice. We need to consider how this guidance can be made accessible to frontline care teams, utilized by clinical educators and improvement advisers, implemented by decision makers and evaluated to determine acceptability, feasibility and impacts on patient safety.

Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST.

PubMed

Shaughnessy, Allen F; Vaswani, Akansha; Andrews, Bonnie K; Erlich, Deborah R; D'Amico, Frank; Lexchin, Joel; Cosgrove, Lisa

2017-09-01

Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring. Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. The 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians. © 2017 Annals of Family Medicine, Inc.

Methods and means of diagnostics of oncological diseases on the basis of pattern recognition: intelligent morphological systems - problems and solutions

NASA Astrophysics Data System (ADS)

Nikitaev, V. G.

2017-01-01

The development of methods of pattern recognition in modern intelligent systems of clinical cancer diagnosis are discussed. The histological (morphological) diagnosis - primary diagnosis for medical setting with cancer are investigated. There are proposed: interactive methods of recognition and structure of intellectual morphological complexes based on expert training-diagnostic and telemedicine systems. The proposed approach successfully implemented in clinical practice.

Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II).

PubMed

Carrascosa, J M; Galán, M; de Lucas, R; Pérez-Ferriols, A; Ribera, M; Yanguas, I

2016-11-01

There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances. We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method. Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice. The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

An Adverse Drug Event and Medication Error Reporting System for Ambulatory Care (MEADERS)

PubMed Central

Zafar, Atif; Hickner, John; Pace, Wilson; Tierney, William

2008-01-01

The Institute of Medicine (IOM) has identified the mitigation of Adverse Drug Events (ADEs) and Medication Errors (MEs) as top national priorities. Currently available reporting tools are fraught with inefficiencies that prevent widespread adoption into busy primary care practices. Using expert panel input we designed and built a new reporting tool that could be used in these settings with a variety of information technology capabilities. We pilot tested the system in four Practice Based Research Networks (PBRNs) comprising 24 practices. Over 10 weeks we recorded 507 reports, of which 370 were MEs and 137 were ADEs. Clinicians found the system easy to use, with the average time to generating a report under 4 minutes. By using streamlined interface design techniques we were successfully able to improve reporting rates of ADEs and MEs in these practices. PMID:18999053

From Zero to Integration in Eight Months, the Dawn Ground Data System Engineering Challenge

NASA Technical Reports Server (NTRS)

Dubon, Lydia P.

2006-01-01

The Dawn GDS Team met the SC Sim integration challenge in eight months. The GDS System Engineering approach in response to the SC Simintegration challenge, focused on a set of key practices: decomposition of project request into manageable requirements; integration of multiple ground disciplines and experts into a focused team effort; risk management thru management of expectations; and aggregation of intermediate products into a final product. By maintaining a a system-level focus, the overall systems engineering process unified team GDS Team members with a common goal: the success of the ground system as a whole and not just the success of their individual expert contributions. Incorporation of Agile-type development efforts were aligned with a risk strategy based on team-oriented principles and expectations management, thus achieving a more stable baseline solution without compromising the integrity of the GDS design.

CORMIX: AN EXPERT SYSTEM FOR MIXING ZONE ANALYSIS

EPA Science Inventory

United States water quality policy includes the concept of a fixing zone, a limited area where initial dilution of a discharge occurs. urrent practice in mixing zone analysis is plagued by a number of problems--mixing zone definitions vary widely, there is a diversity of discharg...

Cairo consensus on the IVF laboratory environment and air quality: report of an expert meeting.

PubMed

Mortimer, D; Cohen, J; Mortimer, S T; Fawzy, M; McCulloh, D H; Morbeck, D E; Pollet-Villard, X; Mansour, R T; Brison, D R; Doshi, A; Harper, J C; Swain, J E; Gilligan, A V

2018-03-02

This proceedings report presents the outcomes from an international Expert Meeting to establish a consensus on the recommended technical and operational requirements for air quality within modern assisted reproduction technology (ART) laboratories. Topics considered included design and construction of the facility, as well as its heating, ventilation and air conditioning system; control of particulates, micro-organisms (bacteria, fungi and viruses) and volatile organic compounds (VOCs) within critical areas; safe cleaning practices; operational practices to optimize air quality while minimizing physicochemical risks to gametes and embryos (temperature control versus air flow); and appropriate infection-control practices that minimize exposure to VOC. More than 50 consensus points were established under the general headings of assessing site suitability, basic design criteria for new construction, and laboratory commissioning and ongoing VOC management. These consensus points should be considered as aspirational benchmarks for existing ART laboratories, and as guidelines for the construction of new ART laboratories. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

A brief history and technical review of the expert system research

NASA Astrophysics Data System (ADS)

Tan, Haocheng

2017-09-01

The expert system is a computer system that emulates the decision-making ability of a human expert, which aims to solve complex problems by reasoning knowledge. It is an important branch of artificial intelligence. In this paper, firstly, we briefly introduce the development and basic structure of the expert system. Then, from the perspective of the enabling technology, we classify the current expert systems and elaborate four expert systems: The Rule-Based Expert System, the Framework-Based Expert System, the Fuzzy Logic-Based Expert System and the Expert System Based on Neural Network.

Expert Systems: An Overview for Teacher-Librarians.

ERIC Educational Resources Information Center

Orwig, Gary; Barron, Ann

1992-01-01

Provides an overview of expert systems for teacher librarians. Highlights include artificial intelligence and expert systems; the development of the MYCIN medical expert system; rule-based expert systems; the use of expert system shells to develop a specific system; and how to select an appropriate application for an expert system. (11 references)…

Novice to expert practice via postprofessional athletic training education: a grounded theory.

PubMed

Neibert, Peter J

2009-01-01

To discover the theoretic constructs that confirm, disconfirm, or extend the principles and their applications appropriate for National Athletic Trainers' Association (NATA)-accredited postprofessional athletic training education programs. Interviews at the 2003 NATA Annual Meeting & Clinical Symposia. Qualitative study using grounded theory procedures. Thirteen interviews were conducted with postprofessional graduates. Participants were purposefully selected based on theoretic sampling and availability. The transcribed interviews were analyzed using open coding, axial coding, and selective coding procedures. Member checks, reflective journaling, and triangulation were used to ensure trustworthiness. The participants' comments confirmed and extended the current principles of postprofessional athletic training education programs and offered additional suggestions for more effective practical applications. The emergence of this central category of novice to expert practice is a paramount finding. The tightly woven fabric of the 10 processes, when interlaced with one another, provides a strong tapestry supporting novice to expert practice via postprofessional athletic training education. The emergence of this theoretic position pushes postprofessional graduate athletic training education forward to the future for further investigation into the theoretic constructs of novice to expert practice.

Developing expertise in surgery.

PubMed

Alderson, David

2010-01-01

The concept of expertise is widely embraced but poorly defined in surgery. Dictionary definitions differentiate between authority and experience, while a third view sees expertise as a mind-set rather than a status. Both absolute and relative models of expertise have been developed, and each allows a richer understanding of the application of these concepts to emerge. Trainees must develop both independent and interdependent expertise, and an appreciation of the essentially constructivist and uncertain nature of medical knowledge. Approach may be more important than innate talent; the concepts of 'flow', sustained 'deliberate practice' and 'adaptive expertise' are examples of expert approaches to learning. Non-analytical reasoning plays a key role in decision making at expert levels of practice. A technically gifted surgeon may be seen as a safety hazard rather than an expert if inter-dependent expertise has not been developed. Key roles of a surgical educator are to facilitate the development of an expert approach to education and to enable entry into and movement towards the centre of an expert community of practice.

Concept formation: a supportive process for early career nurses.

PubMed

Thornley, Tracey; West, Sandra

2010-09-01

Individuals come to understand abstract constructs such as that of the 'expert' through the formation of concepts. Time and repeated opportunity for observation to support the generalisation and abstraction of the developing concept are essential if the concept is to form successfully. Development of an effective concept of the 'expert nurse' is critical for early career nurses who are attempting to integrate theory, values and beliefs as they develop their clinical practice. This study explores the use of a concept development framework in a grounded theory study of the 'expert nurse'. Qualitative. Using grounded theory methods for data collection and analysis, semi-structured interviews were conducted with registered nurses. The participants were asked to describe their concept of the 'expert nurse' and to discuss their experience of developing this. Participants reported forming their concept of the 'expert nurse', after multiple opportunities to engage with nurses identified as 'expert'. This identification did not necessarily relate to the designated position of the 'expert nurse' or assigned mentors. When the early career nurse does not successfully form a concept of the 'expert nurse', difficulties in personal and professional development including skill/knowledge development may arise. To underpin development of their clinical practice effectively, early career nurses need to be provided with opportunities that facilitate the purposive formation of their own concept of the 'expert nurse'. Formation of this concept is not well supported by the common practice of assigning mentors. Early career nurses must be provided with the time and the opportunity to individually develop and refine their concept of the 'expert nurse'. To achieve this, strategies including providing opportunities to engage with expert nurses and discussion of the process of concept formation and its place in underpinning personal judgments may be of assistance. © 2010 Blackwell Publishing Ltd.

The Development and Application of Airway Devices in China

PubMed Central

Chen, Xiangdong; Ma, Wuhua; Liu, Renyu; Yao, Shanglong

2017-01-01

Airway management is one of the most important tasks for anesthesiologists. Anesthesiologists are experts in airway management and have made tremendous contribution to the development of the airway devices. Chinese anesthesiologists have made significant contribution in introducing advanced airway management and developing innovative techniques and devices for airway management in China. This article overviews the development and application of airway devices in China as well as the dedication and contribution of Chinese experts in the development of novel airway devices. With the development of science and technology accompanied by the advanced knowledge in airway management, more effective and safe artificial airways will be developed for clinical practice. The authors believe that Chinese experts will continue their outstanding contribution to the development of innovative airway devices, systems and knowledge. PMID:28191485

Intensive Intervention Practice Guide: System of Least Prompts

ERIC Educational Resources Information Center

Walte, Samantha; Brown, Christerralyn; Wallace, Theresa

2017-01-01

The National Center for Leadership in Intensive Intervention (NCLII), a consortium funded by the Office of Special Education Programs (OSEP), prepares special education leaders to become experts in research on intensive intervention for students with disabilities who have persistent and severe academic (e.g., reading and math) and behavioral…

Adding an Expert to the Team: The Expert Flight Plan Critic

ERIC Educational Resources Information Center

Gibbons, Andrew; Waki, Randy; Fairweather, Peter

2008-01-01

This paper reports the development of a practical tool that provides expert feedback to students following an extended simulation exercise in cross-country flight planning. In contrast to development for laboratory settings, the development of an expert instructional product for everyday use posed some interesting challenges, including dealing…

PI-in-a-box: An expert system to advise astronauts during experiments

NASA Technical Reports Server (NTRS)

Young, Laurence R.

1990-01-01

Perhaps the scarcest resource for manned flight experiments - on Spacelab or on Space Station Freedom - will continue to be crew time. To maximize the efficiency of the crew, and to make use of their abilities to work as scientist collaborators as well as equipment operators, normally requires more training in a wide variety of disciplines than is practical. The successful application of on-board expert systems, as envisioned by the 'Principal Investigator (PI)-in-a-Box' program, should alleviate the training bottleneck and provide the astronaut with the guidance and coaching needed to permit him or her to operate an experiment according to the desires and knowledge of the PI, despite changes in conditions. In addition to the functions of providing expert devise concerning scheduling and repair, the program should bring the astronaut into the scientific evaluation phase of an experiment by sharing with him the guidance and observations regarding the relevance and importance of data as it is being generated. Initial reaction from the astronaut community has been positive.

IEA Task 32: Wind Lidar Systems for Wind Energy Deployment (LIDAR)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuhn, Martin; Trabucchi, Davide; Clifton, Andrew

2016-05-25

Under the International Energy Agency Wind Implementing Agreement (IEA Wind) Task 11, researchers started examining novel applications for remote sensing and the issues around them during the 51st topical expert meeting about remote sensing in January 2007. The 59th topical expert meeting organized by Task 11 in October 2009 was also dedicated to remote sensing, and the first draft of the Task's recommended practices on remote sensing was published in January 2013. The results of the Task 11 topical expert meetings provided solid groundwork for a new IEA Wind Task 32 on wind lidar technologies. Members of the wind communitymore » identified the need to consolidate the knowledge about wind lidar systems to facilitate their use, and to investigate how to exploit the advantages offered by this technology. This was the motivation that led to the start of IEA Wind Task 32 'Lidar Application for Wind Energy Deployment' in November 2011. The kick-off was meeting was held in May 2012.« less

Zero tolerance. With health IT money up for grabs, many EHR vendors are offering financing deals to attract business. But, just like shopping for a car, experts warn about reading the fine print before buying.

PubMed

Blesch, Gregg; Carlson, Joe

2010-03-01

The government, by way of federal stimulus incentives, wants to boost the use of electronic health records. However, physician practices must be careful about low or no-interest offers when buying an EHR system, experts say. "The ultimate power a buyer has--I use the analogy of buying a car--is the ability to say 'no thanks' and walk out of the showroom", says Steven Fox, left, a partner at Post & Schell.

European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | FNLCR Staging

Cancer.gov

European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

Examining pedagogical practices in family systems nursing: intentionality, complexity, and doing well by families.

PubMed

Moules, Nancy J; Bell, Janice M; Paton, Brenda I; Morck, Angela C

2012-05-01

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families' illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master's and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Adaptive control with an expert system based supervisory level. Thesis

NASA Technical Reports Server (NTRS)

Sullivan, Gerald A.

1991-01-01

Adaptive control is presently one of the methods available which may be used to control plants with poorly modelled dynamics or time varying dynamics. Although many variations of adaptive controllers exist, a common characteristic of all adaptive control schemes, is that input/output measurements from the plant are used to adjust a control law in an on-line fashion. Ideally the adjustment mechanism of the adaptive controller is able to learn enough about the dynamics of the plant from input/output measurements to effectively control the plant. In practice, problems such as measurement noise, controller saturation, and incorrect model order, to name a few, may prevent proper adjustment of the controller and poor performance or instability result. In this work we set out to avoid the inadequacies of procedurally implemented safety nets, by introducing a two level control scheme in which an expert system based 'supervisor' at the upper level provides all the safety net functions for an adaptive controller at the lower level. The expert system is based on a shell called IPEX, (Interactive Process EXpert), that we developed specifically for the diagnosis and treatment of dynamic systems. Some of the more important functions that the IPEX system provides are: (1) temporal reasoning; (2) planning of diagnostic activities; and (3) interactive diagnosis. Also, because knowledge and control logic are separate, the incorporation of new diagnostic and treatment knowledge is relatively simple. We note that the flexibility available in the system to express diagnostic and treatment knowledge, allows much greater functionality than could ever be reasonably expected from procedural implementations of safety nets. The remainder of this chapter is divided into three sections. In section 1.1 we give a detailed review of the literature in the area of supervisory systems for adaptive controllers. In particular, we describe the evolution of safety nets from simple ad hoc techniques, up to the use of expert systems for more advanced supervision capabilities.

A model structure for an EBM program in a multihospital system.

PubMed

Schumacher, Dale N; Stock, Joseph R; Richards, Joan K

2003-01-01

Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee and has strong administrative support. The approach relies extensively on physician involvement and expert physician panels to enhance existing EBM practice guidelines, with an explicit strategy of performance reports and feedback.

OVERSEER: An Expert System Monitor for the Psychiatric Hospital

PubMed Central

Bronzino, Joseph D.; Morelli, Ralph A.; Goethe, John W.

1988-01-01

In order to improve patient care, comply with regulatory guidelines and decrease potential liability, psychiatric hospitals and clinics have been searching for computer systems to monitor the management and treatment of patients. This paper describes OVERSEER: a knowledge based system that monitors the treatment of psychiatric patients in real time. Based on procedures and protocols developed in the psychiatric setting, OVERSEER monitors the clinical database and issues alerts when standard clinical practices are not followed or when laboratory results or other clinical indicators are abnormal. Written in PROLOG, OVERSEER is designed to interface directly with the hospital's database, and, thereby utilizes all available pharmacy and laboratory data. Moreover, unlike the interactive expert systems developed for the psychiatric clinic, OVERSEER does not require extensive data entry by the clinician. Consequently, the chief benefit of OVERSEER's monitoring approach is the unobtrusive manner in which it evaluates treatment and patient responses and provides information regarding patient management.

Reasoning and Data Representation in a Health and Lifestyle Support System.

PubMed

Hanke, Sten; Kreiner, Karl; Kropf, Johannes; Scase, Marc; Gossy, Christian

2017-01-01

Case-based reasoning and data interpretation is an artificial intelligence approach that capitalizes on past experience to solve current problems and this can be used as a method for practical intelligent systems. Case-based data reasoning is able to provide decision support for experts and clinicians in health systems as well as lifestyle systems. In this project we were focusing on developing a solution for healthy ageing considering daily activities, nutrition as well as cognitive activities. The data analysis of the reasoner followed state of the art guidelines from clinical practice. Guidelines provide a general framework to guide clinicians, and require consequent background knowledge to become operational, which is precisely the kind of information recorded in practice cases; cases complement guidelines very well and helps to interpret them. It is expected that the interest in case-based reasoning systems in the health.

A Deliberate Practice Approach to Teaching Phylogenetic Analysis

ERIC Educational Resources Information Center

Hobbs, F. Collin; Johnson, Daniel J.; Kearns, Katherine D.

2013-01-01

One goal of postsecondary education is to assist students in developing expert-level understanding. Previous attempts to encourage expert-level understanding of phylogenetic analysis in college science classrooms have largely focused on isolated, or "one-shot," in-class activities. Using a deliberate practice instructional approach, we…

Conceptualizing physical activity parenting practices using expert informed concept mapping analysis.

PubMed

Mâsse, Louise C; O'Connor, Teresia M; Tu, Andrew W; Hughes, Sheryl O; Beauchamp, Mark R; Baranowski, Tom

2017-06-14

Parents are widely recognized as playing a central role in the development of child behaviors such as physical activity. As there is little agreement as to the dimensions of physical activity-related parenting practices that should be measured or how they should be operationalized, this study engaged experts to develop an integrated conceptual framework for assessing parenting practices that influence multiple aspects of 5 to 12 year old children's participation in physical activity. The ultimate goal of this study is to inform the development of an item bank (repository of calibrated items) aimed at measuring physical activity parenting practices. Twenty four experts from 6 countries (Australia, Canada, England, Scotland, the Netherlands, & United States (US)) sorted 77 physical activity parenting practice concepts identified from our previously published synthesis of the literature (74 measures) and survey of Canadian and US parents. Concept Mapping software was used to conduct the multi-dimensional scaling (MDS) analysis and a cluster analysis of the MDS solution of the Expert's sorting which was qualitatively reviewed and commented on by the Experts. The conceptual framework includes 12 constructs which are presented using three main domains of parenting practices (neglect/control, autonomy support, and structure). The neglect/control domain includes two constructs: permissive and pressuring parenting practices. The autonomy supportive domain includes four constructs: encouragement, guided choice, involvement in child physical activities, and praises/rewards for their child's physical activity. Finally, the structure domain includes six constructs: co-participation, expectations, facilitation, modeling, monitoring, and restricting physical activity for safety or academic concerns. The concept mapping analysis provided a useful process to engage experts in re-conceptualizing physical activity parenting practices and identified key constructs to include in measures of physical activity parenting. While the constructs identified ought to be included in measures of physical activity parenting practices, it will be important to collect data among parents to further validate the content of these constructs. In conclusion, the method provided a roadmap for developing an item bank that captures key facets of physical activity parenting and ultimately serves to standardize how we operationalize measures of physical activity parenting.

An Intelligent Decision System for Intraoperative Somatosensory Evoked Potential Monitoring.

PubMed

Fan, Bi; Li, Han-Xiong; Hu, Yong

2016-02-01

Somatosensory evoked potential (SEP) is a useful, noninvasive technique widely used for spinal cord monitoring during surgery. One of the main indicators of a spinal cord injury is the drop in amplitude of the SEP signal in comparison to the nominal baseline that is assumed to be constant during the surgery. However, in practice, the real-time baseline is not constant and may vary during the operation due to nonsurgical factors, such as blood pressure, anaesthesia, etc. Thus, a false warning is often generated if the nominal baseline is used for SEP monitoring. In current practice, human experts must be used to prevent this false warning. However, these well-trained human experts are expensive and may not be reliable and consistent due to various reasons like fatigue and emotion. In this paper, an intelligent decision system is proposed to improve SEP monitoring. First, the least squares support vector regression and multi-support vector regression models are trained to construct the dynamic baseline from historical data. Then a control chart is applied to detect abnormalities during surgery. The effectiveness of the intelligent decision system is evaluated by comparing its performance against the nominal baseline model by using the real experimental datasets derived from clinical conditions.

Translating Guidelines Into Practice: Interpreting the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk.

PubMed

Waite, Laura H; Phan, Yvonne L; Spinler, Sarah A

2017-10-01

In 2016, the American College of Cardiology released a decision pathway, based on expert consensus, to guide use of non-statin agents in the management of atherosclerotic cardiovascular disease risk. The purpose of this article is to assist practitioners, health systems and managed care entities with interpreting this consensus statement in order to simplify implementation of the recommendations into patient care. Major themes from the consensus statement are briefly summarized and explained. Drug therapy recommendations are condensed into a single algorithm, while tables correlate each recommended regimen with the appropriate patient population from both a patient-level and systems-level perspective. Finally, a patient case with evidence-based decision support is explored. These tools allow practitioners to make appropriate patient-specific decisions about the use of non-statin pharmacotherapy and enable health systems and managed care entities to more readily identify guideline-appropriate use of these agents upon review of patient profiles or prescribing patterns. This article provides resources for healthcare providers that facilitate uptake of these recommendations into clinical practice.

European Nanotechnology Experts Visit NCL; Harmonize Best Practices for Nanomedicine Collaboration in Europe | Frederick National Laboratory for Cancer Research

Cancer.gov

European nanotechnology experts visited the Nanotechnology Characterization Laboratory (NCL) to observe best practices and methods and to share their own knowledge with NCL scientists as they prepared to launch an NCL-like operation in Europe. The Eu

Professional Perception and Expert Action: Scaffolding Embodied Practices in Professional Education

ERIC Educational Resources Information Center

Weddle, Amaya Becvar; Hollan, James D.

2010-01-01

From vocational education to neurosurgery residencies, apprenticeship training is characteristic of how people are acculturated to a profession. One of the primary goals of professional education is to develop skillful performance. Expert skill includes an integrated set of perceptual and motor abilities. During practical teaching, instructors…

Guidelines on the use of extracorporeal photopheresis

PubMed Central

Knobler, R; Berlin, G; Calzavara-Pinton, P; Greinix, H; Jaksch, P; Laroche, L; Ludvigsson, J; Quaglino, P; Reinisch, W; Scarisbrick, J; Schwarz, T; Wolf, P; Arenberger, P; Assaf, C; Bagot, M; Barr, M; Bohbot, A; Bruckner-Tuderman, L; Dreno, B; Enk, A; French, L; Gniadecki, R; Gollnick, H; Hertl, M; Jantschitsch, C; Jung, A; Just, U; Klemke, C-D; Lippert, U; Luger, T; Papadavid, E; Pehamberger, H; Ranki, A; Stadler, R; Sterry, W; Wolf, IH; Worm, M; Zic, J; Zouboulis, CC; Hillen, U

2014-01-01

Background After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. Materials and methods In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. Results and conclusion These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. PMID:24354653

[Lege artis].

PubMed

Pafko, P; Mach, J

2013-08-01

It is a common legal practice that a court will ask an expert to testify whether a doctor behaved "lege artis". However, this term is misleading and it was substituted by the law about health services for the term adequate level of expertise. Its definition is based on a proposal by the Czech Medical Chamber and it was confirmed by the Czech Constitutional Court. It is important to pay attention to the specific conditions and objective possibilities in the situation when evaluating the work of doctors. Sometimes, there may be issues concerning incompetent expert evidence, when the evidence does not account for the conditions and possibilities of the specific situations and it is, rather, an expression of subjective opinions of the author. The system of selection of experts (judge advocates) from the medical field is treated vaguely by the Czech law and, thus, assigning responsibility for making a faulty judgement has been insufficient so far. A new law concerning court experts (judge advocates) is currently in preparation.

How to turn a team of experts into an expert medical team: guidance from the aviation and military communities

PubMed Central

Burke, C; Salas, E; Wilson-Donnelly, K; Priest, H

2004-01-01

There is no question that interdisciplinary teams are becoming ubiquitous in healthcare. It is also true that experts do not necessarily combine to make an expert team. However when teams work well they can serve as adaptive systems that allow organisations to mitigate errors within complex domains, thereby increasing safety. The medical community has begun to recognise the importance of teams and as such has begun to implement team training interventions. Over the past 20 years the military and aviation communities have made a large investment in understanding teams and their requisite training requirements. There are many lessons that can be learned from these communities to accelerate the impact of team training within the medical community. Therefore, the purpose of the current paper is to begin to translate some of the lessons learned from the military and aviation communities into practical guidance that can be used by the medical community. PMID:15465963

GANViz: A Visual Analytics Approach to Understand the Adversarial Game.

PubMed

Wang, Junpeng; Gou, Liang; Yang, Hao; Shen, Han-Wei

2018-06-01

Generative models bear promising implications to learn data representations in an unsupervised fashion with deep learning. Generative Adversarial Nets (GAN) is one of the most popular frameworks in this arena. Despite the promising results from different types of GANs, in-depth understanding on the adversarial training process of the models remains a challenge to domain experts. The complexity and the potential long-time training process of the models make it hard to evaluate, interpret, and optimize them. In this work, guided by practical needs from domain experts, we design and develop a visual analytics system, GANViz, aiming to help experts understand the adversarial process of GANs in-depth. Specifically, GANViz evaluates the model performance of two subnetworks of GANs, provides evidence and interpretations of the models' performance, and empowers comparative analysis with the evidence. Through our case studies with two real-world datasets, we demonstrate that GANViz can provide useful insight into helping domain experts understand, interpret, evaluate, and potentially improve GAN models.

The roles of deliberate practice and innate ability in developing expertise: evidence and implications.

PubMed

Kulasegaram, Kulamakan M; Grierson, Lawrence E M; Norman, Geoffrey R

2013-10-01

Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance. This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search. Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability. No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance. © 2013 John Wiley & Sons Ltd.

On the acquisition and representation of procedural knowledge

NASA Technical Reports Server (NTRS)

Saito, T.; Ortiz, C.; Loftin, R. B.

1992-01-01

Historically knowledge acquisition has proven to be one of the greatest barriers to the development of intelligent systems. Current practice generally requires lengthy interactions between the expert whose knowledge is to be captured and the knowledge engineer whose responsibility is to acquire and represent knowledge in a useful form. Although much research has been devoted to the development of methodologies and computer software to aid in the capture and representation of some of some types of knowledge, little attention has been devoted to procedural knowledge. NASA personnel frequently perform tasks that are primarily procedural in nature. Previous work is reviewed in the field of knowledge acquisition and then focus on knowledge acquisition for procedural tasks with special attention devoted to the Navy's VISTA tool. The design and development is described of a system for the acquisition and representation of procedural knowledge-TARGET (Task Analysis and Rule Generation Tool). TARGET is intended as a tool that permits experts to visually describe procedural tasks and as a common medium for knowledge refinement by the expert and knowledge engineer. The system is designed to represent the acquired knowledge in the form of production rules. Systems such as TARGET have the potential to profoundly reduce the time, difficulties, and costs of developing knowledge-based systems for the performance of procedural tasks.

Profile of advanced nursing practice in Spain: A cross-sectional study.

PubMed

Sevilla Guerra, Sonia; Miranda Salmerón, Josep; Zabalegui, Adelaida

2018-03-01

In this study, we described the profile of advanced nursing practice in Spain. A cross-sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence-based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study. © 2017 John Wiley & Sons Australia, Ltd.

Perceived Uncertainty Sources in Wind Power Plant Design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Damiani, Rick R

This presentation for the Fourth Wind Energy Systems Engineering Workshop covers some of the uncertainties that still impact turbulent wind operation and how these affect design and structural reliability; identifies key sources and prioritization for R and D; and summarizes an analysis of current procedures, industry best practice, standards, and expert opinions.

Neural Networks for the Beginner.

ERIC Educational Resources Information Center

Snyder, Robin M.

Motivated by the brain, neural networks are a right-brained approach to artificial intelligence that is used to recognize patterns based on previous training. In practice, one would not program an expert system to recognize a pattern and one would not train a neural network to make decisions from rules; but one could combine the best features of…

A Systematic Appraisal of Peer Review Guidelines for Special Education Journals

ERIC Educational Resources Information Center

Maggin, Daniel M.; Chafouleas, Sandra M.; Berggren, Melissa; Sugai, George

2013-01-01

The evidence-based practice movement in special education has emphasized the use of the scientific process to assist with the identification of effective academic and behavioral strategies. An important but often overlooked aspect of this system is the peer review process in which manuscripts submitted for publication are reviewed by experts to…

Summary and Agreement Statement of the First International Conference on Concussion in Sport, Vienna 2001.

ERIC Educational Resources Information Center

Aubry, Mark; Cantu, Robert; Dvorak, Jiri; Graf-Baumann, Toni; Johnston, Karen; Kelly, James; Lovell, Mark; McCrory, Paul; Meeuwisse, Willem; Schamasch, Patrick

2002-01-01

An international group of concussion experts met in 2001 to discuss the most recent research and findings and to establish guidelines for clinical practice. They addressed such issues as epidemiology, basic and clinical science, grading systems, cognitive assessment, new research methods, protective equipment, management, prevention, and long-term…

Representing System Behaviors and Expert Behaviors for Intelligent Tutoring

DTIC Science & Technology

1987-02-09

Learned .................................. 44 . Future Directions ................................... 47 Sum m ary...and training environments to assist the instructor in meeting the students’ learning needs. The first application of the IMTS will be in training...identifies and resolves learning deficiencies and minimizes unproductive practice time. Another decision made early in the planning phase was to place

Spiritual Development in Adolescence: Toward Enriching Theories, Research, and Professional Practice

ERIC Educational Resources Information Center

Petersen, Anne C.

2008-01-01

The author notes that she finds the case for making spiritual development a priority surprisingly compelling--"surprisingly" because although she is an expert on adolescent development, she has not done research or previously written about spiritual development. She suggests that a systems analysis occur first, before engaging frontline youth…

Using Brief Experimental Analysis to Intensify Tier 3 Reading Interventions

ERIC Educational Resources Information Center

Coolong-Chaffin, Melissa; Wagner, Dana

2015-01-01

As implementation of multi-tiered systems of support becomes common practice across the nation, practitioners continue to need strategies for intensifying interventions and supports for the subset of students who fail to make adequate progress despite strong programs at Tiers 1 and 2. Experts recommend making several changes to the structure and…

Expert Systems: An Overview.

ERIC Educational Resources Information Center

Adiga, Sadashiv

1984-01-01

Discusses: (1) the architecture of expert systems; (2) features that distinguish expert systems from conventional programs; (3) conditions necessary to select a particular application for the development of successful expert systems; (4) issues to be resolved when building expert systems; and (5) limitations. Examples of selected expert systems…

Design and evaluation of a trilateral shared-control architecture for teleoperated training robots.

PubMed

Shamaei, Kamran; Kim, Lawrence H; Okamura, Allison M

2015-08-01

Multilateral teleoperated robots can be used to train humans to perform complex tasks that require collaborative interaction and expert supervision, such as laparoscopic surgical procedures. In this paper, we explain the design and performance evaluation of a shared-control architecture that can be used in trilateral teleoperated training robots. The architecture includes dominance and observation factors inspired by the determinants of motor learning in humans, including observational practice, focus of attention, feedback and augmented feedback, and self-controlled practice. Toward the validation of such an architecture, we (1) verify the stability of a trilateral system by applying Llewellyn's criterion on a two-port equivalent architecture, and (2) demonstrate that system transparency remains generally invariant across relevant observation factors and movement frequencies. In a preliminary experimental study, a dyad of two human users (one novice, one expert) collaborated on the control of a robot to follow a trajectory. The experiment showed that the framework can be used to modulate the efforts of the users and adjust the source and level of haptic feedback to the novice user.

National Institutes of Health Pathways to Prevention Workshop: Advancing Research to Prevent Youth Suicide.

PubMed

Little, Todd D; Roche, Kathleen M; Chow, Sy-Miin; Schenck, Anna P; Byam, Leslie-Ann

2016-12-06

The National Institutes of Health (NIH) Pathways to Prevention Workshop "Advancing Research to Prevent Youth Suicide" was cosponsored by the NIH Office of Disease Prevention, National Institute of Mental Health, National Institute on Drug Abuse, and National Center for Complementary and Integrative Health. A multidisciplinary working group developed the agenda, and an evidence-based practice center prepared an evidence report that addressed data systems relevant to suicide prevention efforts through a contract with the Agency for Healthcare Research and Quality. During the workshop, experts discussed the evidence and participants commented during open forums. After considering the data from the evidence report, expert presentations, and public comments, an independent panel prepared a draft report that was posted on the NIH Office of Disease Prevention Web site for 5 weeks for public comment. This abridged version of the final report provides a road map for optimizing youth suicide prevention efforts by highlighting strategies for guiding the next decade of research in this area. These strategies include recommendations for improving data systems, enhancing data collection and analysis methods, and strengthening the research and practice community.

Sustaining "meaningful use" of health information technology in low-resource practices.

PubMed

Green, Lee A; Potworowski, Georges; Day, Anya; May-Gentile, Rachelle; Vibbert, Danielle; Maki, Bruce; Kiesel, Leslie

2015-01-01

The implementation of electronic health records (EHRs) has been extensively studied, but their maintenance once implemented has not. The Regional Extension Center (REC) program provides implementation assistance to priority practices-those with limited financial, technical, and organizational resources-but the assistance is time limited. Our objective was to identify potential barriers to maintenance of meaningful use of EHRs in priority primary care practices using a qualitative observational study for federally qualified health centers (FQHCs) and priority practices in Michigan. We conducted cognitive task analysis (CTA) interviews and direct observations of health information technology implementation in FQHCs. In addition, we conducted semistructured interviews with implementation specialists serving priority practices to detect emergent themes relevant to maintenance. Maintaining EHR technology will require ongoing expert technical support indefinitely beyond implementation to address upgrades and security needs. Maintaining meaningful use for quality improvement will require ongoing support for leadership and change management. Priority practices not associated with larger systems lack access to the necessary technical expertise, financial resources, and leverage with vendors to continue alone. Rural priority practices are particularly challenged, because expertise is often not available locally. Priority practices, especially in rural areas, are at high risk for falling on the wrong side of a "digital divide" as payers and regulators enact increasing expectations for EHR use and information management. For those without affiliation to maintain the necessary expert staff, ongoing support will be needed for those practices to remain viable. © 2015 Annals of Family Medicine, Inc.

Novice to Expert Practice via Postprofessional Athletic Training Education: A Grounded Theory

PubMed Central

Neibert, Peter J

2009-01-01

Objective: To discover the theoretic constructs that confirm, disconfirm, or extend the principles and their applications appropriate for National Athletic Trainers' Association (NATA)–accredited postprofessional athletic training education programs. Design: Interviews at the 2003 NATA Annual Meeting & Clinical Symposia. Setting: Qualitative study using grounded theory procedures. Patients and Other Participants: Thirteen interviews were conducted with postprofessional graduates. Participants were purposefully selected based on theoretic sampling and availability. Data Collection and Analysis: The transcribed interviews were analyzed using open coding, axial coding, and selective coding procedures. Member checks, reflective journaling, and triangulation were used to ensure trustworthiness. Results: The participants' comments confirmed and extended the current principles of postprofessional athletic training education programs and offered additional suggestions for more effective practical applications. Conclusions: The emergence of this central category of novice to expert practice is a paramount finding. The tightly woven fabric of the 10 processes, when interlaced with one another, provides a strong tapestry supporting novice to expert practice via postprofessional athletic training education. The emergence of this theoretic position pushes postprofessional graduate athletic training education forward to the future for further investigation into the theoretic constructs of novice to expert practice. PMID:19593420

Responding to health care reform by addressing the institute of medicine report on the future of nursing.

PubMed

Ellerbe, Suellyn; Regen, Debra

2012-01-01

The current health care environment has heightened the importance of achieving positive patient outcomes and excellent customer satisfaction. To remain competitive, health care organizations must adapt quickly to changing regulatory requirements, quality improvement initiatives, and customer expectations. To ensure nursing practice at the Saint Clare's Health System in Northwest New Jersey is at the forefront of leading change, the nursing staff has embraced the Institute of Medicine report The Future of Nursing: Leading Change. The empowered nursing team has applied Benner's Novice to Expert model and McCauley's Careful Nursing Theory as the foundation for nursing practice. The ability to apply evidence-based nursing research and cultivate professional development at the bedside has resulted in retention of expert nurses at the bedside. Engaging the nursing team has resulted in increased patient satisfaction and improved clinical outcomes. Advanced practice nurses play an important role to mentor the nursing staff and promote an interdisciplinary, collaborative relationship between all health care disciplines and community support programs. Nurses are recognized for their accomplishments and encouraged to obtain specialty certification, advanced degrees, and earn state and national recognition through professional organizations. The professional nurses at the Saint Clare's Health System are prepared to work in whatever environment the new normal creates.

Expert study to select indicators of the occurrence of emerging mycotoxin hazards.

PubMed

Kandhai, M C; Booij, C J H; Van der Fels-Klerx, H J

2011-01-01

This article describes a Delphi-based expert judgment study aimed at the selection of indicators to identify the occurrence of emerging mycotoxin hazards related to Fusarium spp. in wheat supply chains. A panel of 29 experts from 12 European countries followed a holistic approach to evaluate the most important indicators for different chain stages (growth, transport and storage, and processing) and their relative importance. After three e-mailing rounds, the experts reached consensus on the most important indicators for each of the three stages: wheat growth, transport and storage, and processing. For wheat growth, these indicators include: relative humidity/rainfall, crop rotation, temperature, tillage practice, water activity of the kernels, and crop variety/cultivar. For the transport and storage stage, they include water activity in the kernels, relative humidity, ventilation, temperature, storage capacity, and logistics. For wheat processing, indicators include quality data, fraction of the cereal used, water activity in the kernels, quality management and traceability systems, and carryover of contamination. The indicators selected in this study can be used in an identification system for the occurrence of emerging mycotoxin hazards in wheat supply chains. Such a system can be used by risk managers within governmental (related) organizations and/or the food and feed industry in order to react proactively to the occurrence of these emerging mycotoxins. © 2010 Society for Risk Analysis.

Determination of Flaw Type and Location Using an Expert Module in Ultrasonic Nondestructive Testing for Weld Inspection

NASA Astrophysics Data System (ADS)

Shahriari, D.; Zolfaghari, A.; Masoumi, F.

2011-01-01

Nondestructive evaluation is explained as nondestructive testing, nondestructive inspection, and nondestructive examination. It is a desire to determine some characteristic of the object or to determine whether the object contains irregularities, discontinuities, or flaws. Ultrasound based inspection techniques are used extensively throughout industry for detection of flaws in engineering materials. The range and variety of imperfections encountered is large, and critical assessment of location, size, orientation and type is often difficult. In addition, increasing quality requirements of new standards and codes of practice relating to fitness for purpose are placing higher demands on operators. Applying of an expert knowledge-based analysis in ultrasonic examination is a powerful tool that can help assure safety, quality, and reliability; increase productivity; decrease liability; and save money. In this research, an expert module system is coupled with ultrasonic examination (A-Scan Procedure) to determine and evaluate type and location of flaws that embedded during welding parts. The processing module of this expert system is implemented based on EN standard to classify welding defects, acceptance condition and measuring of their location via echo static pattern and image processing. The designed module introduces new system that can automate evaluating of the results of A-scan method according to EN standard. It can simultaneously recognize the number and type of defects, and determine flaw position during each scan.

Intelligent tutoring using HyperCLIPS

NASA Technical Reports Server (NTRS)

Hill, Randall W., Jr.; Pickering, Brad

1990-01-01

HyperCard is a popular hypertext-like system used for building user interfaces to databases and other applications, and CLIPS is a highly portable government-owned expert system shell. We developed HyperCLIPS in order to fill a gap in the U.S. Army's computer-based instruction tool set; it was conceived as a development environment for building adaptive practical exercises for subject-matter problem-solving, though it is not limited to this approach to tutoring. Once HyperCLIPS was developed, we set out to implement a practical exercise prototype using HyperCLIPS in order to demonstrate the following concepts: learning can be facilitated by doing; student performance evaluation can be done in real-time; and the problems in a practical exercise can be adapted to the individual student's knowledge.

Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach.

PubMed

Scudder, Ashley; Herschell, Amy D

2015-08-01

In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.

Validity evidence for an OSCE to assess competency in systems-based practice and practice-based learning and improvement: a preliminary investigation.

PubMed

Varkey, Prathibha; Natt, Neena; Lesnick, Timothy; Downing, Steven; Yudkowsky, Rachel

2008-08-01

To determine the psychometric properties and validity of an OSCE to assess the competencies of Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) in graduate medical education. An eight-station OSCE was piloted at the end of a three-week Quality Improvement elective for nine preventive medicine and endocrinology fellows at Mayo Clinic. The stations assessed performance in quality measurement, root cause analysis, evidence-based medicine, insurance systems, team collaboration, prescription errors, Nolan's model, and negotiation. Fellows' performance in each of the stations was assessed by three faculty experts using checklists and a five-point global competency scale. A modified Angoff procedure was used to set standards. Evidence for the OSCE's validity, feasibility, and acceptability was gathered. Evidence for content and response process validity was judged as excellent by institutional content experts. Interrater reliability of scores ranged from 0.85 to 1 for most stations. Interstation correlation coefficients ranged from -0.62 to 0.99, reflecting case specificity. Implementation cost was approximately $255 per fellow. All faculty members agreed that the OSCE was realistic and capable of providing accurate assessments. The OSCE provides an opportunity to systematically sample the different subdomains of Quality Improvement. Furthermore, the OSCE provides an opportunity for the demonstration of skills rather than the testing of knowledge alone, thus making it a potentially powerful assessment tool for SBP and PBLI. The study OSCE was well suited to assess SBP and PBLI. The evidence gathered through this study lays the foundation for future validation work.

49 CFR 1503.645 - Expert or opinion witnesses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROCEDURES Rules of Practice in TSA Civil Penalty Actions § 1503.645 Expert or opinion witnesses. An employee of the agency may not be called as an expert or opinion witness, for any party other than TSA, in any... an expert or opinion witness for TSA in any proceeding governed by this subpart to which the...

New telemedicine techniques in dermatology - evaluation with reflectance confocal microscopy via cloud-based platform.

PubMed

Łudzik, Joanna; Witkowski, Alexander Michael; Roterman-Konieczna, Irena

Dermoscopically equivocal skin lesions may present a diagnostic challenge in daily clinical practice and are regularly sent for second expert opinion. We present a new approach to handling these cases in a consultation referral system that enables communication between the initial doctor at the image upload site and dermatology experts at a distance via cloud-based telemedicine. In our study we retrospectively evaluated 100 equivocal cases with complete digital dermoscopy-reflectance confocal microscopy image sets and compared suggested management of the initial doctor to a second expert confocal reader. We evaluated the effect of reader concordance on final management of these lesions resulting in a single reader overall sensitivity of 89% and specificity of 66% and double reader concordance method sensitivity of 98% and specificity of 54%. In conclusion, we found that application of double reader evaluation of these image sets with automatic referral of lesions for removal in the case of discordant diagnosis between two doctors improved the sensitivity of diagnosis in this subset of lesions and may increase the safety threshold of management choice reducing potential misdiagnosis in telemedicine settings. This paper concerns the application of telemedicine in practical medicine.

Clinical Strategy for Optimal Traditional Chinese Medicine (TCM) Herbal Dose Selection in Disease Therapeutics: Expert Consensus on Classic TCM Herbal Formula Dose Conversion.

PubMed

Zha, Lin-Hua; He, Li-Sha; Lian, Feng-Mei; Zhen, Zhong; Ji, Hang-Yu; Xu, Li-Peng; Tong, Xiao-Lin

2015-01-01

The clinical therapeutics of traditional Chinese medicine (TCM) constitutes a complicated process which involves theory, diagnosis, and formula prescription with specific herbal dosage. Zhang Zhong-Jing's classic work, Treatise on Febrile and Miscellaneous Diseases, has been influencing TCM practice for almost 2000 years. However, during this extended period of time in Chinese history, the Chinese weight measurement system experienced noticeable changes. This change in the weight measurement system inevitably, and perhaps even negatively, affected TCM herbal dosage determination and treatment outcome. Thus, in modern society, a full understanding of the accuracy of herbal dose selection has a critical importance in the TCM daily practice of delivering the best treatment to the patients suffering from different illnesses. In the 973 Project of the Chinese National Basic Research Program, expert consensus on classic TCM formula dose conversion has been reached based on extensive literature review and discussion on the dose-effect relationship of classic TCM formulas. One "liang" in classic TCM formulas is equivalent to 13.8 g. However, based on many TCM basic and clinical studies of variable herbal formula prescriptions and herbal drug preparations, the rule of one liang equals 13.8 g should be adjusted according to different disease conditions. Recommended by the committee on TCM formula dose-effect relationship of the China Association of Chinese Medicine and the World Federation of Chinese Medicine Societies, the following expert consensus has been reached: (i) One liang converts to 6-9 g for the severely and critically ill patients. (ii) One liang converts to 3-6 g for the patients suffering from chronic diseases. (iii) One liang converts to 1-3 g in preventive medicine. The above conversions should be used as a future TCM practice guideline. Using this recommended guideline should enhance the effectiveness of daily TCM practice.

Primary care providers' lived experiences of genetics in practice.

PubMed

Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

2018-04-26

To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

Expert systems in civil engineering

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kostem, C.N.; Maher, M.L.

1986-01-01

This book presents the papers given at a symposium on expert systems in civil engineering. Topics considered at the symposium included problem solving using expert system techniques, construction schedule analysis, decision making and risk analysis, seismic risk analysis systems, an expert system for inactive hazardous waste site characterization, an expert system for site selection, knowledge engineering, and knowledge-based expert systems in seismic analysis.

Shared Teaching Culture in Different Forms: A Comparison of Expert and Novice Teachers' Practices

ERIC Educational Resources Information Center

Arani, Mohammad Reza Sarkar

2017-01-01

This study aims to reveal the teaching script and structure of lesson practice of two seventh-grade Japanese mathematics teachers--a "novice" and "expert"--through comparative analysis of mathematics lessons. Specifically, it aims to clarify how the teachers' views of teaching as tacit knowledge determine lesson structure and…

Automatic ICD-10 multi-class classification of cause of death from plaintext autopsy reports through expert-driven feature selection.

PubMed

Mujtaba, Ghulam; Shuib, Liyana; Raj, Ram Gopal; Rajandram, Retnagowri; Shaikh, Khairunisa; Al-Garadi, Mohammed Ali

2017-01-01

Widespread implementation of electronic databases has improved the accessibility of plaintext clinical information for supplementary use. Numerous machine learning techniques, such as supervised machine learning approaches or ontology-based approaches, have been employed to obtain useful information from plaintext clinical data. This study proposes an automatic multi-class classification system to predict accident-related causes of death from plaintext autopsy reports through expert-driven feature selection with supervised automatic text classification decision models. Accident-related autopsy reports were obtained from one of the largest hospital in Kuala Lumpur. These reports belong to nine different accident-related causes of death. Master feature vector was prepared by extracting features from the collected autopsy reports by using unigram with lexical categorization. This master feature vector was used to detect cause of death [according to internal classification of disease version 10 (ICD-10) classification system] through five automated feature selection schemes, proposed expert-driven approach, five subset sizes of features, and five machine learning classifiers. Model performance was evaluated using precisionM, recallM, F-measureM, accuracy, and area under ROC curve. Four baselines were used to compare the results with the proposed system. Random forest and J48 decision models parameterized using expert-driven feature selection yielded the highest evaluation measure approaching (85% to 90%) for most metrics by using a feature subset size of 30. The proposed system also showed approximately 14% to 16% improvement in the overall accuracy compared with the existing techniques and four baselines. The proposed system is feasible and practical to use for automatic classification of ICD-10-related cause of death from autopsy reports. The proposed system assists pathologists to accurately and rapidly determine underlying cause of death based on autopsy findings. Furthermore, the proposed expert-driven feature selection approach and the findings are generally applicable to other kinds of plaintext clinical reports.

Automatic ICD-10 multi-class classification of cause of death from plaintext autopsy reports through expert-driven feature selection

PubMed Central

Mujtaba, Ghulam; Shuib, Liyana; Raj, Ram Gopal; Rajandram, Retnagowri; Shaikh, Khairunisa; Al-Garadi, Mohammed Ali

2017-01-01

Objectives Widespread implementation of electronic databases has improved the accessibility of plaintext clinical information for supplementary use. Numerous machine learning techniques, such as supervised machine learning approaches or ontology-based approaches, have been employed to obtain useful information from plaintext clinical data. This study proposes an automatic multi-class classification system to predict accident-related causes of death from plaintext autopsy reports through expert-driven feature selection with supervised automatic text classification decision models. Methods Accident-related autopsy reports were obtained from one of the largest hospital in Kuala Lumpur. These reports belong to nine different accident-related causes of death. Master feature vector was prepared by extracting features from the collected autopsy reports by using unigram with lexical categorization. This master feature vector was used to detect cause of death [according to internal classification of disease version 10 (ICD-10) classification system] through five automated feature selection schemes, proposed expert-driven approach, five subset sizes of features, and five machine learning classifiers. Model performance was evaluated using precisionM, recallM, F-measureM, accuracy, and area under ROC curve. Four baselines were used to compare the results with the proposed system. Results Random forest and J48 decision models parameterized using expert-driven feature selection yielded the highest evaluation measure approaching (85% to 90%) for most metrics by using a feature subset size of 30. The proposed system also showed approximately 14% to 16% improvement in the overall accuracy compared with the existing techniques and four baselines. Conclusion The proposed system is feasible and practical to use for automatic classification of ICD-10-related cause of death from autopsy reports. The proposed system assists pathologists to accurately and rapidly determine underlying cause of death based on autopsy findings. Furthermore, the proposed expert-driven feature selection approach and the findings are generally applicable to other kinds of plaintext clinical reports. PMID:28166263

A model for technology assessment as applied to closed loop infusion systems. Technology Assessment Task Force of the Society of Critical Care Medicine.

PubMed

Jastremski, M; Jastremski, C; Shepherd, M; Friedman, V; Porembka, D; Smith, R; Gonzales, E; Swedlow, D; Belzberg, H; Crass, R

1995-10-01

To test a model for the assessment of critical care technology on closed loop infusion control, a technology that is in its early stages of development and testing on human subjects. A computer-assisted search of the English language literature and reviews of the gathered data by experts in the field of closed loop infusion control systems. Studies relating to closed loop infusion control that addressed one or more of the questions contained in our technology assessment template were analyzed. Study design was not a factor in article selection. However, the lack of well-designed clinical outcome studies was an important factor in determining our conclusions. A focus person summarized the data from the selected studies that related to each of the assessment questions. The preliminary data summary developed by the focus person was further analyzed and refined by the task force. Experts in closed loop systems were then added to the group to review the summary provided by the task force. These experts' comments were considered by the task force and this final consensus report was developed. Closed loop system control is a technological concept that may be applicable to several aspects of critical care practice. This is a technology in the early stages of evolution and much more research and data are needed before its introduction into usual clinical practice. Furthermore, each specific application and each device for each application (e.g., nitroprusside infusion, ventilator adjustment), although based on the same technological concept, are sufficiently different in terms of hardware and computer algorithms to require independent validation studies. Closed loop infusion systems may have a role in critical care practice. However, for most applications, further development is required to move this technology from the innovation phase to the point where it can be evaluated so that its role in critical car practice can be defined. Each application of closed loop infusion systems must be independently validated by appropriately designed research studies. Users should be provided with the clinical parameters driving each closed loop system so that they can ensure that it agrees with their opinion of acceptable medical practice. Clinical researchers and leaders in industry should collaborate to perform the scientifically valid, outcome-based research that is necessary to evaluate the effect of this new technology. The original model we developed for technology assessment required the addition of several more questions to produce a complete analysis of an emerging technology. An emerging technology should be systematically assessed (using a model such as the model developed by the Society of Critical Care Medicine), before its introduction into clinical practice in order to provide a focus for human outcome validation trials and to minimize the possibility of widespread use of an unproven technology.

Development of a practical approach to expert elicitation for randomised controlled trials with missing health outcomes: Application to the IMPROVE trial.

PubMed

Mason, Alexina J; Gomes, Manuel; Grieve, Richard; Ulug, Pinar; Powell, Janet T; Carpenter, James

2017-08-01

The analyses of randomised controlled trials with missing data typically assume that, after conditioning on the observed data, the probability of missing data does not depend on the patient's outcome, and so the data are 'missing at random' . This assumption is usually implausible, for example, because patients in relatively poor health may be more likely to drop out. Methodological guidelines recommend that trials require sensitivity analysis, which is best informed by elicited expert opinion, to assess whether conclusions are robust to alternative assumptions about the missing data. A major barrier to implementing these methods in practice is the lack of relevant practical tools for eliciting expert opinion. We develop a new practical tool for eliciting expert opinion and demonstrate its use for randomised controlled trials with missing data. We develop and illustrate our approach for eliciting expert opinion with the IMPROVE trial (ISRCTN 48334791), an ongoing multi-centre randomised controlled trial which compares an emergency endovascular strategy versus open repair for patients with ruptured abdominal aortic aneurysm. In the IMPROVE trial at 3 months post-randomisation, 21% of surviving patients did not complete health-related quality of life questionnaires (assessed by EQ-5D-3L). We address this problem by developing a web-based tool that provides a practical approach for eliciting expert opinion about quality of life differences between patients with missing versus complete data. We show how this expert opinion can define informative priors within a fully Bayesian framework to perform sensitivity analyses that allow the missing data to depend upon unobserved patient characteristics. A total of 26 experts, of 46 asked to participate, completed the elicitation exercise. The elicited quality of life scores were lower on average for the patients with missing versus complete data, but there was considerable uncertainty in these elicited values. The missing at random analysis found that patients randomised to the emergency endovascular strategy versus open repair had higher average (95% credible interval) quality of life scores of 0.062 (-0.005 to 0.130). Our sensitivity analysis that used the elicited expert information as pooled priors found that the gain in average quality of life for the emergency endovascular strategy versus open repair was 0.076 (-0.054 to 0.198). We provide and exemplify a practical tool for eliciting the expert opinion required by recommended approaches to the sensitivity analyses of randomised controlled trials. We show how this approach allows the trial analysis to fully recognise the uncertainty that arises from making alternative, plausible assumptions about the reasons for missing data. This tool can be widely used in the design, analysis and interpretation of future trials, and to facilitate this, materials are available for download.

Development of casthouse expert system for tapping

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takihira, K.; Ino, K.; Yamana, S.

1993-01-01

Although the standardization of casting operations is necessary to secure stable blast furnace operation, intuitive practices (which are by definition non-quantifiable) and experience are prevalent. Because BF operation is a field which is difficult to standardize and reduce to documentary form, the present work had as its goal the standardization of judgments and systematization of information related to taphole opening and closing. The project was carried out in the highly computerized environment at Mizushima No. 3 BF, where the authors introduced an expert system guidance function in February, 1992. Standardization of operations through the use of this guidance system andmore » the completion of guidance function development resulted in better consistency in taphole depths and optimization of the size of the taphole (taphole volume), which have in turn led to improvement in the pig/slag balance and a reduction in the time required for taphole opening.« less

WHO Expert Committee on specifications for pharmaceutical preparations.

PubMed

2010-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use: good practices for pharmaceutical quality control laboratories; supplementary guidelines for active pharmaceutical ingredients; good manufacturing practices for pharmaceutical products containing hazardous substances; good manufacturing practices for sterile pharmaceutical products; good distribution practices for pharmaceutical products; guidelines on the requalification of prequalified dossiers: and guidelines for the preparation of a contract research organization master file.

Sustaining “Meaningful Use” of Health Information Technology in Low-Resource Practices

PubMed Central

Green, Lee A.; Potworowski, Georges; Day, Anya; May-Gentile, Rachelle; Vibbert, Danielle; Maki, Bruce; Kiesel, Leslie

2015-01-01

PURPOSE The implementation of electronic health records (EHRs) has been extensively studied, but their maintenance once implemented has not. The Regional Extension Center (REC) program provides implementation assistance to priority practices—those with limited financial, technical, and organizational resources—but the assistance is time limited. Our objective was to identify potential barriers to maintenance of meaningful use of EHRs in priority primary care practices using a qualitative observational study for federally qualified health centers (FQHCs) and priority practices in Michigan. METHODS We conducted cognitive task analysis (CTA) interviews and direct observations of health information technology implementation in FQHCs. In addition, we conducted semistructured interviews with implementation specialists serving priority practices to detect emergent themes relevant to maintenance. RESULTS Maintaining EHR technology will require ongoing expert technical support indefinitely beyond implementation to address upgrades and security needs. Maintaining meaningful use for quality improvement will require ongoing support for leadership and change management. Priority practices not associated with larger systems lack access to the necessary technical expertise, financial resources, and leverage with vendors to continue alone. Rural priority practices are particularly challenged, because expertise is often not available locally. CONCLUSIONS Priority practices, especially in rural areas, are at high risk for falling on the wrong side of a “digital divide” as payers and regulators enact increasing expectations for EHR use and information management. For those without affiliation to maintain the necessary expert staff, ongoing support will be needed for those practices to remain viable. PMID:25583887

Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer): Methods and results.

PubMed

Reese, Christina; Weis, Joachim; Schmucker, Dieter; Mittag, Oskar

2017-10-01

The goal of this project was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer). First of all, we conducted a literature search and survey of all oncological rehabilitation centers in Germany (N = 145) to obtain a thorough perspective of the recent evidence, guidelines, the structural framework, and practice of psychological services in oncological rehabilitation. Next, an expert workshop was held with national experts from scientific departments, clinicians from rehabilitation centers, and patients. In this workshop, we drafted and agreed upon an initial version of the practice guidelines. Afterwards, the practice guidelines were sent to all head physicians and senior psychologists at oncological rehabilitation centers in Germany for approval (N = 280 questionnaires). In addition, key recommendations were discussed with a group of rehabilitation patients. Finally, the practice guidelines were revised by the expert panel and made available online to the public. The practice guidelines have been widely accepted by both the expert panel and the surveyed clinicians and patients. They include recommendations for psycho-oncological interventions that should be offered to all rehabilitation patients with breast, prostate, or colorectal cancer. They also comprise recommendations for specific problem areas concerning psychological functions, body functions, and environmental and personal factors. The practice guidelines provide detailed recommendations for high-quality psychosocial care in an oncological rehabilitation context. It is their aim to guide the multidisciplinary team, especially psychologists and physicians, in their daily practice. Copyright © 2016 John Wiley & Sons, Ltd.

A practical guideline for examining a uterine niche using ultrasonography in non-pregnant women: a modified Delphi method amongst European experts.

PubMed

Jordans, I P M; de Leeuw, R; Stegwee, S I; Amso, N N; Barri-Soldevila, P N; van den Bosch, T; Bourne, T; Brolmann, H A M; Donnez, O; Dueholm, M; Hehenkamp, W J K; Jastrow, N; Jurkovic, D; Mashiach, R; Naji, O; Streuli, I; Timmerman, D; Vd Voet, L F; Huirne, J A F

2018-03-14

To generate a uniform, internationally recognized guideline for detailed uterine niche evaluation by ultrasonography in non-pregnant women using a modified Delphi method amongst international experts. Fifteen international gynecological experts were recruited by their membership of the European niche taskforce group. All experts were physicians with extensive experience in niche evaluation in clinical practice and/or authors of niche studies. Relevant items for niche measurement were determined based on the results of a literature search and recommendations of a focus group. Two online questionnaires were sent to the expert panel and one group meeting was organized. Consensus was predefined as a consensus rate of at least 70%. In total 15 experts participated in this study. Consensus was reached for a total of 42 items on niche evaluation, including definitions, relevance, method of measurement and tips for visualization of the niche. All experts agreed on the proposed guideline for niche evaluation in non-pregnant women as presented in this paper. Consensus between niche experts was achieved on all items regarding ultrasonographic niche measurement. This article is protected by copyright. All rights reserved.

mDurance: A Novel Mobile Health System to Support Trunk Endurance Assessment

PubMed Central

Banos, Oresti; Moral-Munoz, Jose Antonio; Diaz-Reyes, Ignacio; Arroyo-Morales, Manuel; Damas, Miguel; Herrera-Viedma, Enrique; Hong, Choong Seon; Lee, Sungyong; Pomares, Hector; Rojas, Ignacio; Villalonga, Claudia

2015-01-01

Low back pain is the most prevalent musculoskeletal condition. This disorder constitutes one of the most common causes of disability worldwide, and as a result, it has a severe socioeconomic impact. Endurance tests are normally considered in low back pain rehabilitation practice to assess the muscle status. However, traditional procedures to evaluate these tests suffer from practical limitations, which potentially lead to inaccurate diagnoses. The use of digital technologies is considered here to facilitate the task of the expert and to increase the reliability and interpretability of the endurance tests. This work presents mDurance, a novel mobile health system aimed at supporting specialists in the functional assessment of trunk endurance by using wearable and mobile devices. The system employs a wearable inertial sensor to track the patient trunk posture, while portable electromyography sensors are used to seamlessly measure the electrical activity produced by the trunk muscles. The information registered by the sensors is processed and managed by a mobile application that facilitates the expert's normal routine, while reducing the impact of human errors and expediting the analysis of the test results. In order to show the potential of the mDurance system, a case study has been conducted. The results of this study prove the reliability of mDurance and further demonstrate that practitioners are certainly interested in the regular use of a system of this nature. PMID:26057034

NESSUS/EXPERT - An expert system for probabilistic structural analysis methods

NASA Technical Reports Server (NTRS)

Millwater, H.; Palmer, K.; Fink, P.

1988-01-01

An expert system (NESSUS/EXPERT) is presented which provides assistance in using probabilistic structural analysis methods. NESSUS/EXPERT is an interactive menu-driven expert system that provides information to assist in the use of the probabilistic finite element code NESSUS/FEM and the fast probability integrator. NESSUS/EXPERT was developed with a combination of FORTRAN and CLIPS, a C language expert system tool, to exploit the strengths of each language.

Expert elicitation of population-level effects of disturbance

USGS Publications Warehouse

Fleishman, Erica; Burgman, Mark; Runge, Michael C.; Schick, Robert S; Krauss, Scott; Popper, Arthur N.; Hawkins, Anthony

2016-01-01

Expert elicitation is a rigorous method for synthesizing expert knowledge to inform decision making and is reliable and practical when field data are limited. We evaluated the feasibility of applying expert elicitation to estimate population-level effects of disturbance on marine mammals. Diverse experts estimated parameters related to mortality and sublethal injury of North Atlantic right whales (Eubalaena glacialis). We are now eliciting expert knowledge on the movement of right whales among geographic regions to parameterize a spatial model of health. Expert elicitation complements methods such as simulation models or extrapolations from other species, sometimes with greater accuracy and less uncertainty.

The value of participatory development to support antimicrobial stewardship with a clinical decision support system.

PubMed

Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette

2017-04-01

Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians. The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Teaching biomedical design through a university-industry partnership.

PubMed

Khuon, Lunal; Zum, Karl R; Zurn, Jane B; Herrera, Gerald M

2016-08-01

This paper describes a course that, as a result of a university-industry partnership, emphasizes bringing industry experts into the classroom to teach biomedical design. Full-time faculty and industry engineers and entrepreneurs teach the senior technical elective course, Biomedical System Design. This hands-on senior course in biomedical system design places varied but connected emphasis on understanding the biological signal source, electronics design, safety, patient use, medical device qualifications, and good manufacturing practices.

Science and Technology Community in Crisis

DTIC Science & Technology

2002-05-01

centralized, highly bureaucratic, support system that considers itself an end, a point noted in the management literature by Peter Drucker :48 “What...Review Quarterly, Spring 2000. 48 Drucker , Peter F., Management : Tasks, Responsibilities, Practices, Apr 1993. 43 regionalization of personnel...technical areas as information technology, biotechnology, nanotechnology, etc. Peter Drucker , the well-known management expert once commented: “In

Substance Abuse Treatment For Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series 44

ERIC Educational Resources Information Center

Bartlett, Catalina; Dinsmore, Janet; Gilbert, J. Max; Kornblum, Annette; Latham, Joyce; Oliff, Helen; Paisner, Susan; Sutton, David

2005-01-01

This Treatment Improvement Protocol (TIP) provides guidelines for counselors and criminal justice personnel who treat offenders with substance use disorders. TIPs are best-practice guidelines that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts in the…

Teacherpreneurs: Cultivating and Scaling up a Bold Brand of Teacher Leadership

ERIC Educational Resources Information Center

Berry, Barnett

2015-01-01

The prospects for a high-quality public education system for all students hinge on expanded roles for teachers. In particular, districts and states must create hybrid positions for teacherpreneurs: classroom experts who teach students regularly but also have time, space, and reward to spread their ideas and practices to colleagues as well as…

Active Surveillance for Low and Intermediate Risk Prostate Cancer: Opinions of North American Genitourinary Oncology Expert Radiation Oncologists.

PubMed

McClelland, Shearwood; Sandler, Kiri A; Degnin, Catherine; Chen, Yiyi; Mitin, Timur

2018-04-01

The ProtecT trial has provided level 1 evidence supporting active surveillance for prostate cancer patients with low-risk and intermediate-risk disease. The effect of these findings on the opinions of North American genitourinary (GU) experts regarding the role of active surveillance for these patients has not been previously examined. A survey was distributed to 88 practicing North American GU physicians serving on decision-making committees of cooperative group research organizations. Questions pertained to appropriateness of active surveillance in patients with low-risk and intermediate-risk (Gleason 3+4) disease. Opinions regarding active surveillance were correlated with practice patterns using Fisher exact test. Forty-two radiation oncologists completed the survey. Forty percent had been in practice for more than 20 years; 90% practice at an academic center. Forty-five percent see ≥ 20 patients per month in consultation. More than 95% (40 of 42) recommended active surveillance for Gleason 6 disease, whereas only 17% recommended active surveillance for Gleason 3+4 disease. There were no demographic differences between supporters or opponents regarding active surveillance with regard to monthly patient volume, practice type, likelihood of self-identifying as an expert brachytherapist, belief in advanced imaging techniques, or preferred default external beam radiation therapy dose/fractionation for either low-risk or intermediate-risk disease. However, there was a trend toward greater support of active surveillance for Gleason 3+4 disease among experts having practiced < 10 years versus ≥ 10 years (P = .085). Active surveillance is almost universally supported by North American GU expert radiation oncologists for low-risk prostate cancer. However, there is very weak support for this strategy in Gleason 3+4 disease despite the ProtecT trial providing level 1 evidentiary support in both risk groups. There were no significant differences between experts supporting versus opposing active surveillance for either low-risk or intermediate-risk disease. These preferences might affect the design of future clinical studies, influencing the adoption of active surveillance in North American clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

A framework to assess landscape structural capacity to provide regulating ecosystem services in West Africa.

PubMed

Inkoom, Justice Nana; Frank, Susanne; Greve, Klaus; Fürst, Christine

2018-03-01

The Sudanian savanna landscapes of West Africa are amongst the world's most vulnerable areas to climate change impacts. Inappropriate land use and agriculture management practices continuously impede the capacity of agricultural landscapes to provide ecosystem services (ES). Given the absence of practical assessment techniques to evaluate the landscape's capacity to provide regulating ES in this region, the goal of this paper is to propose an integrative assessment framework which combines remote sensing, geographic information systems, expert weighting and landscape metrics-based assessment. We utilized Analytical Hierarchical Process and Likert scale for the expert weighting of landscape capacity. In total, 56 experts from several land use and landscape management related departments participated in the assessment. Further, we adapted the hemeroby concept to define areas of naturalness while landscape metrics including Patch Density, Shannon's Diversity, and Shape Index were utilized for structural assessment. Lastly, we tested the reliability of expert weighting using certainty measurement rated by experts themselves. Our study focused on four regulating ES including flood control, pest and disease control, climate control, and wind erosion control. Our assessment framework was tested on four selected sites in the Vea catchment area of Ghana. The outcome of our study revealed that highly heterogeneous landscapes have a higher capacity to provide pest and disease control, while less heterogeneous landscapes have a higher potential to provide climate control. Further, we could show that the potential capacities to provide ecosystem services are underestimated by 15% if landscape structural aspects assessed through landscape metrics are not considered. We conclude that the combination of adapted land use and an optimized land use pattern could contribute considerably to lower climate change impacts in West African agricultural landscapes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Testing a Web-Based, Trained-Peer Model to Build Capacity for Evidence-Based Practices in Community Mental Health Systems.

PubMed

German, Ramaris E; Adler, Abby; Frankel, Sarah A; Stirman, Shannon Wiltsey; Pinedo, Paola; Evans, Arthur C; Beck, Aaron T; Creed, Torrey A

2018-03-01

Use of expert-led workshops plus consultation has been established as an effective strategy for training community mental health (CMH) clinicians in evidence-based practices (EBPs). Because of high rates of staff turnover, this strategy inadequately addresses the need to maintain capacity to deliver EBPs. This study examined knowledge, competency, and retention outcomes of a two-phase model developed to build capacity for an EBP in CMH programs. In the first phase, an initial training cohort in each CMH program participated in in-person workshops followed by expert-led consultation (in-person, expert-led [IPEL] phase) (N=214 clinicians). After this cohort completed training, new staff members participated in Web-based training (in place of in-person workshops), followed by peer-led consultation with the initial cohort (Web-based, trained-peer [WBTP] phase) (N=148). Tests of noninferiority assessed whether WBTP was not inferior to IPEL at increasing clinician cognitive-behavioral therapy (CBT) competency, as measured by the Cognitive Therapy Rating Scale. WBTP was not inferior to IPEL at developing clinician competency. Hierarchical linear models showed no significant differences in CBT knowledge acquisition between the two phases. Survival analyses indicated that WBTP trainees were less likely than IPEL trainees to complete training. In terms of time required from experts, WBTP required 8% of the resources of IPEL. After an initial investment to build in-house CBT expertise, CMH programs were able to use a WBTP model to broaden their own capacity for high-fidelity CBT. IPEL followed by WBTP offers an effective alternative to build EBP capacity in CMH programs, rather than reliance on external experts.

Expert panel on practice patterns in the management of cow's milk protein allergy and associated economic burden of disease on health service in Turkey.

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

To evaluate practice patterns in the management of cow's milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey. This study was based on experts' views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment. According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89-92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively. Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

PubMed

Bretschneider, Wiebke; Elger, Bernice Simone

2014-09-01

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control.

PubMed

Boonyasai, Romsai T; Rakotz, Michael K; Lubomski, Lisa H; Daniel, Donna M; Marsteller, Jill A; Taylor, Kathryn S; Cooper, Lisa A; Hasan, Omar; Wynia, Matthew K

2017-07-01

Hypertension is the leading cause of cardiovascular disease in the United States and worldwide. It also provides a useful model for team-based chronic disease management. This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence-based care to patients with hypertension. Consisting of three domains-Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities-the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two states. In contrast to many guidelines, the M.A.P. checklists specifically target practice teams, instead of individual clinicians, and are designed to be brief, cognitively easy to consume and recall, and accessible to healthcare workers from a range of professional backgrounds. ©2017 Wiley Periodicals, Inc.

Are reporting radiographers fulfilling the role of advanced practitioner?

PubMed

Milner, R C; Snaith, B

2017-02-01

Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Mapping agricultural landscapes and characterizing adaptive capacity in Central America

NASA Astrophysics Data System (ADS)

Holland, M. B.; Imbach, P. A.; Bouroncle, C.; Donatti, C.; Leguia, E.; Martinez, M.; Medellin, C.; Saborio-Rodriguez, M.; Shamer, S.; Zamora, J.

2013-12-01

One of the key challenges in developing adaptation strategies for smallholder farmers in developing countries is that of a data-poor environment, where spatially-explicit information about where the most vulnerable smallholder communities are located is lacking. Developing countries tend to lack consistent and reliable maps on agricultural land use, and have limited information available on smallholder adaptive capacity. We developed a novel participatory and expert mapping process to overcome these barriers and develop detailed national-scale maps that allow for a characterization of unique agricultural landscapes based on profiles of adaptive capacity for smallholder agriculture in each area. This research focuses specifically on the Central American nations of Costa Rica, Guatemala, and Honduras, where our focus is on coffee and basic grains as the two main cropping systems. Here we present the methodology and results of a series of in-depth interviews and participatory mapping sessions with experts working within the broader agricultural sector in each country. We held individual interviews and mapping sessions with approximately thirty experts from each country, and used a detailed survey instrument for each mapping session to both spatially identify distinct agricultural landscapes, and to further characterize each area based on specific farm practices and social context. The survey also included a series of questions to help us assess the relative adaptive capacity of smallholder agriculture within each landscape. After all expert mapping sessions were completed in each country we convened an expert group to assist in both validating and refining the set of landscapes already defined. We developed a characterization of adaptive capacity by aggregating indicators into main assets-based criteria (e.g. land tenure, access to credit, access to technical assistance, sustainable farm practices) derived from further expert weighting of indicators through an online platform. Our final steps in this process have been to compare the series of expert-derived agricultural landscapes with a set of probability maps for smallholder farming developed from available country-level secondary datasets in order to fill area gaps. We see this analysis and participatory process as closely related to previous work by Eakin et al. (2011) in the region. It provides an example of how expert input and participatory mapping can help meet the pressing need for a deeper contextual understanding of the vulnerability of smallholder farmers to climate change in a data-poor environment. The methods and results of our research also offer an applied example how to approach analysis of adaptive capacity and vulnerability within agricultural systems, and we have purposefully focused on a set of methods that can easily transfer to other countries within regions such as the Tropics. Reference: Eakin, H., L.A. Bojórquez-Tapia, R. Monterde Diaz, E. Castellanos, J. Haggar. 2011. Adaptive Capacity and Social-Environmental Change: Theoretical and Operational Modeling of Smallholder Coffee Systems Response in Mesoamerican Pacific Rim. Environmental Management 47:352-367.

Is there a need for biomedical CBIR systems in clinical practice? Outcomes from a usability study

NASA Astrophysics Data System (ADS)

Antani, Sameer; Xue, Zhiyun; Long, L. Rodney; Bennett, Deborah; Ward, Sarah; Thoma, George R.

2011-03-01

Articles in the literature routinely describe advances in Content Based Image Retrieval (CBIR) and its potential for improving clinical practice, biomedical research and education. Several systems have been developed to address particular needs, however, surprisingly few are found to be in routine practical use. Our collaboration with the National Cancer Institute (NCI) has identified a need to develop tools to annotate and search a collection of over 100,000 cervigrams and related, anonymized patient data. One such tool developed for a projected need for retrieving similar patient images is the prototype CBIR system, called CervigramFinder, which retrieves images based on the visual similarity of particular regions on the cervix. In this article we report the outcomes from a usability study conducted at a primary meeting of practicing experts. We used the study to not only evaluate the system for software errors and ease of use, but also to explore its "user readiness", and to identify obstacles that hamper practical use of such systems, in general. Overall, the participants in the study found the technology interesting and bearing great potential; however, several challenges need to be addressed before the technology can be adopted.

MEADERS: Medication Errors and Adverse Drug Event Reporting system.

PubMed

Zafar, Atif

2007-10-11

The Agency for Healthcare Research and Quality (AHRQ) recently funded the PBRN Resource Center to develop a system for reporting ambulatory medication errors. Our goal was to develop a usable system that practices could use internally to track errors. We initially performed a comprehensive literature review of what is currently available. Then, using a combination of expert panel meetings and iterative development we designed an instrument for ambulatory medication error reporting and createad a reporting system based both in MS Access 2003 and on the web using MS ASP.NET 2.0 technologies.

Design Development Test and Evaluation (DDT and E) Considerations for Safe and Reliable Human Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Miller, James; Leggett, Jay; Kramer-White, Julie

2008-01-01

A team directed by the NASA Engineering and Safety Center (NESC) collected methodologies for how best to develop safe and reliable human rated systems and how to identify the drivers that provide the basis for assessing safety and reliability. The team also identified techniques, methodologies, and best practices to assure that NASA can develop safe and reliable human rated systems. The results are drawn from a wide variety of resources, from experts involved with the space program since its inception to the best-practices espoused in contemporary engineering doctrine. This report focuses on safety and reliability considerations and does not duplicate or update any existing references. Neither does it intend to replace existing standards and policy.

A demonstration of expert systems applications in transportation engineering : volume I, transportation engineers and expert systems.

DOT National Transportation Integrated Search

1987-01-01

Expert systems, a branch of artificial-intelligence studies, is introduced with a view to its relevance in transportation engineering. Knowledge engineering, the process of building expert systems or transferring knowledge from human experts to compu...

Interfacing An Intelligent Decision-Maker To A Real-Time Control System

NASA Astrophysics Data System (ADS)

Evers, D. C.; Smith, D. M.; Staros, C. J.

1984-06-01

This paper discusses some of the practical aspects of implementing expert systems in a real-time environment. There is a conflict between the needs of a process control system and the computational load imposed by intelligent decision-making software. The computation required to manage a real-time control problem is primarily concerned with routine calculations which must be executed in real time. On most current hardware, non-trivial AI software should not be forced to operate under real-time constraints. In order for the system to work efficiently, the two processes must be separated by a well-defined interface. Although the precise nature of the task separation will vary with the application, the definition of the interface will need to follow certain fundamental principles in order to provide functional separation. This interface was successfully implemented in the expert scheduling software currently running the automated chemical processing facility at Lockheed-Georgia. Potential applications of this concept in the areas of airborne avionics and robotics will be discussed.

The need for tort reform as part of health care reform.

PubMed

Thornton, Tiffany; Saha, Subrata

2008-01-01

There is no doubt about the need for tort reform. The current state of the legal system imposes great costs on the U.S. health care system and society in general-an astounding $865 billion each year. Physicians are forced to practice defensive medicine to protect themselves from litigation. Caps on non-economic damages have helped reduce malpractice insurance rates and encouraged young physicians to pursue specialties such as obstetrics. Collective insurance pools and national insurance programs for physicians and hospitals are some options that other countries employ to reduce malpractice rates. Regulation of expert testimony by medical societies would curb false or biased testimony. Other recommendations to improve the tort system include establishing expert health courts similar to those that currently exist for tax and patent law, using mediation, creating patient compensation funds, making acknowledgment of errors inadmissible in court, providing certificates of merit or pretrial screening panels to confirm the validity of lawsuits, and developing treatment contracts. Clearly some action must be taken to amend our current wasteful tort system.

[Identification of the scope of practice for dental nurses with Delphi method].

PubMed

Li, Yu-Hong; Lu, Yue-Cen; Huang, Yao; Ruan, Hong; Wu, Zheng-Yi

2016-10-01

To identify the practice scope of dental nurses under the new situations. The draft of scope of practice for dental nurses was based on theoretical analysis, literature review and consultation of advisory panel, and the final scope of practice for dental nurses was established by using the Delphi method. Statistical analysis was implemented using coefficient of variation, Kendall W with SPSS 17.0 software package. Thirty experts were consulted twice by using the Delphi method. The effective rates of two rounds of questionnaire were 100% and 73.3%, respectively. The authority coefficient was 0.837, and the P value of expert coordination coefficients W was less than 0.05. There were totally 116 suggestions from the experts, and 96 were accepted. The scope of practice for dental nurses was finally established, including 4 primary indexes and 25 secondary indexes. The scope of practice for dental nurses under the new situations is established in China through scientific methods. It is favorable for position management of dental nurses and may promote the development of nurse specialists in dental clinic.

Challenges faced in implementation of a telehealth enabled chronic wound care system.

PubMed

Barrett, M; Larson, A; Carville, K; Ellis, I

2009-01-01

In the rural Midwest region of Western Australia (WA), wound care is a major burden on the healthcare system. Optimal wound care was found to be impeded by issues that included the involvement of multiple healthcare providers, incomplete and inconsistent documentation, and limited access to expert review. A telehealth solution was trailed in 2007. To describe the systemic barriers encountered in implementing a telehealth program in rural WA and to provide recommendations for future telehealth initiatives. This study trialled the use of a shared electronic wound imaging and reporting system in combination with an expert remote wound consultation service for the management of patients with chronic wounds in the Midwest of WA. The trial sites included rural hospital out-patient clinics, a private domiciliary nursing service, residential aged care facilities, general practices and a podiatry clinic. The implementation conformed to accepted best practice in introducing telehealth initiatives. During the trial 12 sites had the relevant software installed and were able to access a central server. Although a total of 41 patients with chronic wounds were enrolled, four sites did not enroll any patients and only two sites successfully incorporated the system into regular practice. Major obstacles were workforce issues and significant delays in installing the software at some sites. Only 47% of the healthcare providers trained to use the software at the beginning of the trial were still employed when the trial ended. Prolonged periods of vacant positions at one remote clinic and an aged care facility made it impossible for the remaining providers to allocate time for using the wound care software. The disease burden of the patient group, funding models and workforce shortages frustrated the successful adoption of an evidence based strategy that was known to improve health outcomes.

Hierarchy curriculum for practical skills training in optics and photonics

NASA Astrophysics Data System (ADS)

Zheng, XiaoDong; Wang, XiaoPing; Liu, Xu; Liu, XiangDong; Lin, YuanFang

2017-08-01

The employers in optical engineering fields hope to recruit students who are capable of applying optical principles to solve engineering problems and have strong laboratory skills. In Zhejiang University, a hierarchy curriculum for practical skill training has been constructed to satisfy this demand. This curriculum includes "Introductive practicum" for freshmen, "Opto-mechanical systems design", "Engineering training", "Electronic system design", "Student research training program (SRTP)", "National University Students' Optical-Science-Technology Competition game", and "Offcampus externship". Without cutting optical theory credit hours, this hierarchy curriculum provides a step-by-step solution to enhance students' practical skills. By following such a hierarchy curriculum, students can smoothly advance from a novice to a qualified professional expert in optics. They will be able to utilize optical engineering tools to design, build, analyze, improve, and test systems, and will be able to work effectively in teams to solve problems in engineering and design.

The Hub Population Health System: distributed ad hoc queries and alerts

PubMed Central

Anane, Sheila; Taverna, John; Amirfar, Sam; Stubbs-Dame, Remle; Singer, Jesse

2011-01-01

The Hub Population Health System enables the creation and distribution of queries for aggregate count information, clinical decision support alerts at the point-of-care for patients who meet specified conditions, and secure messages sent directly to provider electronic health record (EHR) inboxes. Using a metronidazole medication recall, the New York City Department of Health was able to determine the number of affected patients and message providers, and distribute an alert to participating practices. As of September 2011, the system is live in 400 practices and within a year will have over 532 practices with 2500 providers, representing over 2.5 million New Yorkers. The Hub can help public health experts to evaluate population health and quality improvement activities throughout the ambulatory care network. Multiple EHR vendors are building these features in partnership with the department's regional extension center in anticipation of new meaningful use requirements. PMID:22071531

PCLIPS: Parallel CLIPS

NASA Technical Reports Server (NTRS)

Gryphon, Coranth D.; Miller, Mark D.

1991-01-01

PCLIPS (Parallel CLIPS) is a set of extensions to the C Language Integrated Production System (CLIPS) expert system language. PCLIPS is intended to provide an environment for the development of more complex, extensive expert systems. Multiple CLIPS expert systems are now capable of running simultaneously on separate processors, or separate machines, thus dramatically increasing the scope of solvable tasks within the expert systems. As a tool for parallel processing, PCLIPS allows for an expert system to add to its fact-base information generated by other expert systems, thus allowing systems to assist each other in solving a complex problem. This allows individual expert systems to be more compact and efficient, and thus run faster or on smaller machines.

The expert-generalist: a contradiction whose time has come.

PubMed

Fins, Joseph J

2015-08-01

The author suggests the creation of expert-generalists to help provide the additional cost-effective access to care necessitated by increased insurance coverage under the Affordable Care Act. Expert-generalists, a concept drawn from an extant Canadian model, would be a cohort of primary care physicians who obtain additional training in a subspecialty area, which would widen their practice portfolio and bring enhanced infrastructure to primary care settings. Expanding the reach of primary care into the realm of more advanced subspecialty practice could be a way to enhance both access to and quality of care in a cost-effective fashion, in part because the educational framework for additional training already exists. Trainees could opt for an extra year of training after traditional residency or return to training after years in practice. Properly trained, an expert-generalist would benefit both the quality of the patient experience and the bottom line by expertly triaging patients to determine who will truly benefit from specialty consultations, decreasing specialists' engagement with cases that do not require their higher-tier care. The author considers the merits of this proposal, as well as potential objections and implementation challenges. It is suggested that this model be adopted incrementally, using demonstration projects that could assess the impact of an expert-generalist initiative on the physician workforce and on patients' access to quality primary and specialty care.

Development of a practical approach to expert elicitation for randomised controlled trials with missing health outcomes: Application to the IMPROVE trial

PubMed Central

Mason, Alexina J; Gomes, Manuel; Grieve, Richard; Ulug, Pinar; Powell, Janet T; Carpenter, James

2017-01-01

Background/aims: The analyses of randomised controlled trials with missing data typically assume that, after conditioning on the observed data, the probability of missing data does not depend on the patient’s outcome, and so the data are ‘missing at random’ . This assumption is usually implausible, for example, because patients in relatively poor health may be more likely to drop out. Methodological guidelines recommend that trials require sensitivity analysis, which is best informed by elicited expert opinion, to assess whether conclusions are robust to alternative assumptions about the missing data. A major barrier to implementing these methods in practice is the lack of relevant practical tools for eliciting expert opinion. We develop a new practical tool for eliciting expert opinion and demonstrate its use for randomised controlled trials with missing data. Methods: We develop and illustrate our approach for eliciting expert opinion with the IMPROVE trial (ISRCTN 48334791), an ongoing multi-centre randomised controlled trial which compares an emergency endovascular strategy versus open repair for patients with ruptured abdominal aortic aneurysm. In the IMPROVE trial at 3 months post-randomisation, 21% of surviving patients did not complete health-related quality of life questionnaires (assessed by EQ-5D-3L). We address this problem by developing a web-based tool that provides a practical approach for eliciting expert opinion about quality of life differences between patients with missing versus complete data. We show how this expert opinion can define informative priors within a fully Bayesian framework to perform sensitivity analyses that allow the missing data to depend upon unobserved patient characteristics. Results: A total of 26 experts, of 46 asked to participate, completed the elicitation exercise. The elicited quality of life scores were lower on average for the patients with missing versus complete data, but there was considerable uncertainty in these elicited values. The missing at random analysis found that patients randomised to the emergency endovascular strategy versus open repair had higher average (95% credible interval) quality of life scores of 0.062 (−0.005 to 0.130). Our sensitivity analysis that used the elicited expert information as pooled priors found that the gain in average quality of life for the emergency endovascular strategy versus open repair was 0.076 (−0.054 to 0.198). Conclusion: We provide and exemplify a practical tool for eliciting the expert opinion required by recommended approaches to the sensitivity analyses of randomised controlled trials. We show how this approach allows the trial analysis to fully recognise the uncertainty that arises from making alternative, plausible assumptions about the reasons for missing data. This tool can be widely used in the design, analysis and interpretation of future trials, and to facilitate this, materials are available for download. PMID:28675302

Guidelines on the use of extracorporeal photopheresis.

PubMed

Knobler, R; Berlin, G; Calzavara-Pinton, P; Greinix, H; Jaksch, P; Laroche, L; Ludvigsson, J; Quaglino, P; Reinisch, W; Scarisbrick, J; Schwarz, T; Wolf, P; Arenberger, P; Assaf, C; Bagot, M; Barr, M; Bohbot, A; Bruckner-Tuderman, L; Dreno, B; Enk, A; French, L; Gniadecki, R; Gollnick, H; Hertl, M; Jantschitsch, C; Jung, A; Just, U; Klemke, C-D; Lippert, U; Luger, T; Papadavid, E; Pehamberger, H; Ranki, A; Stadler, R; Sterry, W; Wolf, I H; Worm, M; Zic, J; Zouboulis, C C; Hillen, U

2014-01-01

After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. © 2013 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

Usability of clinical decision support system as a facilitator for learning the assistive technology adaptation process.

PubMed

Danial-Saad, Alexandra; Kuflik, Tsvi; Weiss, Patrice L Tamar; Schreuer, Naomi

2016-01-01

The aim of this study was to evaluate the usability of Ontology Supported Computerized Assistive Technology Recommender (OSCAR), a Clinical Decision Support System (CDSS) for the assistive technology adaptation process, its impact on learning the matching process, and to determine the relationship between its usability and learnability. Two groups of expert and novice clinicians (total, n = 26) took part in this study. Each group filled out system usability scale (SUS) to evaluate OSCAR's usability. The novice group completed a learning questionnaire to assess OSCAR's effect on their ability to learn the matching process. Both groups rated OSCAR's usability as "very good", (M [SUS] = 80.7, SD = 11.6, median = 83.7) by the novices, and (M [SUS] = 81.2, SD = 6.8, median = 81.2) by the experts. The Mann-Whitney results indicated that no significant differences were found between the expert and novice groups in terms of OSCAR's usability. A significant positive correlation existed between the usability of OSCAR and the ability to learn the adaptation process (rs = 0.46, p = 0.04). Usability is an important factor in the acceptance of a system. The successful application of user-centered design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically in developing other systems. Implications for Rehabilitation Creating a CDSS with a focus on its usability is an important factor for its acceptance by its users. Successful usability outcomes can impact the learning process of the subject matter in general, and the AT prescription process in particular. The successful application of User-Centered Design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically. The study emphasizes the importance of close collaboration between the developers and the end users.

ART-Ada: An Ada-based expert system tool

NASA Technical Reports Server (NTRS)

Lee, S. Daniel; Allen, Bradley P.

1990-01-01

The Department of Defense mandate to standardize on Ada as the language for software systems development has resulted in an increased interest in making expert systems technology readily available in Ada environments. NASA's Space Station Freedom is an example of the large Ada software development projects that will require expert systems in the 1990's. Another large scale application that can benefit from Ada based expert system tool technology is the Pilot's Associate (PA) expert system project for military combat aircraft. The Automated Reasoning Tool-Ada (ART-Ada), an Ada expert system tool, is explained. ART-Ada allows applications of a C-based expert system tool called ART-IM to be deployed in various Ada environments. ART-Ada is being used to implement several prototype expert systems for NASA's Space Station Freedom program and the U.S. Air Force.

ART-Ada: An Ada-based expert system tool

NASA Technical Reports Server (NTRS)

Lee, S. Daniel; Allen, Bradley P.

1991-01-01

The Department of Defense mandate to standardize on Ada as the language for software systems development has resulted in increased interest in making expert systems technology readily available in Ada environments. NASA's Space Station Freedom is an example of the large Ada software development projects that will require expert systems in the 1990's. Another large scale application that can benefit from Ada based expert system tool technology is the Pilot's Associate (PA) expert system project for military combat aircraft. Automated Reasoning Tool (ART) Ada, an Ada Expert system tool is described. ART-Ada allow applications of a C-based expert system tool called ART-IM to be deployed in various Ada environments. ART-Ada is being used to implement several prototype expert systems for NASA's Space Station Freedom Program and the U.S. Air Force.

Mathematical modeling in realistic mathematics education

NASA Astrophysics Data System (ADS)

Riyanto, B.; Zulkardi; Putri, R. I. I.; Darmawijoyo

2017-12-01

The purpose of this paper is to produce Mathematical modelling in Realistics Mathematics Education of Junior High School. This study used development research consisting of 3 stages, namely analysis, design and evaluation. The success criteria of this study were obtained in the form of local instruction theory for school mathematical modelling learning which was valid and practical for students. The data were analyzed using descriptive analysis method as follows: (1) walk through, analysis based on the expert comments in the expert review to get Hypothetical Learning Trajectory for valid mathematical modelling learning; (2) analyzing the results of the review in one to one and small group to gain practicality. Based on the expert validation and students’ opinion and answers, the obtained mathematical modeling problem in Realistics Mathematics Education was valid and practical.

Porting a Mental Expert System to a Mainstream Programming Environment

PubMed Central

Jao, Chiang S.; Hier, Daniel B.; Dollear, Winifred; Fu, Wenying

2001-01-01

Expert systems are increasingly being applied to problems in medical diagnosis and treatment. Initial medical expert systems were programmed in specialized “expert system” shell programming environments. As the power of mainstream programming languages has increased, it has become possible to implement medical expert systems within these mainstream languages. We originally implemented an expert system to record and score the mental status examination utilizing a specialized expert system programming environment. We have now ported that application to a mainstream programming environment without losing any functionality of an accurate and comprehensive diagnostic tool. New system supplements the need of normative consultation report and offline reference library to the traditional patient care system.

Team deliberate practice in medicine and related domains: a consideration of the issues.

PubMed

Harris, Kevin R; Eccles, David W; Shatzer, John H

2017-03-01

A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental "model" of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.

Ranking experts' preferences regarding measures and methods of assessment of welfare in dairy herds using Adaptive Conjoint Analysis.

PubMed

Lievaart, J J; Noordhuizen, J P T M

2011-07-01

Welfare in dairy herds can be addressed using different concepts. The difficulty is to extract which measures are the most important to practically address welfare at the herd level and the methods to assess traits considered most important. Therefore, the preferences of 24 acknowledged European welfare experts were ranked regarding 70 measures suitable to assess dairy cattle welfare at herd level using the Adaptive Conjoint Analysis (ACA; Sawtooth Software, Inc., Sequim, WA) technique. The experts were selected on the basis of 3 criteria: at least 5 yr experience in animal welfare research; recent scientific publications in the field of animal welfare; and, at the most, 3 animal species including dairy cattle as their field of expertise. The 70 traits were ranked by using the median ACA questionnaire utility scores and the range between the answers of the 24 experts. A high utility score with a low range between the answers of the experts was considered as suitable to assess welfare at farm level. Measures meeting these criteria were prevalence of lameness cases (107.3±11.7), competition for feed and water (96.4±13.9), and number of freestalls per 10 cows (84.8±13.3). Based on the utility score alone, these former measures were replaced by stereotypic behavior (111.7±17.1), prevalence of lameness cases (107.3±11.7), body condition score (108.0±18.9), and hock lesions (104.7±16.1). Subsequently, to demonstrate that the ACA technique can be used to rank either well-known or inconclusive methods of assessment, the methods for the traits lameness cases and the hygiene of the calving pen were ranked using another 2 ACA questionnaires. The results are based on the opinions of selected, internationally acknowledged dairy cattle welfare experts within the European Union. In the future, other parties like dairy farmers and farmers' organization should be included to achieve consensus about the most suitable traits applicable in practice. The currently investigated traits do not always apply to all dairy husbandry systems across the world, but are based on a system that includes indoor housing during winter. It is concluded that ACA is a useful technique to rank the different scientific opinions of experts regarding suitable traits and methods of assessment of dairy cattle at the herd level. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

New insights into the classification and nomenclature of cortical GABAergic interneurons.

PubMed

DeFelipe, Javier; López-Cruz, Pedro L; Benavides-Piccione, Ruth; Bielza, Concha; Larrañaga, Pedro; Anderson, Stewart; Burkhalter, Andreas; Cauli, Bruno; Fairén, Alfonso; Feldmeyer, Dirk; Fishell, Gord; Fitzpatrick, David; Freund, Tamás F; González-Burgos, Guillermo; Hestrin, Shaul; Hill, Sean; Hof, Patrick R; Huang, Josh; Jones, Edward G; Kawaguchi, Yasuo; Kisvárday, Zoltán; Kubota, Yoshiyuki; Lewis, David A; Marín, Oscar; Markram, Henry; McBain, Chris J; Meyer, Hanno S; Monyer, Hannah; Nelson, Sacha B; Rockland, Kathleen; Rossier, Jean; Rubenstein, John L R; Rudy, Bernardo; Scanziani, Massimo; Shepherd, Gordon M; Sherwood, Chet C; Staiger, Jochen F; Tamás, Gábor; Thomson, Alex; Wang, Yun; Yuste, Rafael; Ascoli, Giorgio A

2013-03-01

A systematic classification and accepted nomenclature of neuron types is much needed but is currently lacking. This article describes a possible taxonomical solution for classifying GABAergic interneurons of the cerebral cortex based on a novel, web-based interactive system that allows experts to classify neurons with pre-determined criteria. Using Bayesian analysis and clustering algorithms on the resulting data, we investigated the suitability of several anatomical terms and neuron names for cortical GABAergic interneurons. Moreover, we show that supervised classification models could automatically categorize interneurons in agreement with experts' assignments. These results demonstrate a practical and objective approach to the naming, characterization and classification of neurons based on community consensus.

An expert system for the design of heating, ventilating, and air-conditioning systems

NASA Astrophysics Data System (ADS)

Camejo, Pedro Jose

1989-12-01

Expert systems are computer programs that seek to mimic human reason. An expert system shelf, a software program commonly used for developing expert systems in a relatively short time, was used to develop a prototypical expert system for the design of heating, ventilating, and air-conditioning (HVAC) systems in buildings. Because HVAC design involves several related knowledge domains, developing an expert system for HVAC design requires the integration of several smaller expert systems known as knowledge bases. A menu program and several auxiliary programs for gathering data, completing calculations, printing project reports, and passing data between the knowledge bases are needed and have been developed to join the separate knowledge bases into one simple-to-use program unit.

Questions on Verbal Behavior and Its Application to Individuals with Autism: An Interview with the Experts

ERIC Educational Resources Information Center

Behavior Analyst Today, 2010

2010-01-01

The use of Skinner's Verbal Behavior (VB) classification system has been increasingly applied to learners with autism. In this interview, several of the best known behavior analysts were asked to answer some key questions regarding this practice, the state of research regarding the advantages of this approach, and the confusion that exists…

MARBLE: A system for executing expert systems in parallel

NASA Technical Reports Server (NTRS)

Myers, Leonard; Johnson, Coe; Johnson, Dean

1990-01-01

This paper details the MARBLE 2.0 system which provides a parallel environment for cooperating expert systems. The work has been done in conjunction with the development of an intelligent computer-aided design system, ICADS, by the CAD Research Unit of the Design Institute at California Polytechnic State University. MARBLE (Multiple Accessed Rete Blackboard Linked Experts) is a system of C Language Production Systems (CLIPS) expert system tool. A copied blackboard is used for communication between the shells to establish an architecture which supports cooperating expert systems that execute in parallel. The design of MARBLE is simple, but it provides support for a rich variety of configurations, while making it relatively easy to demonstrate the correctness of its parallel execution features. In its most elementary configuration, individual CLIPS expert systems execute on their own processors and communicate with each other through a modified blackboard. Control of the system as a whole, and specifically of writing to the blackboard is provided by one of the CLIPS expert systems, an expert control system.

The Finishing Touch: Anatomy of Expert Lesson Closures

ERIC Educational Resources Information Center

Webster, Collin A.; Connolly, Graeme; Schempp, Paul G.

2009-01-01

Background: Based on the idea that students remember best what is presented last, the lesson closure is commonly identified as an important component of effective teaching and has recently surfaced as a routine practice of expert teachers in sport. Despite its link to both effective and expert instruction, the lesson closure has seen scarce…

The Formation of Future Socionomic Experts' Conflictological Culture in Germany and Austria

ERIC Educational Resources Information Center

Branitska, Tetiana

2015-01-01

At the present stage of Ukrainian society development there is a requirement for studying and the analysis of the maintenance of experts' preparation in social, socially pedagogical sphere in foreign countries. Therefore the great value has research of experience in theoretical and practical preparation of the future socionomic experts in the…

29 CFR 18.702 - Testimony by experts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Testimony by experts. 18.702 Section 18.702 Labor Office of the Secretary of Labor RULES OF PRACTICE AND PROCEDURE FOR ADMINISTRATIVE HEARINGS BEFORE THE OFFICE... to understand the evidence or to determine a fact in issue, a witness qualified as an expert by...

18 CFR 401.85 - Staff and other expert testimony.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Staff and other expert... ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Administrative and Other Hearings § 401.85 Staff and other... the presentation of testimony by the Commission's technical staff and other experts, as he may deem...

18 CFR 401.85 - Staff and other expert testimony.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Staff and other expert... ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Administrative and Other Hearings § 401.85 Staff and other... the presentation of testimony by the Commission's technical staff and other experts, as he may deem...

18 CFR 401.85 - Staff and other expert testimony.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Staff and other expert... ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Administrative and Other Hearings § 401.85 Staff and other... the presentation of testimony by the Commission's technical staff and other experts, as he may deem...

18 CFR 401.85 - Staff and other expert testimony.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Staff and other expert... ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Administrative and Other Hearings § 401.85 Staff and other... the presentation of testimony by the Commission's technical staff and other experts, as he may deem...

Development of Interactive Multimedia Courseware (e-CRAFT) for Craft Education

ERIC Educational Resources Information Center

Osman, Salyani; Sahari, Noraidah; Zin, Nor Azan Mat

2012-01-01

The way of teaching and learning traditional crafts have always used traditional apprenticeship learning methods where the expert facilitates transfer of practice skill sets to novices. As a craft has been taught in conventional approach, the students and experts have been facing several problems especially when expert needs to teach a group of…

The knowledge of expert nurses and the practical-reflective rationality.

PubMed

Pina Queirós, Paulo Joaquim

2015-01-01

To identify the characteristics of an expert nurse. A group of 49 nurses starting their Master's degree was asked to answer the following question: ''Which characteristics and skills distinguish a novice from an expert nurse?'' The answers were analyzed and classified based on Bardin's content analysis. Through a three-stage classification process, the competences and skills assigned to expert nurses were divided into 17 categories. These nurses showed wide-ranging skills and acquired meta-competencies. Expert nurses are characterized by their leadership, supervision and ability to manage change, as well as their communication and relational skills. They have the ability to act reflectively, plan, systematize and consistently assess; they also show more dexterity. They have more adaptive skills, confidence and achieve a broader view. They are competent while managing conflicts and stress, as well as articulating theory and practice; they create knowledge, make use of research, respond to complex situations and are capable of making decisions. Expert nurses have anticipation skills, insight, use detailed observation, take immediate action and are able to define priorities; they keep context in mind and have a tendency for specialization.

Psychology of developing and designing expert systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tonn, B.; MacGregor, D.

This paper discusses psychological problems relevant to developing and designing expert systems. With respect to the former, the psychological literature suggests that several cognitive biases may affect the elicitation of a valid knowledge base from the expert. The literature also suggests that common expert system inference engines may be quite inconsistent with reasoning heuristics employed by experts. With respect to expert system user interfaces, care should be taken when eliciting uncertainty estimates from users, presenting system conclusions, and ordering questions.

Consensus development on the essential competencies for Iranian public health nutritionists.

PubMed

Sadeghi-Ghotbabadi, Farzaneh; Shakibazadeh, Elham; Omidvar, Nasrin; Mortazavi, Fathieh; Kolahdooz, Fariba

2015-03-01

To assess key experts' opinion regarding essential competencies required for effective public health nutrition practice within the health-care system of Iran. Qualitative study using the modified Delphi technique through an email-delivered questionnaire. Iran. Fifty-five experts were contacted through email. The inclusion criterion for the study panel was being in a relevant senior-level position in nutrition science or public health nutrition in Iran. In the first round, forty-two out of fifty-five experts responded to the questionnaire (response rate=76 %). A sixty-five-item questionnaire was designed with nine competency areas, including 'nutrition science', 'planning and implementing nutritional interventions', 'health and nutrition services', 'advocacy and communication', 'assessment and analysis', 'evaluation', 'cultural, social and political aspects', 'using technology' and 'leadership and management'. All experts who had participated in the first round completed a modified version of the questionnaire with seventy-seven items in the second round. The experts scored 'nutrition science' as the most essential competency area, while more applied areas such as 'management and leadership' were less emphasized. In both rounds, the mean difference between the opinions of the necessity of each area was 5.6 %. The Iranian experts had general agreement on most of the core competency areas of public health nutritionists. The results indicated the need for capacity building and revisions to educational curricula for public health nutritionist programmes, with more emphasis on skill-based competency development.

Issues and controversies of hepatocellular carcinoma-targeted therapy clinical trials in Asia: experts' opinion.

PubMed

Chen, Pei-Jer; Furuse, Junji; Han, Kwang-Hyub; Hsu, Chiun; Lim, Ho-Yeong; Moon, Hanlim; Qin, Shukui; Ye, Sheng-Long; Yeoh, Ee-Min; Yeo, Winnie

2010-11-01

Asia has a disproportionate share of the world's burden of hepatocellular carcinoma (HCC). However, the highly regarded clinical practice guidelines and recommendations for the design and conduct of clinical trials for HCC largely reflect Western practice. In order to design mutually beneficial international clinical trials of promising targeted therapies, it is imperative to understand how the aetiology, staging and treatment of HCC differ between Asian and Western countries. Our group, comprising experts in oncology and hepatology from countries that constitute the Eastern Asian region, convened to compare and contrast our current practices, evaluate potential compliance with the clinical trial recommendations, and offer suggestions for modifications that would enhance international collaboration. Here, we describe the results of our discussions, including recommendations for appropriate patient stratification based on potentially important differences in HCC aetiology, identification of practices that may confound interpretation of clinical trial outcomes (traditional Chinese medicine; antivirals that target hepatitis B virus; heterogeneous embolization procedures), suggestions for utilizing a common staging system in study protocols, recognition that sorafenib usage is limited by financial constraints and potentially increased toxicity in Asian patients, and expansion of patient populations that should be eligible for initial clinical trials with new agents. © 2010 John Wiley & Sons A/S.

Data storage and retrieval.

PubMed

Kalisman, M; Kalisman, A

1986-07-01

The entire face of modern medical and surgical practice is being significantly affected by the application of technologic developments to the practice of surgery--developments that will tie together such areas as information management and processing, robotics, communication networks, and computerized surgical equipment. The achievements in these areas will create a sophisticated, fully automatic system that will assist the plastic surgeon in many aspects of work, such as regular office activities, doctor-patient interaction, professional updating, communication, and even assistance during the operational process itself. It will be as simple as dialing a telephone today. When it is necessary to consult with other colleagues, a combined vocal and visual consulting network in other medical centers as well as consulting computerized expert systems will be available all day and night as part of the communication services. The plastic surgical expert systems will store valuable information, based on the knowledge of the best human experts, on any important subtopics and will be accessed in a very friendly way. This will be an invaluable tool for the residents in training, for emergency room work, and for just getting a second opinion, even for the more experienced practitioner. All the electronic mail, professional magazines, and any other required professional information will flow between central and personal retrieval systems. The doctor, at a desired time in the privacy and comfort of his or her own home or office, can read the mail, make required changes to suit his or her needs, and store, send back, or distribute information, all in a speedy and efficient manner. The simulation of a planned surgery will give the surgeon the ability to prepare and will prevent difficulties during complicated procedures through the luxury of a dry run, without any sequelae if certain expected outcomes fail to materialize. The preprogrammed control of sophisticated surgical equipment and the use of robotics would generate new operational possibilities for more complicated surgeries, which are now prevented owing to the surgeon's physical limitations. Information urgently required during the operation as a result of an unexpected situation will be available immediately from storage and retrieval systems, and real-time vocal and visual consulting with expert colleagues, often in remote locations, will bring the operations process itself to a new era.(ABSTRACT TRUNCATED AT 400 WORDS)

Processes in construction of failure management expert systems from device design information

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Lance, Nick

1987-01-01

This paper analyzes the tasks and problem solving methods used by an engineer in constructing a failure management expert system from design information about the device to te diagnosed. An expert test engineer developed a trouble-shooting expert system based on device design information and experience with similar devices, rather than on specific expert knowledge gained from operating the device or troubleshooting its failures. The construction of the expert system was intensively observed and analyzed. This paper characterizes the knowledge, tasks, methods, and design decisions involved in constructing this type of expert system, and makes recommendations concerning tools for aiding and automating construction of such systems.

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.

PubMed

Noyes, Jane; Brenner, Maria; Fox, Patricia; Guerin, Ashleigh

2014-05-01

To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Novel mixed-method integrative review informed by health systems theory. DATA  CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW  Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. © 2013 John Wiley & Sons Ltd.

Re-Codified Standards from the Perspective of Language Experts: Credentials, Practice and Attitudes Amongst Translators and Interpreters of the Bosnian, Croatian and Serbian Languages

ERIC Educational Resources Information Center

Hlavac, Jim

2015-01-01

This article examines aspects of linguistic behaviour, attitudes and professional practices amongst a group of 47 "expert users" who are translators or interpreters for one, two or three of the following languages: Bosnian, Croatian and Serbian. The official terms for these languages in the respective successor states of Socialist…

Testing expert systems

NASA Technical Reports Server (NTRS)

Chang, C. L.; Stachowitz, R. A.

1988-01-01

Software quality is of primary concern in all large-scale expert system development efforts. Building appropriate validation and test tools for ensuring software reliability of expert systems is therefore required. The Expert Systems Validation Associate (EVA) is a validation system under development at the Lockheed Artificial Intelligence Center. EVA provides a wide range of validation and test tools to check correctness, consistency, and completeness of an expert system. Testing a major function of EVA. It means executing an expert system with test cases with the intent of finding errors. In this paper, we describe many different types of testing such as function-based testing, structure-based testing, and data-based testing. We describe how appropriate test cases may be selected in order to perform good and thorough testing of an expert system.

Real Time Data System (RTDS)

NASA Technical Reports Server (NTRS)

Muratore, John F.

1991-01-01

Lessons learned from operational real time expert systems are examined. The basic system architecture is discussed. An expert system is any software that performs tasks to a standard that would normally require a human expert. An expert system implies knowledge contained in data rather than code. And an expert system implies the use of heuristics as well as algorithms. The 15 top lessons learned by the operation of a real time data system are presented.

Expectations of medical specialists about image-based teleconsultation - A qualitative study on acute burns in South Africa.

PubMed

Blom, Lisa; Laflamme, Lucie; Mölsted Alvesson, Helle

2018-01-01

Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data. The experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow-clinical specialist and gatekeeper-and two to point of care staff-educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles-the mentor-came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position. The quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App during remote consultations. Experts' reflections on remote consultations highlight the embedded social and cultural dimensions of implementing new technology.

Management of Clostridium difficile Infection in Inflammatory Bowel Disease: Expert Review from the Clinical Practice Updates Committee of the AGA Institute.

PubMed

Khanna, Sahil; Shin, Andrea; Kelly, Ciarán P

2017-02-01

The purpose of this expert review is to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying inflammatory bowel disease. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Best Practice Advice 1: Clinicians should test patients who present with a flare of underlying inflammatory bowel disease for Clostridium difficile infection. Best Practice Advice 2: Clinicians should screen for recurrent C difficile infection if diarrhea or other symptoms of colitis persist or return after antibiotic treatment for C difficile infection. Best Practice Advice 3: Clinicians should consider treating C difficile infection in inflammatory bowel disease patients with vancomycin instead of metronidazole. Best Practice Advice 4: Clinicians strongly should consider hospitalization for close monitoring and aggressive management for inflammatory bowel disease patients with C difficile infection who have profuse diarrhea, severe abdominal pain, a markedly increased peripheral blood leukocyte count, or other evidence of sepsis. Best Practice Advice 5: Clinicians may postpone escalation of steroids and other immunosuppression agents during acute C difficile infection until therapy for C difficile infection has been initiated. However, the decision to withhold or continue immunosuppression in inflammatory bowel disease patients with C difficile infection should be individualized because there is insufficient existing robust literature on which to develop firm recommendations. Best Practice Advice 6: Clinicians should offer a referral for fecal microbiota transplantation to inflammatory bowel disease patients with recurrent C difficile infection. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Expert systems applications for space shuttle payload integration automation

NASA Technical Reports Server (NTRS)

Morris, Keith

1988-01-01

Expert systems technologies have been and are continuing to be applied to NASA's Space Shuttle orbiter payload integration problems to provide a level of automation previously unrealizable. NASA's Space Shuttle orbiter was designed to be extremely flexible in its ability to accommodate many different types and combinations of satellites and experiments (payloads) within its payload bay. This flexibility results in differnet and unique engineering resource requirements for each of its payloads, creating recurring payload and cargo integration problems. Expert systems provide a successful solution for these recurring problems. The Orbiter Payload Bay Cabling Expert (EXCABL) was the first expert system, developed to solve the electrical services provisioning problem. A second expert system, EXMATCH, was developed to generate a list of the reusable installation drawings available for each EXCABL solution. These successes have proved the applicability of expert systems technologies to payload integration problems and consequently a third expert system is currently in work. These three expert systems, the manner in which they resolve payload problems and how they will be integrated are described.

Re-defining nursing expertise in the United kingdom.

PubMed

Hardy, Sally; Titchen, Angie; Manley, Kim; McCormack, Brendan

2006-07-01

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

From control to causation: Validating a 'complex systems model' of running-related injury development and prevention.

PubMed

Hulme, A; Salmon, P M; Nielsen, R O; Read, G J M; Finch, C F

2017-11-01

There is a need for an ecological and complex systems approach for better understanding the development and prevention of running-related injury (RRI). In a previous article, we proposed a prototype model of the Australian recreational distance running system which was based on the Systems Theoretic Accident Mapping and Processes (STAMP) method. That model included the influence of political, organisational, managerial, and sociocultural determinants alongside individual-level factors in relation to RRI development. The purpose of this study was to validate that prototype model by drawing on the expertise of both systems thinking and distance running experts. This study used a modified Delphi technique involving a series of online surveys (December 2016- March 2017). The initial survey was divided into four sections containing a total of seven questions pertaining to different features associated with the prototype model. Consensus in opinion about the validity of the prototype model was reached when the number of experts who agreed or disagreed with survey statement was ≥75% of the total number of respondents. A total of two Delphi rounds was needed to validate the prototype model. Out of a total of 51 experts who were initially contacted, 50.9% (n = 26) completed the first round of the Delphi, and 92.3% (n = 24) of those in the first round participated in the second. Most of the 24 full participants considered themselves to be a running expert (66.7%), and approximately a third indicated their expertise as a systems thinker (33.3%). After the second round, 91.7% of the experts agreed that the prototype model was a valid description of the Australian distance running system. This is the first study to formally examine the development and prevention of RRI from an ecological and complex systems perspective. The validated model of the Australian distance running system facilitates theoretical advancement in terms of identifying practical system-wide opportunities for the implementation of sustainable RRI prevention interventions. This 'big picture' perspective represents the first step required when thinking about the range of contributory causal factors that affect other system elements, as well as runners' behaviours in relation to RRI risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

Best Practices for Suicide Prevention Messaging and Evaluating California's "Know the Signs" Media Campaign.

PubMed

Acosta, Joie; Ramchand, Rajeev; Becker, Amariah

2017-09-01

Although communication is a key component of US strategies to prevent suicide and there are a number of marketing campaigns promoting messages that suicide is a preventable public health problem, there has been little evaluation of these campaigns. The study describes the development of a checklist of best practices for suicide prevention communication campaigns and the use of the checklist to evaluate California's investment in "Know the Signs" (KTS-M), a suicide prevention mass media campaign. We conducted a literature review and solicited expert feedback to identify best practices and then used the RAND/UCLA appropriateness method to assess whether KTS-M was consistent with the identified best practices. Overall, experts agreed that KTS-M adhered to most of the 46 checklist items and suggested that the campaign was among the best suicide prevention media campaigns they had observed. The checklist was developed through expert input and literature review and focuses only on media campaigns. Given the nascent state of the evidence about what makes an effective suicide prevention message and the growing number of campaigns, the checklist of best practices reflects one way of promoting quality in this evolving field. The consistency between the experts' comments and their ratings of KTS-M suggests that the checklist may provide important guidance to inform the development of future campaigns and the evaluation of ongoing campaigns.

Expert consensus regarding drivers of antimicrobial stewardship in companion animal veterinary practice: a Delphi study.

PubMed

Currie, Kay; King, Caroline; Nuttall, Tim; Smith, Matt; Flowers, Paul

2018-03-23

Antimicrobial resistance (AMR) is a global challenge facing both human and animal healthcare professionals; an effective response to this threat requires a 'One-Health' approach to antimicrobial stewardship (AMS) to preserve important antibiotics for urgent clinical need. However, understanding of barriers and enablers to effective AMS behaviour in companion animal veterinary practice is currently limited. We conducted a Delphi study of 16 nationally recognised experts from UK-based veterinary policymakers, university academics and leaders of professional bodies. This Delphi study sought to identify veterinary behaviours which experts believe contribute to AMR and form vital aspects of AMS. Analysis of Delphi findings indicated a perceived hierarchy of behaviours, the most influential being antibiotic prescribing behaviours and interactions with clients. Other veterinary behaviours perceived as being important related to interactions with veterinary colleagues; infection control practices; and the use of diagnostic tests to confirm infection. Key barriers and enablers to AMS within each of these behavioural domains were identified. Specific interventions to address important barriers and enablers are recommended. To the authors' knowledge, this is the first study to establish expert consensus at a national level about which 'behaviours' (aspects of veterinarian practice) should be targeted in relation to AMR and AMS in companion animal veterinary practice. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Systems SOAP Note: A Systems Learning Tool.

PubMed

Mitsuishi, Fumi; Young, John Q; Leary, Mark; Dilley, James; Mangurian, Christina

2016-02-01

Systems-based practice (SBP) is the only Accreditation Council for Graduate Medical Education (ACGME) competency concerned with public health and is relatively neglected in residency curricula. A tool was developed and pilot-tested to improve SBP learning on inpatient psychiatry rotations. A four-step approach was used: (1) literature review, (2) expert consultation, (3) tool development, and (4) pilot testing on four cases and evaluation for completion time and preliminary efficacy. Out of 51 SBP articles, six (12%) focused on psychiatric residency programs, and none had a practical SBP learning tool. The "systems SOAP (subjective, objective, assessment, plan) note" (S-SOAP) was structured after a clinical SOAP note and was easy to use (mean completion time = 60 min), and residents self-reported more insight into systems issues. The S-SOAP tool was effectively integrated into clinical experience and provided insight into systemic complexities. Future research should assess SBP knowledge acquisition after the use of such tools.

Expert system technology

NASA Technical Reports Server (NTRS)

Prince, Mary Ellen

1987-01-01

The expert system is a computer program which attempts to reproduce the problem-solving behavior of an expert, who is able to view problems from a broad perspective and arrive at conclusions rapidly, using intuition, shortcuts, and analogies to previous situations. Expert systems are a departure from the usual artificial intelligence approach to problem solving. Researchers have traditionally tried to develop general modes of human intelligence that could be applied to many different situations. Expert systems, on the other hand, tend to rely on large quantities of domain specific knowledge, much of it heuristic. The reasoning component of the system is relatively simple and straightforward. For this reason, expert systems are often called knowledge based systems. The report expands on the foregoing. Section 1 discusses the architecture of a typical expert system. Section 2 deals with the characteristics that make a problem a suitable candidate for expert system solution. Section 3 surveys current technology, describing some of the software aids available for expert system development. Section 4 discusses the limitations of the latter. The concluding section makes predictions of future trends.

Expert system for the design of heating, ventilating, and air-conditioning systems. Master's thesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Camejo, P.J.

1989-12-01

Expert systems are computer programs that seek to mimic human reason. An expert system shelf, a software program commonly used for developing expert systems in a relatively short time, was used to develop a prototypical expert system for the design of heating, ventilating, and air-conditioning (HVAC) systems in buildings. Because HVAC design involves several related knowledge domains, developing an expert system for HVAC design requires the integration of several smaller expert systems known as knowledge bases. A menu program and several auxiliary programs for gathering data, completing calculations, printing project reports, and passing data between the knowledge bases are neededmore » and have been developed to join the separate knowledge bases into one simple-to-use program unit.« less

TARGET - TASK ANALYSIS REPORT GENERATION TOOL, VERSION 1.0

NASA Technical Reports Server (NTRS)

Ortiz, C. J.

1994-01-01

The Task Analysis Report Generation Tool, TARGET, is a graphical interface tool used to capture procedural knowledge and translate that knowledge into a hierarchical report. TARGET is based on VISTA, a knowledge acquisition tool developed by the Naval Systems Training Center. TARGET assists a programmer and/or task expert organize and understand the steps involved in accomplishing a task. The user can label individual steps in the task through a dialogue-box and get immediate graphical feedback for analysis. TARGET users can decompose tasks into basic action kernels or minimal steps to provide a clear picture of all basic actions needed to accomplish a job. This method allows the user to go back and critically examine the overall flow and makeup of the process. The user can switch between graphics (box flow diagrams) and text (task hierarchy) versions to more easily study the process being documented. As the practice of decomposition continues, tasks and their subtasks can be continually modified to more accurately reflect the user's procedures and rationale. This program is designed to help a programmer document an expert's task thus allowing the programmer to build an expert system which can help others perform the task. Flexibility is a key element of the system design and of the knowledge acquisition session. If the expert is not able to find time to work on the knowledge acquisition process with the program developer, the developer and subject matter expert may work in iterative sessions. TARGET is easy to use and is tailored to accommodate users ranging from the novice to the experienced expert systems builder. TARGET is written in C-language for IBM PC series and compatible computers running MS-DOS and Microsoft Windows version 3.0 or 3.1. No source code is supplied. The executable also requires 2Mb of RAM, a Microsoft compatible mouse, a VGA display and an 80286, 386 or 486 processor machine. The standard distribution medium for TARGET is one 5.25 inch 360K MS-DOS format diskette. TARGET was developed in 1991.

Forum for Injection Technique and Therapy Expert Recommendations, India: The Indian Recommendations for Best Practice in Insulin Injection Technique, 2017

PubMed Central

Tandon, Nikhil; Kalra, Sanjay; Balhara, Yatan Pal Singh; Baruah, Manash P.; Chadha, Manoj; Chandalia, Hemraj B.; Prasanna Kumar, K. M.; Madhu, S. V.; Mithal, Ambrish; Sahay, Rakesh; Shukla, Rishi; Sundaram, Annamalai; Unnikrishnan, Ambika G.; Saboo, Banshi; Gupta, Vandita; Chowdhury, Subhankar; Kesavadev, Jothydev; Wangnoo, Subhash K.

2017-01-01

Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD. PMID:28670547

Creating financial transparency in public health: examining best practices of system partners.

PubMed

Honoré, Peggy A; Clarke, Richard L; Mead, Dean Michael; Menditto, Susan M

2007-01-01

Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.

Scientists in the courtroom: basic pointers for the expert scientific witness.

PubMed Central

Eaton, D L; Kalman, D

1994-01-01

The need for expert and unbiased participation in legal proceedings by physicians, industrial hygienists, toxicologists, environmental scientists, regulators, and similar professionals is hampered by lack of familiarity with the requirements of expert testimony and lack of opportunities for professional training in this activity. Drawing on material developed in a continuing education course offered by the University of Washington, we describe the role and process of being an expert witness and provide basic information regarding good professional practices pertaining to the testifying expert role. PMID:7895706

Treatment of severe psoriasis in children: recommendations of an Italian expert group.

PubMed

Fortina, Anna Belloni; Bardazzi, Federico; Berti, Samantha; Carnevale, Claudia; Di Lernia, Vito; El Hachem, Maya; Neri, Iria; Gelmetti, Carlo Mario; Lora, Viviana; Mazzatenta, Carlo; Milioto, Mirella; Moretta, Gaia; Patrizi, Annalisa; Peris, Ketty; Villani, Alberto

2017-10-01

This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions.

Experts' views regarding Australian school-leavers' knowledge of nutrition and food systems.

PubMed

Sadegholvad, Sanaz; Yeatman, Heather; Parrish, Anne-Maree; Worsley, Anthony

2017-10-01

To explore Australian experts' views regarding strengths and gaps in school-leavers' knowledge of nutrition and food systems ( N&FS) and factors that influence that knowledge. Semi-structured interviews were conducted with 21 highly experienced food-related experts in Australia. Qualitative data were analysed thematically using Attride-Stirling's thematic network framework. Two global themes and several organising themes were identified. The first global theme, 'structural curriculum-based problems', emerged from three organising themes of: inconsistencies in provided food education programs at schools in Australia; insufficient coverage of food-related skills and food systems topics in school curricula; and the lack of trained school teachers. The second global theme, 'insufficient levels of school-leavers knowledge of N&FS ', was generated from four organising themes, which together described Australian school-leavers' poor knowledge of N&FS more broadly and knowledge translation problem for everyday practices. Study findings identified key problems relating to current school-based N&FS education programs in Australia and reported knowledge gaps in relation to N&FS among Australian school-leavers. These findings provide important guidance for N&FS curriculum development, to clearly articulate broadly-based N&FS knowledge acquisition in curriculum policy and education documents for Australian schools. © 2017 The Authors.

Expert consensus on best evaluative practices in community-based rehabilitation.

PubMed

Grandisson, Marie; Thibeault, Rachel; Hébert, Michèle; Cameron, Debra

2016-01-01

The objective of this study was to generate expert consensus on best evaluative practices for community-based rehabilitation (CBR). This consensus includes key features of the evaluation process and methods, and discussion of whether a shared framework should be used to report findings and, if so, which framework should play this role. A Delphi study with two predefined rounds was conducted. Experts in CBR from a wide range of geographical areas and disciplinary backgrounds were recruited to complete the questionnaires. Both quantitative and qualitative analyses were performed to generate the recommendations for best practices in CBR evaluation. A panel of 42 experts reached consensus on 13 recommendations for best evaluative practices in CBR. In regard to the critical qualities of sound CBR evaluation processes, panellists emphasized that these processes should be inclusive, participatory, empowering and respectful of local cultures and languages. The group agreed that evaluators should consider the use of mixed methods and participatory tools, and should combine indicators from a universal list of CBR indicators with locally generated ones. The group also agreed that a common framework should guide CBR evaluations, and that this framework should be a flexible combination between the CBR Matrix and the CBR Principles. An expert panel reached consensus on key features of best evaluative practices in CBR. Knowledge transfer initiatives are now required to develop guidelines, tools and training opportunities to facilitate CBR program evaluations. CBR evaluation processes should strive to be inclusive, participatory, empowering and respectful of local cultures and languages. CBR evaluators should strongly consider using mixed methods, participatory tools, a combination of indicators generated with the local community and with others from a bank of CBR indicators. CBR evaluations should be situated within a shared, but flexible, framework. This shared framework could combine the CBR Matrix and the CBR Principles.

Automatic segmentation software in locally advanced rectal cancer: READY (REsearch program in Auto Delineation sYstem)-RECTAL 02: prospective study.

PubMed

Gambacorta, Maria A; Boldrini, Luca; Valentini, Chiara; Dinapoli, Nicola; Mattiucci, Gian C; Chiloiro, Giuditta; Pasini, Danilo; Manfrida, Stefania; Caria, Nicola; Minsky, Bruce D; Valentini, Vincenzo

2016-07-05

To validate autocontouring software (AS) in a clinical practice including a two steps delineation quality assurance (QA) procedure.The existing delineation agreement among experts for rectal cancer and the overlap and time criteria that have to be verified to allow the use of AS were defined.Median Dice Similarity Coefficient (MDSC), Mean slicewise Hausdorff Distances (MSHD) and Total-Time saving (TT) were analyzed.Two expert Radiation Oncologists reviewed CT-scans of 44 patients and agreed the reference-CTV: the first 14 consecutive cases were used to populate the software Atlas and 30 were used as Test.Each expert performed a manual (group A) and an automatic delineation (group B) of 15 Test patients.The delineations were compared with the reference contours.The overlap between the manual and automatic delineations with MDSC and MSHD and the TT were analyzed.Three acceptance criteria were set: MDSC ≥ 0.75, MSHD ≤1mm and TT sparing ≥ 50%.At least 2 criteria had to be met, one of which had to be TT saving, to validate the system.The MDSC was 0.75, MSHD 2.00 mm and the TT saving 55.5% between group A and group B. MDSC among experts was 0.84.Autosegmentation systems in rectal cancer partially met acceptability criteria with the present version.

International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation

PubMed Central

2013-01-01

Background To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. Methods One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical . Results The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics). Conclusions This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system. PMID:23432905

Engineering monitoring expert system's developer

NASA Technical Reports Server (NTRS)

Lo, Ching F.

1991-01-01

This research project is designed to apply artificial intelligence technology including expert systems, dynamic interface of neural networks, and hypertext to construct an expert system developer. The developer environment is specifically suited to building expert systems which monitor the performance of ground support equipment for propulsion systems and testing facilities. The expert system developer, through the use of a graphics interface and a rule network, will be transparent to the user during rule constructing and data scanning of the knowledge base. The project will result in a software system that allows its user to build specific monitoring type expert systems which monitor various equipments used for propulsion systems or ground testing facilities and accrues system performance information in a dynamic knowledge base.

Expert systems built by the Expert: An evaluation of OPS5

NASA Technical Reports Server (NTRS)

Jackson, Robert

1987-01-01

Two expert systems were written in OPS5 by the expert, a Ph.D. astronomer with no prior experience in artificial intelligence or expert systems, without the use of a knowledge engineer. The first system was built from scratch and uses 146 rules to check for duplication of scientific information within a pool of prospective observations. The second system was grafted onto another expert system and uses 149 additional rules to estimate the spacecraft and ground resources consumed by a set of prospective observations. The small vocabulary, the IF this occurs THEN do that logical structure of OPS5, and the ability to follow program execution allowed the expert to design and implement these systems with only the data structures and rules of another OPS5 system as an example. The modularity of the rules in OPS5 allowed the second system to modify the rulebase of the system onto which it was grafted without changing the code or the operation of that system. These experiences show that experts are able to develop their own expert systems due to the ease of programming and code reusability in OPS5.

Common sense of experts: Social representations of justice amongst professionals.

PubMed

Rochira, Alessia

2014-09-01

The dialectics between different modes of knowledge is at the very core of social sciences. In particular, the theory of social representations looks at expert and lay modes as they were not peculiar of specific domains but rather as they were mutually interdependent. Based on the conceptual distinction between reified and consensual universes, this article explores the interplay between these two sources of knowledge through the analysis of the social representations of justice produced by justice professionals. In particular, the exploration of the social representations of justice amongst experts offers intriguing clues to overtake the idea that the lay understanding of justice is somehow opposed to the expert viewpoint and to accept the polyphasic understanding of this complex object. The article reports the findings of a qualitative investigation of the social representations of justice amongst professionals. The staff members of the Youth Social Services (YSS) and the Juvenile Classification Home and Residential Community (JCHRC) were interviewed, and transcriptions were content analysed. The findings indicated that professionals generate multiple theories of justice with each presenting a particular articulation of the basic interplay between expert and lay viewpoints. Most important, findings indicate that the context of everyday working practice has a significant symbolic valence that goes beyond the boundaries of the reified context of institutional justice system.

An Expert Elicitation of the Proliferation Resistance of Using Small Modular Reactors (SMR) for the Expansion of Civilian Nuclear Systems.

PubMed

Siegel, Jonas; Gilmore, Elisabeth A; Gallagher, Nancy; Fetter, Steve

2018-02-01

To facilitate the use of nuclear energy globally, small modular reactors (SMRs) may represent a viable alternative or complement to large reactor designs. One potential benefit is that SMRs could allow for more proliferation resistant designs, manufacturing arrangements, and fuel-cycle practices at widespread deployment. However, there is limited work evaluating the proliferation resistance of SMRs, and existing proliferation assessment approaches are not well suited for these novel arrangements. Here, we conduct an expert elicitation of the relative proliferation resistance of scenarios for future nuclear energy deployment driven by Generation III+ light-water reactors, fast reactors, or SMRs. Specifically, we construct the scenarios to investigate relevant technical and institutional features that are postulated to enhance the proliferation resistance of SMRs. The experts do not consistently judge the scenario with SMRs to have greater overall proliferation resistance than scenarios that rely on conventional nuclear energy generation options. Further, the experts disagreed on whether incorporating a long-lifetime sealed core into an SMR design would strengthen or weaken proliferation resistance. However, regardless of the type of reactor, the experts judged that proliferation resistance would be enhanced by improving international safeguards and operating several multinational fuel-cycle facilities rather than supporting many more national facilities. © 2017 Society for Risk Analysis.

The role of information technology in the development of community pharmacy services: visions and strategic views of international experts.

PubMed

Westerling, Anna M; Haikala, Veikko; Airaksinen, Marja

2011-12-01

Community pharmacy's strategic vision has been to extend practice responsibilities beyond dispensing and provide patient care services. Few studies have evaluated the strategic and long-term development of information technology (IT) systems to support this vision. The objective of this study was to explore international experts' visions and strategic views on IT development needs in relation to service provision in community pharmacies. Semistructured interviews were conducted with a purposive sample of 14 experts from 8 countries in 2007-2008. These experts had expertise in the development of community pharmacy services and IT. The interviews were content analyzed using a constant comparison approach and a SWOT (strengths, weaknesses, opportunities, threats) analysis was undertaken. Most of the experts shared the vision for community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Opportunities to achieve this vision included IT solutions, professional skills, and interprofessional collaboration. Threats included costs, pharmacists' attitude, and the absence of IT solutions. Those responsible for IT development in community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies. Copyright © 2011 Elsevier Inc. All rights reserved.

The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo.

PubMed

Mohammad, Tasneem F; Al-Jamal, Mohammed; Hamzavi, Iltefat H; Harris, John E; Leone, Giovanni; Cabrera, Raúl; Lim, Henry W; Pandya, Amit G; Esmat, Samia M

2017-05-01

Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world. To create phototherapy recommendations to facilitate clinical management and identify areas requiring future research. The Vitiligo Working Group (VWG) Phototherapy Committee addressed 19 questions regarding the administration of phototherapy over 3 conference calls. Members of the Photomedicine Society and a group of phototherapy experts were surveyed regarding their phototherapy practices. Based on comparison and analysis of survey results, expert opinion, and discussion held during conference calls, expert recommendations for the administration of NBUVB phototherapy in vitiligo were created. There were several areas that required further research before final recommendations could be made. In addition, no standardized methodology was used during literature review and to assess the strength of evidence during the development of these recommendations. This set of expert recommendations by the VWG is based on the prescribing practices of phototherapy experts from around the world to create a unified, broadly applicable set of recommendations on the use of NBUVB in vitiligo. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Artificial intelligence and space power systems automation

NASA Technical Reports Server (NTRS)

Weeks, David J.

1987-01-01

Various applications of artificial intelligence to space electrical power systems are discussed. An overview is given of completed, on-going, and planned knowledge-based system activities. These applications include the Nickel-Cadmium Battery Expert System (NICBES) (the expert system interfaced with the Hubble Space Telescope electrical power system test bed); the early work with the Space Station Experiment Scheduler (SSES); the three expert systems under development in the space station advanced development effort in the core module power management and distribution system test bed; planned cooperation of expert systems in the Core Module Power Management and Distribution (CM/PMAD) system breadboard with expert systems for the space station at other research centers; and the intelligent data reduction expert system under development.

Operator Performance Support System (OPSS)

NASA Technical Reports Server (NTRS)

Conklin, Marlen Z.

1993-01-01

In the complex and fast reaction world of military operations, present technologies, combined with tactical situations, have flooded the operator with assorted information that he is expected to process instantly. As technologies progress, this flow of data and information have both guided and overwhelmed the operator. However, the technologies that have confounded many operators today can be used to assist him -- thus the Operator Performance Support Team. In this paper we propose an operator support station that incorporates the elements of Video and Image Databases, productivity Software, Interactive Computer Based Training, Hypertext/Hypermedia Databases, Expert Programs, and Human Factors Engineering. The Operator Performance Support System will provide the operator with an integrating on-line information/knowledge system that will guide expert or novice to correct systems operations. Although the OPSS is being developed for the Navy, the performance of the workforce in today's competitive industry is of major concern. The concepts presented in this paper which address ASW systems software design issues are also directly applicable to industry. the OPSS will propose practical applications in how to more closely align the relationships between technical knowledge and equipment operator performance.

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative.

PubMed

Dick, Andrew D; Rosenbaum, James T; Al-Dhibi, Hassan A; Belfort, Rubens; Brézin, Antoine P; Chee, Soon Phaik; Davis, Janet L; Ramanan, Athimalaipet V; Sonoda, Koh-Hei; Carreño, Ester; Nascimento, Heloisa; Salah, Sawsen; Salek, Sherveen; Siak, Jay; Steeples, Laura

2018-05-01

An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Seeking an oracle: using the Delphi process to develop practice guidelines for the treatment of endometriosis with Chinese herbal medicine.

PubMed

Flower, Andrew; Lewith, George T; Little, Paul

2007-11-01

For most complementary and alternative medicine interventions, the absence of a high-quality evidence base to define good practice presents a serious problem for clinicians, educators, and researchers. The Delphi process may offer a pragmatic way to establish good practice guidelines until more rigorous forms of assessment can be undertaken. To use a modified Delphi to develop good practice guidelines for a feasibility study exploring the role of Chinese herbal medicine (CHM) in the treatment of endometriosis. To compare the outcomes from Delphi with data derived from a systematic review of the Chinese language database. An expert group was convened for a three-round Delphi that initially produced key statements relating to the CHM diagnosis and treatment of endometriosis (round 1) and then anonymously rated these on a 1-7 Likert scale (rounds 2 and 3). Statements with a median score of 5 and above were regarded as demonstrating positive group consensus. The differential diagnoses within Chinese Medicine and rating of the clinical value of individual herbs were then contrasted with comparable data from a review of Chinese language reports in the Chinese Biomedical Retrieval System (1978-2002), and China Academy of Traditional Chinese Medicine (1985-2002) databases and the Chinese TCM and magazine literature (1984-2004) databases. Consensus (good practice) guidelines for the CHM treatment of endometriosis relating to common diagnostic patterns, herb selection, dosage, and patient management were produced. The Delphi guidelines demonstrated a high degree of congruence with the information from the Chinese language databases. In the absence of rigorous evidence, Delphi offers a way to synthesize expert knowledge relating to diagnosis, patient management, and herbal selection in the treatment of endometriosis. The limitations of the expert group and the inability of Delphi to capture the subtle nuances of individualized clinical decision-making limit the usefulness of this approach.

Reforming the Portuguese mental health system: an incentive-based approach.

PubMed

Perelman, Julian; Chaves, Pedro; de Almeida, José Miguel Caldas; Matias, Maria Ana

2018-01-01

To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

Treatment of Childhood and Adolescent Obesity: An Integrative Review of Recent Recommendations from Five Expert Groups

ERIC Educational Resources Information Center

Kirschenbaum, Daniel S.; Gierut, Kristen

2013-01-01

Objective: To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. Method: We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and…

Inclusive Practices at the Teacher and Class Level: The Experts' View

ERIC Educational Resources Information Center

Bešic, Edvina; Paleczek, Lisa; Krammer, Mathias; Gasteiger-Klicpera, Barbara

2017-01-01

One concern for teachers and schools is how to implement inclusion. This paper examines its implementation at the teacher and class level in Styria, (a state in Austria). To do so, a qualitative study with expert interviews was conducted. Twenty-five experts from seven schools and four Centres for Inclusion and Special Education were interviewed.…

Considerations in development of expert systems for real-time space applications

NASA Technical Reports Server (NTRS)

Murugesan, S.

1988-01-01

Over the years, demand on space systems has increased tremendously and this trend will continue for the near future. Enhanced capabilities of space systems, however, can only be met with increased complexity and sophistication of onboard and ground systems. Artificial Intelligence and expert system techniques have great potential in space applications. Expert systems could facilitate autonomous decision making, improve in-orbit fault diagnosis and repair, enhance performance and reduce reliance on ground support. However, real-time expert systems, unlike conventional off-line consultative systems, have to satisfy certain special stringent requirements before they could be used for onboard space applications. Challenging and interesting new environments are faced while developing expert system space applications. This paper discusses the special characteristics, requirements and typical life cycle issues for onboard expert systems. Further, it also describes considerations in design, development, and implementation which are particularly important to real-time expert systems for space applications.

[Medical expert assessment in criminal processes from the legal viewpoint].

PubMed

Ulsenheimer, K

1996-11-01

In the area of medical professional blunder, the medical expert witness is the one participant in a trial whose statement is practically decisive for the court or the prosecutor. Legally, the responsibility remains naturally in the legal hand as the expert witness is only the assistant of the judge. The most important demands on the expert witness are strict objectiveness including towards the colleague, no independent inquiries or interrogations, comprehensive processing of the expert assessment, readiness to revise a written expert assessment according to better knowledge or new facts, independence from the client, no legal comments, clarity of language and intellectual honesty.

Electronic Nicotine Delivery Systems (ENDS): What Nurses Need to Know.

PubMed

Essenmacher, Carol; Naegle, Madeline; Baird, Carolyn; Vest, Bridgette; Spielmann, Rene; Smith-East, Marie; Powers, Leigh

Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. Current knowledge gaps in research literature and practice implications of the literature are discussed. The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven.

Automatic Sleep Stage Determination by Multi-Valued Decision Making Based on Conditional Probability with Optimal Parameters

NASA Astrophysics Data System (ADS)

Wang, Bei; Sugi, Takenao; Wang, Xingyu; Nakamura, Masatoshi

Data for human sleep study may be affected by internal and external influences. The recorded sleep data contains complex and stochastic factors, which increase the difficulties for the computerized sleep stage determination techniques to be applied for clinical practice. The aim of this study is to develop an automatic sleep stage determination system which is optimized for variable sleep data. The main methodology includes two modules: expert knowledge database construction and automatic sleep stage determination. Visual inspection by a qualified clinician is utilized to obtain the probability density function of parameters during the learning process of expert knowledge database construction. Parameter selection is introduced in order to make the algorithm flexible. Automatic sleep stage determination is manipulated based on conditional probability. The result showed close agreement comparing with the visual inspection by clinician. The developed system can meet the customized requirements in hospitals and institutions.

Priorities and Future Actions for an Effective Use of Phytotherapy in Livestock—Outputs from an Expert Workshop

PubMed Central

Blanco-Penedo, Isabel; Fernández González, César; Tamminen, Lena-Mari; Sundrum, Albert; Emanuelson, Ulf

2018-01-01

This study reflects on the recognised need for more joined-up, high-quality research on phytotherapy that addresses the current societal challenges in finding alternatives to the use of antibiotics. The study applied a multidisciplinary participatory approach in an expert workshop exercise within the FP7 EU IMPRO project. Prior to this study, a literature review was elaborated on research in the field of phytotherapy as applied to farm animals, cooperation between research bodies and initiatives to reduce the use of antibiotics by using phytotherapeutic remedies. The review was delivered to the participants of the workshop so as to receive feedback on it and enrich the discussion. Different expertise, background in research or veterinary practice, and varying positions regarding phytotherapy were the criteria in targeting participants. A structured workshop was subsequently organised, with questions to experts addressing scientific validation of phytotherapy, effective treatment under farm conditions and necessary developments for the future. Challenges identified by the experts were as follows: poor study designs, lack of reproducibility of studies, poor standardisation of products, cost–benefit concerns, lack of veterinarian training and poor data availability. To overcome obstacles, the need for improved study designs for clinical trials was given priority in order to prove the efficacy of remedies and to implement a monitoring system which enables the assessment of the effectiveness of treatments in farm practice. Reflections in this report are intended to be a resource for scientists, policy makers and end users for an effective use of phytotherapy at farm level. PMID:29404346

An hierarchical approach to performance evaluation of expert systems

NASA Technical Reports Server (NTRS)

Dominick, Wayne D. (Editor); Kavi, Srinu

1985-01-01

The number and size of expert systems is growing rapidly. Formal evaluation of these systems - which is not performed for many systems - increases the acceptability by the user community and hence their success. Hierarchical evaluation that had been conducted for computer systems is applied for expert system performance evaluation. Expert systems are also evaluated by treating them as software systems (or programs). This paper reports many of the basic concepts and ideas in the Performance Evaluation of Expert Systems Study being conducted at the University of Southwestern Louisiana.

An engineering approach to the use of expert systems technology in avionics applications

NASA Technical Reports Server (NTRS)

Duke, E. L.; Regenie, V. A.; Brazee, M.; Brumbaugh, R. W.

1986-01-01

The concept of using a knowledge compiler to transform the knowledge base and inference mechanism of an expert system into a conventional program is presented. The need to accommodate real-time systems requirements in applications such as embedded avionics is outlined. Expert systems and a brief comparison of expert systems and conventional programs are reviewed. Avionics applications of expert systems are discussed before the discussions of applying the proposed concept to example systems using forward and backward chaining.

Expert systems for real-time monitoring and fault diagnosis

NASA Technical Reports Server (NTRS)

Edwards, S. J.; Caglayan, A. K.

1989-01-01

Methods for building real-time onboard expert systems were investigated, and the use of expert systems technology was demonstrated in improving the performance of current real-time onboard monitoring and fault diagnosis applications. The potential applications of the proposed research include an expert system environment allowing the integration of expert systems into conventional time-critical application solutions, a grammar for describing the discrete event behavior of monitoring and fault diagnosis systems, and their applications to new real-time hardware fault diagnosis and monitoring systems for aircraft.

Equating an expert system to a classifier in order to evaluate the expert system

NASA Technical Reports Server (NTRS)

Odell, Patrick L.

1989-01-01

A strategy to evaluate an expert system is formulated. The strategy proposed is based on finding an equivalent classifier to an expert system and evaluate that classifier with respect to an optimal classifier, a Bayes classifier. Here it is shown that for the rules considered an equivalent classifier exists. Also, a brief consideration of meta and meta-meta rules is included. Also, a taxonomy of expert systems is presented and an assertion made that an equivalent classifier exists for each type of expert system in the taxonomy with associated sets of underlying assumptions.

Three CLIPS-based expert systems for solving engineering problems

NASA Technical Reports Server (NTRS)

Parkinson, W. J.; Luger, G. F.; Bretz, R. E.

1990-01-01

We have written three expert systems, using the CLIPS PC-based expert system shell. These three expert systems are rule based and are relatively small, with the largest containing slightly less than 200 rules. The first expert system is an expert assistant that was written to help users of the ASPEN computer code choose the proper thermodynamic package to use with their particular vapor-liquid equilibrium problem. The second expert system was designed to help petroleum engineers choose the proper enhanced oil recovery method to be used with a given reservoir. The effectiveness of each technique is highly dependent upon the reservoir conditions. The third expert system is a combination consultant and control system. This system was designed specifically for silicon carbide whisker growth. Silicon carbide whiskers are an extremely strong product used to make ceramic and metal composites. The manufacture of whiskers is a very complicated process. which to date. has defied a good mathematical model. The process was run by experts who had gained their expertise by trial and error. A system of rules was devised by these experts both for procedure setup and for the process control. In this paper we discuss the three problem areas of the design, development and evaluation of the CLIPS-based programs.

Module generation for self-testing integrated systems

NASA Astrophysics Data System (ADS)

Vanriessen, Ronald Pieter

Hardware used for self test in VLSI (Very Large Scale Integrated) systems is reviewed, and an architecture to control the test hardware in an integrated system is presented. Because of the increase of test times, the use of self test techniques has become practically and economically viable for VLSI systems. Beside the reduction in test times and costs, self test also provides testing at operational speeds. Therefore, a suitable combination of scan path and macrospecific (self) tests is required to reduce test times and costs. An expert system that can be used in a silicon compilation environment is presented. The approach requires a minimum of testability knowledge from a system designer. A user friendly interface was described for specifying and modifying testability requirements by a testability expert. A reason directed backtracking mechanism is used to solve selection failures. Both the hierarchical testable architecture and the design for testability expert system are used in a self test compiler. The definition of a self test compiler was given. A self test compiler is a software tool that selects an appropriate test method for every macro in a design. The hardware to control a macro test will be included in the design automatically. As an example, the integration of the self-test compiler in a silicon compilation system PIRAMID was described. The design of a demonstrator circuit by self test compiler is described. This circuit consists of two self testable macros. Control of the self test hardware is carried out via the test access port of the boundary scan standard.

Small Knowledge-Based Systems in Education and Training: Something New Under the Sun.

ERIC Educational Resources Information Center

Wilson, Brent G.; Welsh, Jack R.

1986-01-01

Discusses artificial intelligence, robotics, natural language processing, and expert or knowledge-based systems research; examines two large expert systems, MYCIN and XCON; and reviews the resources required to build large expert systems and affordable smaller systems (intelligent job aids) for training. Expert system vendors and products are…

Designing and validation of a yoga-based intervention for obsessive compulsive disorder.

PubMed

Bhat, Shubha; Varambally, Shivarama; Karmani, Sneha; Govindaraj, Ramajayam; Gangadhar, B N

2016-06-01

Some yoga-based practices have been found to be useful for patients with obsessive compulsive disorder (OCD). The authors could not find a validated yoga therapy module available for OCD. This study attempted to formulate a generic yoga-based intervention module for OCD. A yoga module was designed based on traditional and contemporary yoga literature. The module was sent to 10 yoga experts for content validation. The experts rated the usefulness of the practices on a scale of 1-5 (5 = extremely useful). The final version of the module was pilot-tested on patients with OCD (n = 17) for both feasibility and effect on symptoms. Eighty-eight per cent (22 out of 25) of the items in the initial module were retained, with modifications in the module as suggested by the experts along with patients' inputs and authors' experience. The module was found to be feasible and showed an improvement in symptoms of OCD on total Yale-Brown Obsessive-Compulsive Scale (YBOCS) score (p = 0.001). A generic yoga therapy module for OCD was validated by experts in the field and found feasible to practice in patients. A decrease in the symptom scores was also found following yoga practice of 2 weeks. Further clinical validation is warranted to confirm efficacy.

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process.

PubMed

Sweidan, Michelle; Williamson, Margaret; Reeve, James F; Harvey, Ken; O'Neill, Jennifer A; Schattner, Peter; Snowdon, Teri

2010-04-15

Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

PubMed Central

2010-01-01

Background Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Methods Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. Results A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. Conclusions This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries. PMID:20398294

Interfaces and Expert Systems for Online Retrieval.

ERIC Educational Resources Information Center

Kehoe, Cynthia A.

1985-01-01

This paper reviews the history of separate online system interfaces which led to efforts to develop expert systems for searching databases, particularly for end users, and introduces the research on such expert systems. Appended is a bibliography of sources on interfaces and expert systems for online retrieval. (Author/EJS)

Multidisciplinary Design Technology Development: A Comparative Investigation of Integrated Aerospace Vehicle Design Tools

NASA Technical Reports Server (NTRS)

Renaud, John E.; Batill, Stephen M.; Brockman, Jay B.

1999-01-01

This research effort is a joint program between the Departments of Aerospace and Mechanical Engineering and the Computer Science and Engineering Department at the University of Notre Dame. The purpose of the project was to develop a framework and systematic methodology to facilitate the application of Multidisciplinary Design Optimization (MDO) to a diverse class of system design problems. For all practical aerospace systems, the design of a systems is a complex sequence of events which integrates the activities of a variety of discipline "experts" and their associated "tools". The development, archiving and exchange of information between these individual experts is central to the design task and it is this information which provides the basis for these experts to make coordinated design decisions (i.e., compromises and trade-offs) - resulting in the final product design. Grant efforts focused on developing and evaluating frameworks for effective design coordination within a MDO environment. Central to these research efforts was the concept that the individual discipline "expert", using the most appropriate "tools" available and the most complete description of the system should be empowered to have the greatest impact on the design decisions and final design. This means that the overall process must be highly interactive and efficiently conducted if the resulting design is to be developed in a manner consistent with cost and time requirements. The methods developed as part of this research effort include; extensions to a sensitivity based Concurrent Subspace Optimization (CSSO) NMO algorithm; the development of a neural network response surface based CSSO-MDO algorithm; and the integration of distributed computing and process scheduling into the MDO environment. This report overviews research efforts in each of these focus. A complete bibliography of research produced with support of this grant is attached.

Expert and Knowledge Based Systems.

ERIC Educational Resources Information Center

Demaid, Adrian; Edwards, Lyndon

1987-01-01

Discusses the nature and current state of knowledge-based systems and expert systems. Describes an expert system from the viewpoints of a computer programmer and an applications expert. Addresses concerns related to materials selection and forecasts future developments in the teaching of materials engineering. (ML)

Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

PubMed

Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

2009-10-01

The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

Towards evidence-based, quality-controlled health promotion: the Dutch recognition system for health promotion interventions

PubMed Central

Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

2010-01-01

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and effectiveness of available health promotion interventions and to promote use of good-practice and evidence-based interventions by health promotion organizations. The quality assessments are supervised by the Netherlands Organization for Public Health and the Environment and the Netherlands Youth Institute and conducted by two committees, one for interventions aimed at youth and one for adults. These committees consist of experts in the fields of research, policy and practice. Four levels of recognition are distinguished inspired by the UK Medical Research Council's evaluation framework for complex interventions to improve health: (i) theoretically sound, (ii) probable effectiveness, (iii) established effectiveness, and (iv) established cost effectiveness. Specific criteria have been set for each level of recognition, except for Level 4 which will be included from 2011. This point of view article describes and discusses the rationale, organization and criteria of this Dutch recognition system and the first experiences with the system. PMID:20841318

Primary History: Using the Evidence of the Historic Environment. A Teacher's Guide.

ERIC Educational Resources Information Center

Corbishley, Mike; Fordham, Jennie; Gay, Susan; Hollinshead, Liz; Spicer, Suzanne; Walmsley, David

This guide aims to help busy elementary teachers make the best use of a whole range of evidence for teaching history in schools today, covering areas of study at both Key Stages 1 and 2 (in the British school system). The guide includes: clear, richly illustrated explanatory text for the non-expert, with practical advice and project ideas; how to…

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena.

PubMed

Mannix, Judy; Wilkes, Lesley; Jackson, Debra

2013-01-01

Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses' clinicians' views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses' understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An 'ideal nurse' may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community.

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

PubMed Central

2013-01-01

Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282

Expert opinions on good practice in evaluation of health promotion and primary prevention measures related to children and adolescents in Germany.

PubMed

Korber, Katharina; Becker, Christian

2017-10-02

Determining what constitutes "good practice" in the measurement of the costs and effects of health promotion and disease prevention measures is of particular importance. The aim of this paper was to gather expert knowledge on (economic) evaluations of health promotion and prevention measures for children and adolescents, especially on the practical importance, the determinants of project success, meaningful parameters for evaluations, and supporting factors, but also on problems in their implementation. This information is targeted at people responsible for the development of primary prevention or health promotion programs. Partially structured open interviews were conducted by two interviewers and transcribed, paraphrased, and summarized for further use. Eight experts took part in the interviews. The interviewed experts saw evaluation as a useful tool to establish the effects of prevention programs, to inform program improvement and further development, and to provide arguments to decision making. The respondents' thought that determinants of a program's success were effectiveness with evidence of causality, cost benefit relation, target-group reach and sustainability. It was considered important that hard and soft factors were included in an evaluation; costs were mentioned only by one expert. According to the experts, obstacles to evaluation were lacking resources, additional labor requirements, and the evaluators' unfamiliarity with a program's contents. It was recommended to consider evaluation design before a program is launched, to co-operate with people involved in a program and to make use of existing structures. While in in this study only a partial view of expert knowledge is represented, it could show important points to consider when developing evaluations of prevention programs. By considering these points, researchers could further advance towards a more comprehensive approach of evaluation targeting measures in children and adolescents.

Nursing practice. Report of a WHO expert committee.

PubMed

1996-01-01

Nursing is remarkable for the scope of activities that it includes. Nursing practice involves so many things in so many places that finding a definition that includes everything and applies everywhere is no easy task. This report by the WHO Expert Committee on Nursing Practice describes the basic functions of nursing practice and how they are manifested in different socioeconomic situations. Whatever the environment, the report concludes, there are certain core elements that are the responsibility of nurses the world over. The influence that social attitudes and political and economic policies have on nursing practice is examined. The report is honest in its admission that the situation in many places is far from ideal and that in most there is clear room for improvement. Policy-makers, legislators, managers, educators, researchers, other professionals and nurses themselves have important roles to play in a comprehensive approach to the development of nursing practice proposed by the Expert Committee. The report emphasizes the importance of a well educated and highly skilled nursing workforce that is consistent in maintaining quality of care but is also responsive to change. It points the way to international standards in nursing practice and lays the foundation for new strategies to ensure that nurses will be fully equipped to meet future challenges in the delivery of health care.

Reliability and performance evaluation of systems containing embedded rule-based expert systems

NASA Technical Reports Server (NTRS)

Beaton, Robert M.; Adams, Milton B.; Harrison, James V. A.

1989-01-01

A method for evaluating the reliability of real-time systems containing embedded rule-based expert systems is proposed and investigated. It is a three stage technique that addresses the impact of knowledge-base uncertainties on the performance of expert systems. In the first stage, a Markov reliability model of the system is developed which identifies the key performance parameters of the expert system. In the second stage, the evaluation method is used to determine the values of the expert system's key performance parameters. The performance parameters can be evaluated directly by using a probabilistic model of uncertainties in the knowledge-base or by using sensitivity analyses. In the third and final state, the performance parameters of the expert system are combined with performance parameters for other system components and subsystems to evaluate the reliability and performance of the complete system. The evaluation method is demonstrated in the context of a simple expert system used to supervise the performances of an FDI algorithm associated with an aircraft longitudinal flight-control system.

Emergency medicine point-of-care ultrasonography: a national needs assessment of competencies for general and expert practice.

PubMed

Fischer, Lisa M; Woo, Michael Y; Lee, A Curtis; Wiss, Ray; Socransky, Steve; Frank, Jason R

2015-01-01

Emergency medicine point-of-care ultrasonography (EM-PoCUS) is a core competency for residents in the Royal College of Physicians and Surgeons of Canada and College of Family Physicians of Canada emergency medicine (EM) training programs. Although EM-PoCUS fellowships are currently offered in Canada, there is little consensus regarding what training should be included in a Canadian EM-PoCUS fellowship curriculum or how this contrasts with the training received in an EM residency.Objectives To conduct a systematic needs assessment of major stakeholders to define the essential elements necessary for a Canadian EM-PoCUS fellowship training curriculum. We carried out a national survey of experts in EM-PoCUS, EM residency program directors, and EM residents. Respondents were asked to identify competencies deemed either nonessential to EM practice, essential for general EM practice, essential for advanced EM practice, or essential for EM-PoCUS fellowship trained (‘‘expert’’) practice. The response rate was 81% (351 of 435). PoCUS was deemed essential to general EM practice for basic cardiac, aortic, trauma, and procedural imaging. PoCUS was deemed essential to advanced EM practice in undifferentiated symptomatology, advanced chest pathologies, and advanced procedural applications. Expert-level PoCUS competencies were identified for administrative, pediatric, and advanced gynecologic applications. Eighty-seven percent of respondents indicated that there was a need for EM-PoCUS fellowships, with an ideal length of 6 months. This is the first needs assessment of major stakeholders in Canada to identify competencies for expert training in EM-PoCUS. The competencies should form the basis for EM-PoCUS fellowship programs in Canada.

Executing CLIPS expert systems in a distributed environment

NASA Technical Reports Server (NTRS)

Taylor, James; Myers, Leonard

1990-01-01

This paper describes a framework for running cooperating agents in a distributed environment to support the Intelligent Computer Aided Design System (ICADS), a project in progress at the CAD Research Unit of the Design Institute at the California Polytechnic State University. Currently, the systems aids an architectural designer in creating a floor plan that satisfies some general architectural constraints and project specific requirements. At the core of ICADS is the Blackboard Control System. Connected to the blackboard are any number of domain experts called Intelligent Design Tools (IDT). The Blackboard Control System monitors the evolving design as it is being drawn and helps resolve conflicts from the domain experts. The user serves as a partner in this system by manipulating the floor plan in the CAD system and validating recommendations made by the domain experts. The primary components of the Blackboard Control System are two expert systems executed by a modified CLIPS shell. The first is the Message Handler. The second is the Conflict Resolver. The Conflict Resolver synthesizes the suggestions made by the domain experts, which can be either CLIPS expert systems, or compiled C programs. In DEMO1, the current ICADS prototype, the CLIPS domain expert systems are Acoustics, Lighting, Structural, and Thermal; the compiled C domain experts are the CAD system and the User Interface.

Expert system prototype developments for NASA-KSC business and engineering applications

NASA Technical Reports Server (NTRS)

Ragusa, James M.; Gonzalez, Avelino J.

1988-01-01

Prototype expert systems developed for a variety of NASA projects in the business/management and engineering domains are discussed. Business-related problems addressed include an assistant for simulating launch vehicle processing, a plan advisor for the acquisition of automated data processing equipment, and an expert system for the identification of customer requirements. Engineering problems treated include an expert system for detecting potential ignition sources in LOX and gaseous-oxygen transportation systems and an expert system for hazardous-gas detection.

A CLIPS expert system for maximizing alfalfa (Medicago Sativa L.) production

NASA Technical Reports Server (NTRS)

Engel, B. A.; Jones, D. D.; Rhykerd, R. L.; Rhykerd, L. M.; Rhykerd, C. L., Jr.; Rhykerd, C. L.

1990-01-01

An alfalfa management expert system originally developed by Purdue University agricultural scientists on the PC Plus expert system shell from Texas Instrument has been updated and successfully converted to CLIPS (C Language Integrated Production System). This reduces the cost and legal restrictions associated with making the expert system available to agribusiness industries, extension personnel and farm managers and operators. The expert system includes recommendations concerning soil drainage, liming, P and K fertilization, weed control, variety selection and seeding rate including pure live seeds.

Practical Solutions for Pesticide Safety: A Farm and Research Team Participatory Model

PubMed Central

Galvin, Kit; Krenz, Jen; Harrington, Marcy; Palmández, Pablo; Fenske, Richard A.

2018-01-01

Development of the Practical Solutions for Pesticide Safety guide used participatory research strategies to identify and evaluate solutions that reduce pesticide exposures for workers and their families and to disseminate these solutions. Project principles were (1) workplace chemicals belong in the workplace, and (2) pesticide handlers and farm managers are experts, with direct knowledge of production practices. The project’s participatory methods were grounded in self-determination theory. Practical solutions were identified and evaluated based on five criteria: practicality, adaptability, health and safety, novelty, and regulatory compliance. Research activities that had more personal contact provided better outcomes. The Expert Working Group, composed of farm managers and pesticide handlers, was key to the identification of solutions, as were farm site visits. Audience participation, hands-on testing, and orchard field trials were particularly effective in the evaluation of potential solutions. Small work groups in a Regional Advisory Committee provided the best direction and guidance for a “user-friendly” translational document that provided evidence-based practical solutions. The “farmer to farmer” format of the guide was endorsed by both the Expert Working Group and the Regional Advisory Committee. Managers and pesticide handlers wanted to share their solutions in order to “help others stay safe,” and they appreciated attribution in the guide. The guide is now being used in educational programs across the region. The fundamental concept that farmers and farmworkers are innovators and experts in agricultural production was affirmed by this study. The success of this process demonstrates the value of participatory industrial hygiene in agriculture. PMID:26488540

Practical Solutions for Pesticide Safety: A Farm and Research Team Participatory Model.

PubMed

Galvin, Kit; Krenz, Jen; Harrington, Marcy; Palmández, Pablo; Fenske, Richard A

2016-01-01

Development of the Practical Solutions for Pesticide Safety guide used participatory research strategies to identify and evaluate solutions that reduce pesticide exposures for workers and their families and to disseminate these solutions. Project principles were (1) workplace chemicals belong in the workplace, and (2) pesticide handlers and farm managers are experts, with direct knowledge of production practices. The project's participatory methods were grounded in self-determination theory. Practical solutions were identified and evaluated based on five criteria: practicality, adaptability, health and safety, novelty, and regulatory compliance. Research activities that had more personal contact provided better outcomes. The Expert Working Group, composed of farm managers and pesticide handlers, was key to the identification of solutions, as were farm site visits. Audience participation, hands-on testing, and orchard field trials were particularly effective in the evaluation of potential solutions. Small work groups in a Regional Advisory Committee provided the best direction and guidance for a "user-friendly" translational document that provided evidence-based practical solutions. The "farmer to farmer" format of the guide was endorsed by both the Expert Working Group and the Regional Advisory Committee. Managers and pesticide handlers wanted to share their solutions in order to "help others stay safe," and they appreciated attribution in the guide. The guide is now being used in educational programs across the region. The fundamental concept that farmers and farmworkers are innovators and experts in agricultural production was affirmed by this study. The success of this process demonstrates the value of participatory industrial hygiene in agriculture.

Knowledge-based fault diagnosis system for refuse collection vehicle

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tan, CheeFai; Juffrizal, K.; Khalil, S. N.

The refuse collection vehicle is manufactured by local vehicle body manufacturer. Currently; the company supplied six model of the waste compactor truck to the local authority as well as waste management company. The company is facing difficulty to acquire the knowledge from the expert when the expert is absence. To solve the problem, the knowledge from the expert can be stored in the expert system. The expert system is able to provide necessary support to the company when the expert is not available. The implementation of the process and tool is able to be standardize and more accurate. The knowledgemore » that input to the expert system is based on design guidelines and experience from the expert. This project highlighted another application on knowledge-based system (KBS) approached in trouble shooting of the refuse collection vehicle production process. The main aim of the research is to develop a novel expert fault diagnosis system framework for the refuse collection vehicle.« less

iRENEX: a clinically informed decision support system for the interpretation of ⁹⁹mTc-MAG3 scans to detect renal obstruction.

PubMed

Garcia, Ernest V; Taylor, Andrew; Folks, Russell; Manatunga, Daya; Halkar, Raghuveer; Savir-Baruch, Bital; Dubovsky, Eva

2012-09-01

Decision support systems for imaging analysis and interpretation are rapidly being developed and will have an increasing impact on the practice of medicine. RENEX is a renal expert system to assist physicians evaluate suspected obstruction in patients undergoing mercaptoacetyltriglycine (MAG3) renography. RENEX uses quantitative parameters extracted from the dynamic renal scan data using QuantEM™II and heuristic rules in the form of a knowledge base gleaned from experts to determine if a kidney is obstructed; however, RENEX does not have access to and could not consider the clinical information available to diagnosticians interpreting these studies. We designed and implemented a methodology to incorporate clinical information into RENEX, implemented motion detection and evaluated this new comprehensive system (iRENEX) in a pilot group of 51 renal patients. To reach a conclusion as to whether a kidney is obstructed, 56 new clinical rules were added to the previously reported 60 rules used to interpret quantitative MAG3 parameters. All the clinical rules were implemented after iRENEX reached a conclusion on obstruction based on the quantitative MAG3 parameters, and the evidence of obstruction was then modified by the new clinical rules. iRENEX consisted of a library to translate parameter values to certainty factors, a knowledge base with 116 heuristic interpretation rules, a forward chaining inference engine to determine obstruction and a justification engine. A clinical database was developed containing patient histories and imaging report data obtained from the hospital information system associated with the pertinent MAG3 studies. The system was fine-tuned and tested using a pilot group of 51 patients (21 men, mean age 58.2 ± 17.1 years, 100 kidneys) deemed by an expert panel to have 61 unobstructed and 39 obstructed kidneys. iRENEX, using only quantitative MAG3 data agreed with the expert panel in 87 % (34/39) of obstructed and 90 % (55/61) of unobstructed kidneys. iRENEX, using both quantitative and clinical data agreed with the expert panel in 95 % (37/39) of obstructed and 92 % (56/61) of unobstructed kidneys. The clinical information significantly (p < 0.001) increased iRENEX certainty in detecting obstruction over using the quantitative data alone. Our renal expert system for detecting renal obstruction has been substantially expanded to incorporate the clinical information available to physicians as well as advanced quality control features and was shown to interpret renal studies in a pilot group at a standardized expert level. These encouraging results warrant a prospective study in a large population of patients with and without renal obstruction to establish the diagnostic performance of iRENEX.

Potential application of machine vision technology to saffron (Crocus sativus L.) quality characterization.

PubMed

Kiani, Sajad; Minaei, Saeid

2016-12-01

Saffron quality characterization is an important issue in the food industry and of interest to the consumers. This paper proposes an expert system based on the application of machine vision technology for characterization of saffron and shows how it can be employed in practical usage. There is a correlation between saffron color and its geographic location of production and some chemical attributes which could be properly used for characterization of saffron quality and freshness. This may be accomplished by employing image processing techniques coupled with multivariate data analysis for quantification of saffron properties. Expert algorithms can be made available for prediction of saffron characteristics such as color as well as for product classification. Copyright © 2016. Published by Elsevier Ltd.

To Think or Not to Think: The Apparent Paradox of Expert Skill in Music Performance

ERIC Educational Resources Information Center

Geeves, Andrew; McIlwain, Doris J. F.; Sutton, John; Christensen, Wayne

2014-01-01

Expert skill in music performance involves an apparent paradox. On stage, expert musicians are required accurately to retrieve information that has been encoded over hours of practice. Yet they must also remain open to the demands of the ever-changing situational contingencies with which they are faced during performance. To further explore this…

The Designer-by-Assignment in Practice: Instructional Design Thinking of Subject Matter Experts

ERIC Educational Resources Information Center

Pesce, Sandra V.

2012-01-01

Designers-by-assignment, or subject matter experts (SMEs) who are pressed into training service, have become common in the workplace. A review of more than 24 studies on expert and novice instructional designers, however, revealed that little is known about how designers-by-assignment think about design and make design decisions in the field. A…

Expert searching in health librarianship: a literature review to identify international issues and Australian concerns.

PubMed

Lasserre, Kaye

2012-03-01

The traditional role of health librarians as expert searchers is under challenge. The purpose of this review is to establish health librarians' views, practices and educational processes on expert searching. The search strategy was developed in LISTA and then customised for ten other databases: ALISA, PubMed, Embase, Scopus, Web of Science, CINAHL, ERIC, PsycINFO, Cochrane Library and Google Scholar. The search terms were (expert search* OR expert retriev* OR mediated search* OR information retriev*) AND librar*. The searches, completed in December 2010 and repeated in May 2011, were limited to English language publications from 2000 to 2011 (unless seminal works). Expert searching remains a key role for health librarians, especially for those supporting systematic reviews or employed as clinical librarians answering clinical questions. Although clients tend to be satisfied with searches carried out for them, improvements are required to effectively position the profession. Evidence-based guidelines, adherence to transparent standards, review of entry-level education requirements and a commitment to accredited, rigorous, ongoing professional development will ensure best practice. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

Explainable expert systems: A research program in information processing

NASA Technical Reports Server (NTRS)

Paris, Cecile L.

1993-01-01

Our work in Explainable Expert Systems (EES) had two goals: to extend and enhance the range of explanations that expert systems can offer, and to ease their maintenance and evolution. As suggested in our proposal, these goals are complementary because they place similar demands on the underlying architecture of the expert system: they both require the knowledge contained in a system to be explicitly represented, in a high-level declarative language and in a modular fashion. With these two goals in mind, the Explainable Expert Systems (EES) framework was designed to remedy limitations to explainability and evolvability that stem from related fundamental flaws in the underlying architecture of current expert systems.

SWAN: An expert system with natural language interface for tactical air capability assessment

NASA Technical Reports Server (NTRS)

Simmons, Robert M.

1987-01-01

SWAN is an expert system and natural language interface for assessing the war fighting capability of Air Force units in Europe. The expert system is an object oriented knowledge based simulation with an alternate worlds facility for performing what-if excursions. Responses from the system take the form of generated text, tables, or graphs. The natural language interface is an expert system in its own right, with a knowledge base and rules which understand how to access external databases, models, or expert systems. The distinguishing feature of the Air Force expert system is its use of meta-knowledge to generate explanations in the frame and procedure based environment.

DELTA: An Expert System for Diesel Electric Locomotive Repair

DTIC Science & Technology

1984-06-01

Rules and Inference Mechanisms. AD-P003 943 The ACE (Automated Cable Expert) Exlpelient: Initial Evaluation of an Expert System for Preventive...tions. The first field prototype expert system, designated CATS -i (Computer-Aided Troubleshooting System - Version 1), was delivered in July 1983 and is

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus.

PubMed

Evers, Andrea W M; Colloca, Luana; Blease, Charlotte; Annoni, Marco; Atlas, Lauren Y; Benedetti, Fabrizio; Bingel, Ulrike; Büchel, Christian; Carvalho, Claudia; Colagiuri, Ben; Crum, Alia J; Enck, Paul; Gaab, Jens; Geers, Andrew L; Howick, Jeremy; Jensen, Karin B; Kirsch, Irving; Meissner, Karin; Napadow, Vitaly; Peerdeman, Kaya J; Raz, Amir; Rief, Winfried; Vase, Lene; Wager, Tor D; Wampold, Bruce E; Weimer, Katja; Wiech, Katja; Kaptchuk, Ted J; Klinger, Regine; Kelley, John M

2018-06-12

Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice. © 2018 S. Karger AG, Basel.

Process for massage therapy practice and essential assessment.

PubMed

Kennedy, Ann Blair; Cambron, Jerrilyn A; Sharpe, Patricia A; Travillian, Ravensara S; Saunders, Ruth P

2016-07-01

Little evidence exists about processes in massage therapy practice. Investigating current frameworks is warranted. This qualitative study is a secondary data analysis using grounded theory to understand how massage therapy experts describe massage therapy practice. 31 massage therapy experts were invited to a 2-day symposium to discuss best practices for the profession. Through qualitative analysis, memoing, and discussion, the data were summarized into themes. Three themes were identified around massage therapy practice: 1) client centered, 2) structure for practice, and 3) influencing factors. Each theme is clarified and expanded. Conceptual models were developed for research and clinical practice and a definition for massage therapy practice was identified. Challenges and limitations are discussed. The goal of providing these models is to give massage therapists tools to deliver the best possible care. The models need testing to see if they help advance the profession. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Techniques for capturing expert knowledge - An expert systems/hypertext approach

NASA Technical Reports Server (NTRS)

Lafferty, Larry; Taylor, Greg; Schumann, Robin; Evans, Randy; Koller, Albert M., Jr.

1990-01-01

The knowledge-acquisition strategy developed for the Explosive Hazards Classification (EHC) Expert System is described in which expert systems and hypertext are combined, and broad applications are proposed. The EHC expert system is based on rapid prototyping in which primary knowledge acquisition from experts is not emphasized; the explosive hazards technical bulletin, technical guidance, and minimal interviewing are used to develop the knowledge-based system. Hypertext is used to capture the technical information with respect to four issues including procedural, materials, test, and classification issues. The hypertext display allows the integration of multiple knowlege representations such as clarifications or opinions, and thereby allows the performance of a broad range of tasks on a single machine. Among other recommendations, it is suggested that the integration of hypertext and expert systems makes the resulting synergistic system highly efficient.

Diagnosis - Using automatic test equipment and artificial intelligence expert systems

NASA Astrophysics Data System (ADS)

Ramsey, J. E., Jr.

Three expert systems (ATEOPS, ATEFEXPERS, and ATEFATLAS), which were created to direct automatic test equipment (ATE), are reviewed. The purpose of the project was to develop an expert system to troubleshoot the converter-programmer power supply card for the F-15 aircraft and have that expert system direct the automatic test equipment. Each expert system uses a different knowledge base or inference engine, basing the testing on the circuit schematic, test requirements document, or ATLAS code. Implementing generalized modules allows the expert systems to be used for any different unit under test. Using converted ATLAS to LISP code allows the expert system to direct any ATE using ATLAS. The constraint propagated frame system allows for the expansion of control by creating the ATLAS code, checking the code for good software engineering techniques, directing the ATE, and changing the test sequence as needed (planning).

Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: a network modelling approach

PubMed Central

2014-01-01

Objective The objective of this study is to develop a statistical model to assess factors associated with information seeking in a Canadian public health department. Methods Managers and professional consultants of a public health department serving a large urban population named whom they turned to for help, whom they considered experts in evidence-informed practice, and whom they considered friends. Multilevel regression analysis and exponential random graph modeling were used to predict the formation of information seeking and expertise-recognition connections by personal characteristics of the seeker and source, and the structural attributes of the social networks. Results The respondents were more likely to recognize the members of the supervisory/administrative division as experts. The extent to which an individual implemented evidence-based practice (EBP) principles in daily practice was a significant predictor of both being an information source and being recognized as expert by peers. Friendship was a significant predictor of both information seeking and expertise-recognition connections. Conclusion The analysis showed a communication network segregated by organizational divisions. Managers were identified frequently as information sources, even though this is not a part of their formal role. Self-perceived implementation of EBP in practice was a significant predictor of being an information source or an expert, implying a positive atmosphere towards implementation of evidence-informed decision making in this public health organization. Results also implied that the perception of accessibility and trust were significant predictors of expertise recognition. PMID:24565228

Using Moos To Help Learn English; Video Jigsaw; Practicing Speaking with Follow-Up Interviews and Student-Read Dictations; "Ask the Expert": Oral Presentations that Work; The Medium Is the Message.

ERIC Educational Resources Information Center

Miller, James; Reynolds, Judith; Noble, P. C.; Altschuler, Lee; Schauber, Holli

2001-01-01

Four short articles provide teaching tips for the English-as-a-Second/Foreign-Language classroom, including the use of Moos, a video jigsaw, practicing oral language skills with interviews and student-read dictations, an ask the expert activity which builds learner confidence in speaking in front of groups of people. (Author/VWL)

Expectations of medical specialists about image-based teleconsultation – A qualitative study on acute burns in South Africa

PubMed Central

Laflamme, Lucie; Mölsted Alvesson, Helle

2018-01-01

Background Image-based teleconsultation between medical experts and healthcare staff at remote emergency centres can improve the diagnosis of conditions which are challenging to assess. One such condition is burns. Knowledge is scarce regarding how medical experts perceive the influence of such teleconsultation on their roles and relations to colleagues at point of care. Methods In this qualitative study, semi-structured interviews were conducted with 15 medical experts to explore their expectations of a newly developed App for burns diagnostics and care prior to its implementation. Purposive sampling included male and female physicians at different stages of their career, employed at different referral hospitals and all potential future tele-experts in remote teleconsultation using the App. Positioning theory was used to analyse the data. Results The experts are already facing changes in their diagnostic practices due to the informal use of open access applications like WhatsApp. Additional changes are expected when the new App is launched. Four positions of medical experts were identified in situations of diagnostic advice, two related to patient flow–clinical specialist and gatekeeper–and two to point of care staff–educator and mentor. The experts move flexibly between the positions during diagnostic practices with remote colleagues. A new position in relation to previous research on medical roles–the mentor–came to light in this setting. The App is expected to have an important educational impact, streamline the diagnostic process, improve both triage and referrals and be a more secure option for remote diagnosis compared to current practices. Verbal communication is however expected to remain important for certain situations, in particular those related to the mentor position. Conclusion The quality and security of referrals are expected to be improved through the App but the medical experts see less potential for conveying moral support via the App during remote consultations. Experts’ reflections on remote consultations highlight the embedded social and cultural dimensions of implementing new technology. PMID:29543847

Techniques and implementation of the embedded rule-based expert system using Ada

NASA Technical Reports Server (NTRS)

Liberman, Eugene M.; Jones, Robert E.

1991-01-01

Ada is becoming an increasingly popular programming language for large Government-funded software projects. Ada with its portability, transportability, and maintainability lends itself well to today's complex programming environment. In addition, expert systems have also assured a growing role in providing human-like reasoning capability and expertise for computer systems. The integration of expert system technology with Ada programming language, specifically a rule-based expert system using an ART-Ada (Automated Reasoning Tool for Ada) system shell is discussed. The NASA Lewis Research Center was chosen as a beta test site for ART-Ada. The test was conducted by implementing the existing Autonomous Power EXpert System (APEX), a Lisp-base power expert system, in ART-Ada. Three components, the rule-based expert system, a graphics user interface, and communications software make up SMART-Ada (Systems fault Management with ART-Ada). The main objective, to conduct a beta test on the ART-Ada rule-based expert system shell, was achieved. The system is operational. New Ada tools will assist in future successful projects. ART-Ada is one such tool and is a viable alternative to the straight Ada code when an application requires a rule-based or knowledge-based approach.

Expert Systems--The New International Language of Business.

ERIC Educational Resources Information Center

Sondak, Norman E.; And Others

A discussion of expert systems, computer programs designed to simulate human reasoning and expertise, begins with the assumption that few business educators understand the impact that expert systems will have on international business. The fundamental principles of the design and development of expert systems in business are outlined, with special…

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

Decoding the Disciplines as a Hermeneutic Practice

ERIC Educational Resources Information Center

Yeo, Michelle

2017-01-01

This chapter argues that expert practice is an inquiry that surfaces a hermeneutic relationship between theory, practice, and the world, with implications for new lines of questioning in the Decoding interview.

Are Earth System model software engineering practices fit for purpose? A case study.

NASA Astrophysics Data System (ADS)

Easterbrook, S. M.; Johns, T. C.

2009-04-01

We present some analysis and conclusions from a case study of the culture and practices of scientists at the Met Office and Hadley Centre working on the development of software for climate and Earth System models using the MetUM infrastructure. The study examined how scientists think about software correctness, prioritize their requirements in making changes, and develop a shared understanding of the resulting models. We conclude that highly customized techniques driven strongly by scientific research goals have evolved for verification and validation of such models. In a formal software engineering context these represents costly, but invaluable, software integration tests with considerable benefits. The software engineering practices seen also exhibit recognisable features of both agile and open source software development projects - self-organisation of teams consistent with a meritocracy rather than top-down organisation, extensive use of informal communication channels, and software developers who are generally also users and science domain experts. We draw some general conclusions on whether these practices work well, and what new software engineering challenges may lie ahead as Earth System models become ever more complex and petascale computing becomes the norm.

Expert anticipatory skill in striking sports: a review and a model.

PubMed

Müller, Sean; Abernethy, Bruce

2012-06-01

Expert performers in striking sports can hit objects moving at high speed with incredible precision. Exceptionally well developed anticipation skills are necessary to cope with the severe constraints on interception. In this papr we provide a review of the empirical evidence regarding expert interception in striking sports and propose a preliminary model of expert anticipation. Central to the review and the model is the notion that the visual information used to guide the sequential phases of the striking action is systematically different between experts and nonexperts. Knowing the factors that contribute to expert anticipation, and how anticipation may guide skilled performance in striking sports, has practical implications for assessment and training across skill levels.

Expert Systems in Education and Training: Automated Job Aids or Sophisticated Instructional Media?

ERIC Educational Resources Information Center

Romiszowski, Alexander J.

1987-01-01

Describes the current status and limitations of expert systems, and explores the possible applications of such systems in education and training. The use of expert systems as tutors, as job aids, and as a vehicle for students to develop their own expert systems on specific topics are discussed. (40 references) (CLB)

Expert systems and simulation models; Proceedings of the Seminar, Tucson, AZ, November 18, 19, 1985

NASA Technical Reports Server (NTRS)

1986-01-01

The seminar presents papers on modeling and simulation methodology, artificial intelligence and expert systems, environments for simulation/expert system development, and methodology for simulation/expert system development. Particular attention is given to simulation modeling concepts and their representation, modular hierarchical model specification, knowledge representation, and rule-based diagnostic expert system development. Other topics include the combination of symbolic and discrete event simulation, real time inferencing, and the management of large knowledge-based simulation projects.

Strategies for adding adaptive learning mechanisms to rule-based diagnostic expert systems

NASA Technical Reports Server (NTRS)

Stclair, D. C.; Sabharwal, C. L.; Bond, W. E.; Hacke, Keith

1988-01-01

Rule-based diagnostic expert systems can be used to perform many of the diagnostic chores necessary in today's complex space systems. These expert systems typically take a set of symptoms as input and produce diagnostic advice as output. The primary objective of such expert systems is to provide accurate and comprehensive advice which can be used to help return the space system in question to nominal operation. The development and maintenance of diagnostic expert systems is time and labor intensive since the services of both knowledge engineer(s) and domain expert(s) are required. The use of adaptive learning mechanisms to increment evaluate and refine rules promises to reduce both time and labor costs associated with such systems. This paper describes the basic adaptive learning mechanisms of strengthening, weakening, generalization, discrimination, and discovery. Next basic strategies are discussed for adding these learning mechanisms to rule-based diagnostic expert systems. These strategies support the incremental evaluation and refinement of rules in the knowledge base by comparing the set of advice given by the expert system (A) with the correct diagnosis (C). Techniques are described for selecting those rules in the in the knowledge base which should participate in adaptive learning. The strategies presented may be used with a wide variety of learning algorithms. Further, these strategies are applicable to a large number of rule-based diagnostic expert systems. They may be used to provide either immediate or deferred updating of the knowledge base.

ART-Ada design project, phase 2

NASA Technical Reports Server (NTRS)

Lee, S. Daniel; Allen, Bradley P.

1990-01-01

Interest in deploying expert systems in Ada has increased. An Ada based expert system tool is described called ART-Ada, which was built to support research into the language and methodological issues of expert systems in Ada. ART-Ada allows applications of an existing expert system tool called ART-IM (Automated Reasoning Tool for Information Management) to be deployed in various Ada environments. ART-IM, a C-based expert system tool, is used to generate Ada source code which is compiled and linked with an Ada based inference engine to produce an Ada executable image. ART-Ada is being used to implement several expert systems for NASA's Space Station Freedom Program and the U.S. Air Force.

Attitudes of Agricultural Experts Toward Genetically Modified Crops: A Case Study in Southwest Iran.

PubMed

Ghanian, Mansour; Ghoochani, Omid M; Kitterlin, Miranda; Jahangiry, Sheida; Zarafshani, Kiumars; Van Passel, Steven; Azadi, Hossein

2016-04-01

The production of genetically modified (GM) crops is growing around the world, and with it possible opportunities to combat food insecurity and hunger, as well as solutions to current problems facing conventional agriculture. In this regard the use of GMOs in food and agricultural applications has increased greatly over the past decade. However, the development of GM crops has been a matter of considerable interest and worldwide public controversy. This, in addition to skepticism, has stifled the use of this practice on a large scale in many areas, including Iran. It stands to reason that a greater understanding of this practice could be formed after a review of the existing expert opinions surrounding GM crops. Therefore, the purpose of this study was to analyze the predictors that influence agricultural experts' attitudes toward the development of and policies related to GM crops. Using a descriptive correlational research method, questionnaire data was collected from 65 experts from the Agricultural Organization in the Gotvand district in Southwest Iran. Results indicated that agricultural experts were aware of the environmental benefits and possible risks associated with GM crops. The majority of participants agreed that GM crops could improve food security and accelerate rural development, and were proponents of labeling practices for GM crops. Finally, there was a positive correlation between the perception of benefits and attitudes towards GM crops.

On using ethical principles of community-engaged research in translational science.

PubMed

Khodyakov, Dmitry; Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2016-05-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits," the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. Copyright © 2016 Elsevier Inc. All rights reserved.

Expert golf instructors' student-teacher interaction patterns.

PubMed

Schempp, Paul; McCullick, Bryan; St Pierre, Peter; Woorons, Sophie; You, JeongAe; Clark, Betsy

2004-03-01

The purpose of this study was to identify the dominant instructional interaction patterns of expert golf instructors. Instructors (N = 22) were selected by the Ladies Professional Golf Association (LPGA) Teaching based on the following criteria: (a) 10 or more years of golf teaching experience, (b) LPGA certification, (c) awards received for the quality of their instruction, and (d) peer and student recognition for outstanding teaching. The instructors were videotaped teaching a 60-min lesson to a novice college-age woman with no previous golf experience. The tapes were then analyzed using both the Cheffers Adaptation of Flanders' Interaction Analysis System (CAFIAS) and a qualitative analysis. Based on the findings from descriptive statistics and correlation analyses of the CAFIAS data and qualitative data analysis, several trends were identified. First, the dominant instructional behavior of these teachers was providing information to the students using both explanations and demonstrations. Second, the prevailing instructional interaction pattern of the expert teachers included extensive explanations and demonstrations followed by directions. The student followed the directions by practicing skills and received praise for their achievements. Third, high rates of directions and praise from teachers prompted student practice. Fourth, engaging students in subject-related discussion was positively correlated with teachers' questions but negatively correlated with teachers' criticisms. Finally, teacher acceptance was positively correlated with student analytic behavior, while teachers' talk negatively correlated with students initiating discussions.

On Using Ethical Principles of Community-Engaged Research in Translational Science

PubMed Central

Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2015-01-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of healthcare systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a re-consideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted two online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed nine ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA Appropriateness Method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be “grounded in trust.” While the academic panel endorsed “culturally appropriate” and “forthcoming with community about study risks and benefits,” the mixed academic-community panel endorsed “scientifically valid” and “ready to involve community in interpretation and dissemination” as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. PMID:26773561

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

PubMed

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

A biomechanical comparison between expert and novice manual materials handlers using a multi-joint EMG-assisted optimization musculoskeletal model of the lumbar spine.

PubMed

Gagnon, Denis; Plamondon, André; Larivière, Christian

2016-09-06

Expertise is a key factor modulating the risk of low back disorders (LBD). Through years of practice in the workplace, the typical expert acquires high level specific skills and maintains a clean record of work-related injuries. Ergonomic observations of manual materials handling (MMH) tasks show that expert techniques differ from those of novices, leading to the idea that expert techniques are safer. Biomechanical studies of MMH tasks performed by experts/novices report mixed results for kinematic/kinetic variables, evoking potential internal effect of expertise. In the context of series of box transfers simulated by actual workers, detailed internal loads predicted by a multiple-joint EMG-assisted optimization lumbar spine model are compared between experts and novices. The results confirmed that the distribution of internal moments are modulated by worker expertise. Experts flexed less their lumbar spine and exerted more active muscle forces while novices relied more on passive resistance of the muscles and ligamentous spine. More specifically for novices, the passive contributions came from global extensor muscles, selected local extensor muscles, and passive structures of the lumbar spine (ligaments and discs). The distinctive distribution of internal forces was not concomitant with a similar effect on joint forces, these forces being dependent on external loading which was equivalent between experts and novices. From a safety standpoint, the present results suggest that experts were more efficient than novices in partitioning internal moment contributions to balance net (external) loading. Thus, safer handling practices might be seen as a result of experts׳ experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

A neural network architecture for implementation of expert systems for real time monitoring

NASA Technical Reports Server (NTRS)

Ramamoorthy, P. A.

1991-01-01

Since neural networks have the advantages of massive parallelism and simple architecture, they are good tools for implementing real time expert systems. In a rule based expert system, the antecedents of rules are in the conjunctive or disjunctive form. We constructed a multilayer feedforward type network in which neurons represent AND or OR operations of rules. Further, we developed a translator which can automatically map a given rule base into the network. Also, we proposed a new and powerful yet flexible architecture that combines the advantages of both fuzzy expert systems and neural networks. This architecture uses the fuzzy logic concepts to separate input data domains into several smaller and overlapped regions. Rule-based expert systems for time critical applications using neural networks, the automated implementation of rule-based expert systems with neural nets, and fuzzy expert systems vs. neural nets are covered.

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations.

PubMed

Oddo, Mauro; Poole, Daniele; Helbok, Raimund; Meyfroidt, Geert; Stocchetti, Nino; Bouzat, Pierre; Cecconi, Maurizio; Geeraerts, Thomas; Martin-Loeches, Ignacio; Quintard, Hervé; Taccone, Fabio Silvio; Geocadin, Romergryko G; Hemphill, Claude; Ichai, Carole; Menon, David; Payen, Jean-François; Perner, Anders; Smith, Martin; Suarez, José; Videtta, Walter; Zanier, Elisa R; Citerio, Giuseppe

2018-04-01

To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients. A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions-using a sequential approach to avoid biases and misinterpretations-was used to generate the final consensus statement. The final consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements. We present a consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients.

Bridging Body and Mind: Considerations for Trauma-Informed Yoga.

PubMed

Justice, Lauren; Brems, Christiane; Ehlers, Karrie

2018-02-08

Individuals who suffer from trauma-related symptoms are a unique population that could benefit from the mind-body practice of yoga-or have their symptoms reactivated by it, depending on the type of yoga. Trauma-informed yoga (TIY), that is, yoga adapted to the unique needs of individuals working to overcome trauma, may ameliorate symptoms by creating a safe, tailored practice for students to learn how to respond, rather than react, to symptoms and circumstances. Yoga not thus adapted, on the other hand, may increase reactivity and activate symptoms such as hyperarousal or dissociation. This article reports on expert input about adapting yoga for individuals with trauma, with special considerations for military populations. Eleven experts, recruited based on literature review and referrals, were interviewed in person or via telephone and asked seven questions about trauma-informed yoga. Verbatim transcripts were subjected to open-coding thematic analysis and a priori themes. Findings revealed that TIY needs to emphasize beneficial practices (e.g., diaphragmatic breath and restorative postures), consider contraindications (e.g., avoiding sequences that overly engage the sympathetic nervous system), adapt to limitations and challenges for teaching in unconventional settings (e.g., prisons, VA hospitals), and provide specialized training and preparation (e.g., specialized TIY certifications, self-care of instructors/therapists, adaptions for student needs). TIY for veterans must additionally consider gender- and culture-related barriers, differing relationships to pain and injury, and medication as a barrier to practice.

What Is An Expert System? ERIC Digest.

ERIC Educational Resources Information Center

Boss, Richard W.

This digest describes and defines the various components of an expert system, e.g., a computerized tool designed to enhance the quality and availability of knowledge required by decision makers. It is noted that expert systems differ from conventional applications software in the following areas: (1) the existence of the expert systems shell, or…

Rhetorical Consequences of the Computer Society: Expert Systems and Human Communication.

ERIC Educational Resources Information Center

Skopec, Eric Wm.

Expert systems are computer programs that solve selected problems by modelling domain-specific behaviors of human experts. These computer programs typically consist of an input/output system that feeds data into the computer and retrieves advice, an inference system using the reasoning and heuristic processes of human experts, and a knowledge…

Expert Systems: A Challenge for the Reading Profession.

ERIC Educational Resources Information Center

Balajthy, Ernest

The expert systems are designed to imitate the reasoning of a human expert in a content area field. Designed to be advisors, these software systems combine the content area knowledge and decision-making ability of an expert with the user's understanding and knowledge of particular circumstances. The reading diagnosis system, the RD2P System…

Expert Systems: Implications for the Diagnosis and Treatment of Learning Disabilities.

ERIC Educational Resources Information Center

Hofmeister, Alan M.; Lubke, Margaret M.

1988-01-01

The article examines characteristics and present or potential applications of expert systems technology for diagnosis and treatment of learning disabilities. Preliminary findings indicate that expert systems can perform as well as humans in specific areas, and that the process of organizing knowledge bases for expert systems helps clarify existing…

Development of knowledge base of intellectual system for support of formal and informal training of IT staff

NASA Astrophysics Data System (ADS)

Kurvaeva, L. V.; Gavrilova, I. V.; Mahmutova, M. V.; Chichilanova, S. A.; Povituhin, S. A.

2018-05-01

The choice of educational digital content, according to education goals (descriptors which are formed by competences, labor functions, etc.), becomes an important practical task because of the variety of existing educational online systems that is available to persons within formal, informal IT education formats. Ontologies can form a basis for working out knowledge bases, which are center of intellectual system support in IT specialist training. The paper describes a technology of ontological model creation; analyzes the structure and the content of basic data. The structure of knowledge interrelation of the considered subject and IT education is considered. This knowledge base is applied for solving tasks of educational and methodical supplementation of educational programs of the higher and additional professional education, corporate training; for creating systems of certification and testing for students and practicing experts; for forming individual trajectories of training and career development.

Design of an Ada expert system shell for the VHSIC avionic modular flight processor

NASA Technical Reports Server (NTRS)

Fanning, F. Jesse

1992-01-01

The Embedded Computer System Expert System Shell (ES Shell) is an Ada-based expert system shell developed at the Avionics Laboratory for use on the VHSIC Avionic Modular Processor (VAMP) running under the Ada Avionics Real-Time Software (AARTS) Operating System. The ES Shell provides the interface between the expert system and the avionics environment, and controls execution of the expert system. Testing of the ES Shell in the Avionics Laboratory's Integrated Test Bed (ITB) has demonstrated its ability to control a non-deterministic software application executing on the VAMP's which can control the ITB's real-time closed-loop aircraft simulation. The results of these tests and the conclusions reached in the design and development of the ES Shell have played an important role in the formulation of the requirements for a production-quality expert system inference engine, an ingredient necessary for the successful use of expert systems on the VAMP embedded avionic flight processor.

The need for a comprehensive expert system development methodology

NASA Technical Reports Server (NTRS)

Baumert, John; Critchfield, Anna; Leavitt, Karen

1988-01-01

In a traditional software development environment, the introduction of standardized approaches has led to higher quality, maintainable products on the technical side and greater visibility into the status of the effort on the management side. This study examined expert system development to determine whether it differed enough from traditional systems to warrant a reevaluation of current software development methodologies. Its purpose was to identify areas of similarity with traditional software development and areas requiring tailoring to the unique needs of expert systems. A second purpose was to determine whether existing expert system development methodologies meet the needs of expert system development, management, and maintenance personnel. The study consisted of a literature search and personal interviews. It was determined that existing methodologies and approaches to developing expert systems are not comprehensive nor are they easily applied, especially to cradle to grave system development. As a result, requirements were derived for an expert system development methodology and an initial annotated outline derived for such a methodology.

42 CFR 423.120 - Access to covered Part D drugs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... majority of members who are practicing physicians and/or practicing pharmacists. (ii) Includes at least one practicing physician and at least one practicing pharmacist who are independent and free of conflict relative... least one practicing physician and one practicing pharmacist who are experts regarding care of elderly...

42 CFR 423.120 - Access to covered Part D drugs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... majority of members who are practicing physicians and/or practicing pharmacists. (ii) Includes at least one practicing physician and at least one practicing pharmacist who are independent and free of conflict relative... least one practicing physician and one practicing pharmacist who are experts regarding care of elderly...

Validation of an expert system intended for research in distributed artificial intelligence

NASA Technical Reports Server (NTRS)

Grossner, C.; Lyons, J.; Radhakrishnan, T.

1991-01-01

The expert system discussed in this paper is designed to function as a testbed for research on cooperating expert systems. Cooperating expert systems are members of an organization which dictates the manner in which the expert systems will interact when solving a problem. The Blackbox Expert described in this paper has been constructed using the C Language Integrated Production System (CLIPS), C++, and X windowing environment. CLIPS is embedded in a C++ program which provides objects that are used to maintain the state of the Blackbox puzzle. These objects are accessed by CLIPS rules through user-defined functions calls. The performance of the Blackbox Expert is validated by experimentation. A group of people are asked to solve a set of test cases for the Blackbox puzzle. A metric has been devised which evaluates the 'correctness' of a solution proposed for a test case of Blackbox. Using this metric and the solutions proposed by the humans, each person receives a rating for their ability to solve the Blackbox puzzle. The Blackbox Expert solves the same set of test cases and is assigned a rating for its ability. Then the rating obtained by the Blackbox Expert is compared with the ratings of the people, thus establishing the skill level of our expert system.

Problem representation and variation in the forecasts of ’political experts’

DTIC Science & Technology

2001-06-01

artificial intelligence classification of the themes that were used by the Presidential Commission on Women in Combat. Psychological constraints to...In contrast, controls for expert-novice differences is standard practice in psychology . Cognitive psychologists who have studied how experts and...participant=s Athink aloud@ analysis from Alevel of verbosity.@ By summarizing verbatim statements associated with free-hand cognitive diagrams it

Photolithography diagnostic expert systems: a systematic approach to problem solving in a wafer fabrication facility

NASA Astrophysics Data System (ADS)

Weatherwax Scott, Caroline; Tsareff, Christopher R.

1990-06-01

One of the main goals of process engineering in the semiconductor industry is to improve wafer fabrication productivity and throughput. Engineers must work continuously toward this goal in addition to performing sustaining and development tasks. To accomplish these objectives, managers must make efficient use of engineering resources. One of the tools being used to improve efficiency is the diagnostic expert system. Expert systems are knowledge based computer programs designed to lead the user through the analysis and solution of a problem. Several photolithography diagnostic expert systems have been implemented at the Hughes Technology Center to provide a systematic approach to process problem solving. This systematic approach was achieved by documenting cause and effect analyses for a wide variety of processing problems. This knowledge was organized in the form of IF-THEN rules, a common structure for knowledge representation in expert system technology. These rules form the knowledge base of the expert system which is stored in the computer. The systems also include the problem solving methodology used by the expert when addressing a problem in his area of expertise. Operators now use the expert systems to solve many process problems without engineering assistance. The systems also facilitate the collection of appropriate data to assist engineering in solving unanticipated problems. Currently, several expert systems have been implemented to cover all aspects of the photolithography process. The systems, which have been in use for over a year, include wafer surface preparation (HMDS), photoresist coat and softbake, align and expose on a wafer stepper, and develop inspection. These systems are part of a plan to implement an expert system diagnostic environment throughout the wafer fabrication facility. In this paper, the systems' construction is described, including knowledge acquisition, rule construction, knowledge refinement, testing, and evaluation. The roles played by the process engineering expert and the knowledge engineer are discussed. The features of the systems are shown, particularly the interactive quality of the consultations and the ease of system use.

MOORE: A prototype expert system for diagnosing spacecraft problems

NASA Technical Reports Server (NTRS)

Howlin, Katherine; Weissert, Jerry; Krantz, Kerry

1988-01-01

MOORE is a rule-based, prototype expert system that assists in diagnosing operational Tracking and Data Relay Satellite (TDRS) problems. It is intended to assist spacecraft engineers at the TDRS ground terminal in trouble shooting problems that are not readily solved with routine procedures, and without expert counsel. An additional goal of the prototype system is to develop in-house expert system and knowledge engineering skills. The prototype system diagnoses antenna pointing and earth pointing problems that may occur within the TDRS Attitude Control System (ACS). Plans include expansion to fault isolation of problems in the most critical subsystems of the TDRS spacecraft. Long term benefits are anticipated with use of an expert system during future TDRS programs with increased mission support time, reduced problem solving time, and retained expert knowledge and experience. Phase 2 of the project is intended to provide NASA the necessary expertise and capability to define requirements, evaluate proposals, and monitor the development progress of a highly competent expert system for NASA's Tracking Data Relay Satellite. Phase 2 also envisions addressing two unexplored applications for expert systems, spacecraft integration and tests (I and T) and support to launch activities. The concept, goals, domain, tools, knowledge acquisition, developmental approach, and design of the expert system. It will explain how NASA obtained the knowledge and capability to develop the system in-house without assistance from outside consultants. Future plans will also be presented.

[ANALYSIS USING AN EXPERT PANEL OF ACTIVITIES AND COMPETENCIES WHICH NURSING CLINICAL PRACTICE TUTORS IN THE COMUNIDAD AUTÓNOMA DE MADRID SHOULD POSSESS].

PubMed

Argüello López, María Teresa; Palmar Santos, Ana María; Sellán Soto, Carmen

2015-01-01

Although practical training has always been important in Nursing, it has reached a new dimension in the European Higher Education Area. This has involved adapting the syllabus, where one of the new features is considering clinical practice as an independent subject and also including the concept of competence as a result of the students' learning. The figure of the tutor becomes one of the key factors and therefore their activities and competencies must be defined. To enumerate and prioritize, by agreement, the main activities and competences by the tutor of clinical practices in the Comunidad Autónoma de Madrid should posses. METHODOLOGY. Quantitative focus, analysis by group of experts between 2010 and 2013. RESULTS. A total of 510 nurses have participated, 17 panels of experts have met and consensus has been reached on 22 competencies and 12 activities. The description of activities and competencies can be extremely useful for selecting, evaluating and developing nursing clinical practice tutors, becoming a baseline and reducing the subjectivity in the development of tutors according to the new demands of the European Higher Education Area.

Joint University Program for Air Transportation Research, 1989-1990

NASA Technical Reports Server (NTRS)

Morrell, Frederick R. (Compiler)

1990-01-01

Research conducted during the academic year 1989-90 under the NASA/FAA sponsored Joint University Program for Air Transportation research is discussed. Completed works, status reports and annotated bibliographies are presented for research topics, which include navigation, guidance and control theory and practice, aircraft performance, human factors, and expert systems concepts applied to airport operations. An overview of the year's activities for each university is also presented.

Rocket Design for the Future

NASA Technical Reports Server (NTRS)

Follett, William W.; Rajagopal, Raj

2001-01-01

The focus of the AA MDO team is to reduce product development cost through the capture and automation of best design and analysis practices and through increasing the availability of low-cost, high-fidelity analysis. Implementation of robust designs reduces costs associated with the Test-Fall-Fix cycle. RD is currently focusing on several technologies to improve the design process, including optimization and robust design, expert and rule-based systems, and collaborative technologies.

Code of ethics for the national pharmaceutical system: Codifying and compilation

PubMed Central

Salari, Pooneh; Namazi, Hamidreza; Abdollahi, Mohammad; Khansari, Fatemeh; Nikfar, Shekoufeh; Larijani, Bagher; Araminia, Behin

2013-01-01

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended. PMID:24174954

Knowledge engineering for health: a new discipline required to bridge the "ICT gap" between research and healthcare.

PubMed

Beck, Tim; Gollapudi, Sirisha; Brunak, Søren; Graf, Norbert; Lemke, Heinz U; Dash, Debasis; Buchan, Iain; Díaz, Carlos; Sanz, Ferran; Brookes, Anthony J

2012-05-01

Despite vast amount of money and research being channeled toward biomedical research, relatively little impact has been made on routine clinical practice. At the heart of this failure is the information and communication technology "chasm" that exists between research and healthcare. A new focus on "knowledge engineering for health" is needed to facilitate knowledge transmission across the research-healthcare gap. This discipline is required to engineer the bidirectional flow of data: processing research data and knowledge to identify clinically relevant advances and delivering these into healthcare use; conversely, making outcomes from the practice of medicine suitably available for use by the research community. This system will be able to self-optimize in that outcomes for patients treated by decisions that were based on the latest research knowledge will be fed back to the research world. A series of meetings, culminating in the "I-Health 2011" workshop, have brought together interdisciplinary experts to map the challenges and requirements for such a system. Here, we describe the main conclusions from these meetings. An "I4Health" interdisciplinary network of experts now exists to promote the key aims and objectives, namely "integrating and interpreting information for individualized healthcare," by developing the "knowledge engineering for health" domain. © 2012 Wiley Periodicals, Inc.

Expert systems applied to spacecraft fire safety

NASA Technical Reports Server (NTRS)

Smith, Richard L.; Kashiwagi, Takashi

1989-01-01

Expert systems are problem-solving programs that combine a knowledge base and a reasoning mechanism to simulate a human expert. The development of an expert system to manage fire safety in spacecraft, in particular the NASA Space Station Freedom, is difficult but clearly advantageous in the long-term. Some needs in low-gravity flammability characteristics, ventilating-flow effects, fire detection, fire extinguishment, and decision models, all necessary to establish the knowledge base for an expert system, are discussed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

MacAllister, D.J.; Day, R.; McCormack, M.D.

This paper gives an overview of a major integrated oil company`s experience with artificial intelligence (AI) over the last 5 years, with an emphasis on expert systems. The authors chronicle the development of an AI group, including details on development tool selection, project selection strategies, potential pitfalls, and descriptions of several completed expert systems. Small expert systems produced by teams of petroleum technology experts and experienced expert system developers that are focused in well-defined technical areas have produced substantial benefits and accelerated petroleum technology transfer.

An expert systems approach to automated fault management in a regenerative life support subsystem

NASA Technical Reports Server (NTRS)

Malin, J. T.; Lance, N., Jr.

1986-01-01

This paper describes FIXER, a prototype expert system for automated fault management in a regenerative life support subsystem typical of Space Station applications. The development project provided an evaluation of the use of expert systems technology to enhance controller functions in space subsystems. The software development approach permitted evaluation of the effectiveness of direct involvement of the expert in design and development. The approach also permitted intensive observation of the knowledge and methods of the expert. This paper describes the development of the prototype expert system and presents results of the evaluation.

Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment.

PubMed

de Wit, Maike; Ortner, Petra; Lipp, Hans-Peter; Sehouli, Jalid; Untch, Michael; Ruhnke, Markus; Mayer-Steinacker, Regine; Bokemeyer, Carsten; Jordan, Karin

2013-01-01

Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects. Copyright © 2013 S. Karger AG, Basel.

Tracking Plasticity: Effects of Long-Term Rehearsal in Expert Dancers Encoding Music to Movement

PubMed Central

Bar, Rachel J.; DeSouza, Joseph F. X.

2016-01-01

Our knowledge of neural plasticity suggests that neural networks show adaptation to environmental and intrinsic change. In particular, studies investigating the neuroplastic changes associated with learning and practicing motor tasks have shown that practicing such tasks results in an increase in neural activation in several specific brain regions. However, studies comparing experts and non-experts suggest that experts employ less neuronal activation than non-experts when performing a familiar motor task. Here, we aimed to determine the long-term changes in neural networks associated with learning a new dance in professional ballet dancers over 34 weeks. Subjects visualized dance movements to music while undergoing fMRI scanning at four time points over 34-weeks. Results demonstrated that initial learning and performance at seven weeks led to increases in activation in cortical regions during visualization compared to the first week. However, at 34 weeks, the cortical networks showed reduced activation compared to week seven. Specifically, motor learning and performance over the 34 weeks showed the typical inverted-U-shaped function of learning. Further, our result demonstrate that learning of a motor sequence of dance movements to music in the real world can be visualized by expert dancers using fMRI and capture highly significant modeled fits of the brain network variance of BOLD signals from early learning to expert level performance. PMID:26824475

Expert Consensus Survey on Medication Adherence in Psychiatric Patients and Use of a Digital Medicine System.

PubMed

Hatch, Ainslie; Docherty, John P; Carpenter, Daniel; Ross, Ruth; Weiden, Peter J

2017-07-01

There is an unmet need to objectively assess adherence problems that are a common cause of unexplained or unexpected suboptimal outcome. A digital medicine system (DMS) has been developed to address this need in patients with serious mental illness. To conduct a quantitative expert consensus survey to (1) assess relative importance of causes of suboptimal outcomes, (2) examine modalities used to assess adherence, (3) provide guidance on when and how to use the DMS in clinical practice once available, and (4) suggest interventions for specific reasons for nonadherence. A panel of 58 experts in psychiatry completed a 23-question survey (October 13 through December 23, 2013) and rated their responses on a 9-point Likert scale. A χ² test of score distributions was used to determine consensus (P < .05). The panel rated adherence as the most important factor in suboptimal outcomes and yet the least likely to be assessed accurately. All predefined uses of the DMS received high mean first-line ratings (≥ 7.4). The experts recognized the utility of the DMS in managing adherence problems, identified clinical situations appropriate for DMS, and assessed potential benefits and challenges of this technology. Consensus was reached on first-line interventions for 10 of 11 reasons for nonadherence. The results provide a guide to clinicians on the evaluation of suboptimal outcomes, when and how to use the DMS, and the most appropriate interventions to address detected adherence problems. © Copyright 2017 Physicians Postgraduate Press, Inc.

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children.

PubMed

Peckover, Sue; Aston, Megan

2018-01-01

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families. © 2017 John Wiley & Sons Ltd.

A modified Delphi translation strategy and challenges of International Classification for Nursing Practice (ICNP®).

PubMed

Hou, I-Ching; Chang, Polun; Chan, Hui-Ya; Dykes, Patricia C

2013-05-01

Standardized terminology is an important infrastructure component of the electronic health record. ICNP(®) is a systemic coding system that can support the development of nursing information systems. Translation of the standardized terminology preferred terms into local terms is an important first step in the translation process. The purpose of this case report is to describe the translation strategy used and challenges faced in translating ICNP(®) Version 2 preferred terms from English to traditional Chinese. A modified Delphi strategy using forward translation and expert consensus was conducted to facilitate semantic and cultural translation and validation of the ICNP(®) and to make the process generalizable. A nursing informatics expert completed the initial forward translation. Five nursing experts with rich clinical and academic experiences joined this process and validated the initial translation. The nursing experts' consensus was then used to finalize the traditional Chinese terms. A total of 1863 preferred terms from the ICNP(®) Version 2 were translated from English into traditional Chinese. Majority agreement from two or more nursing experts was achieved for 98.3% (n=1832) of the preferred term translations. Less than 2% (n=31) of terms had no majority agreement. Translation challenges include the following: (1) changes in code structure of preferred terms from the ICNP(®) β2 version to Verson 2, (2) inability to identify resources to complete the translation that fully met ICNP recommendations for terminology translators, (3) ambiguous preferred term descriptions, and (4) ambiguous preferred term names. Most of the ICNP(®) Version 2 preferred terms were translated from English into traditional Chinese with majority consensus. For the terms without consensus, we recommend that all synonyms be included in the ICNP(®) translation. In countries like Taiwan where nursing education occurs in English, it is recommended that English terms are displayed along with the translated official language to help nurses to interpret and use the terminology correctly. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Evolution of a research prototype expert system for endemic populations of mountain pine beetle in lodgepole pine forests

Treesearch

Dale L. Bartos; Kent B. Downing

1989-01-01

A knowledge acquisition program was written to aid in obtaining knowledge from the experts concerning endemic populations of mountain pine beetle in lodgepole pine forest. An application expert system is then automatically generated by the knowledge acquisition program that contains the codified base of expert knowledge. Data can then be entered into the expert system...

Debating the legitimacy of a contested environmental illness: a case study of multiple chemical sensitivities (MCS).

PubMed

Phillips, Tarryn

2010-11-01

More than 20years after it was first identified, the anomalous condition, multiple chemical sensitivities (MCS), remains immersed in controversy, with a continuing debate over its causation being played out in the medico-scientific community and in the courts. This article examines why sceptical and supportive experts disagree over the condition's legitimacy as an organic condition. Drawing on ethnographic research conducted in Perth, Western Australia, the author scrutinises the decision-making practices of 16 experts (eight sceptical and eight supportive of a chemical explanation). Both groups were found to use evidence-based, inductive reasoning. However, sceptical experts tended to use a different set of evidence requirements, exhibited more faith in the efficiency of the current biomedical paradigm regarding toxicity and were less likely to acknowledge uncertainty in their field. All the experts recognised a spectrum of beliefs about the causal mechanisms of MCS. However, when they were engaged in litigation as expert witnesses due to their supportive or sceptical tendency, the oppositional legal system polarised their opinions and exacerbated the perceived divide between them. Ultimately, the adversarial medico-legal process inhibits genuine dialogue between some of the key players in the MCS debate, thus impeding understanding and consensus about the condition. © 2010 The Author. Sociology of Health & Illness © 2010 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

An SSME High Pressure Oxidizer Turbopump diagnostic system using G2 real-time expert system

NASA Technical Reports Server (NTRS)

Guo, Ten-Huei

1991-01-01

An expert system which diagnoses various seal leakage faults in the High Pressure Oxidizer Turbopump of the SSME was developed using G2 real-time expert system. Three major functions of the software were implemented: model-based data generation, real-time expert system reasoning, and real-time input/output communication. This system is proposed as one module of a complete diagnostic system for the SSME. Diagnosis of a fault is defined as the determination of its type, severity, and likelihood. Since fault diagnosis is often accomplished through the use of heuristic human knowledge, an expert system based approach has been adopted as a paradigm to develop this diagnostic system. To implement this approach, a software shell which can be easily programmed to emulate the human decision process, the G2 Real-Time Expert System, was selected. Lessons learned from this implementation are discussed.

An SSME high pressure oxidizer turbopump diagnostic system using G2(TM) real-time expert system

NASA Technical Reports Server (NTRS)

Guo, Ten-Huei

1991-01-01

An expert system which diagnoses various seal leakage faults in the High Pressure Oxidizer Turbopump of the SSME was developed using G2(TM) real-time expert system. Three major functions of the software were implemented: model-based data generation, real-time expert system reasoning, and real-time input/output communication. This system is proposed as one module of a complete diagnostic system for Space Shuttle Main Engine. Diagnosis of a fault is defined as the determination of its type, severity, and likelihood. Since fault diagnosis is often accomplished through the use of heuristic human knowledge, an expert system based approach was adopted as a paradigm to develop this diagnostic system. To implement this approach, a software shell which can be easily programmed to emulate the human decision process, the G2 Real-Time Expert System, was selected. Lessons learned from this implementation are discussed.

Operation and Structure of an Artificial Intelligence Expert Consultative System for Reading and Learning.

ERIC Educational Resources Information Center

Balajthy, Ernest

1989-01-01

The article examines decision-making expert systems and discusses their implications for diagnosis and prescription of reading difficulties. A detailed description of how a reading diagnostic expert system might operate to aid classroom teachers is followed by a discussion of advantages and limitations of expert systems for educational use.…

EXSPRT: An Expert Systems Approach to Computer-Based Adaptive Testing.

ERIC Educational Resources Information Center

Frick, Theodore W.; And Others

Expert systems can be used to aid decision making. A computerized adaptive test (CAT) is one kind of expert system, although it is not commonly recognized as such. A new approach, termed EXSPRT, was devised that combines expert systems reasoning and sequential probability ratio test stopping rules. EXSPRT-R uses random selection of test items,…

Expert database system for quality control

NASA Astrophysics Data System (ADS)

Wang, Anne J.; Li, Zhi-Cheng

1993-09-01

There are more competitors today. Markets are not homogeneous they are fragmented into increasingly focused niches requiring greater flexibility in the product mix shorter manufacturing production runs and above allhigher quality. In this paper the author identified a real-time expert system as a way to improve plantwide quality management. The quality control expert database system (QCEDS) by integrating knowledge of experts in operations quality management and computer systems use all information relevant to quality managementfacts as well as rulesto determine if a product meets quality standards. Keywords: expert system quality control data base

Parallel processing and expert systems

NASA Technical Reports Server (NTRS)

Yan, Jerry C.; Lau, Sonie

1991-01-01

Whether it be monitoring the thermal subsystem of Space Station Freedom, or controlling the navigation of the autonomous rover on Mars, NASA missions in the 90's cannot enjoy an increased level of autonomy without the efficient use of expert systems. Merely increasing the computational speed of uniprocessors may not be able to guarantee that real time demands are met for large expert systems. Speed-up via parallel processing must be pursued alongside the optimization of sequential implementations. Prototypes of parallel expert systems have been built at universities and industrial labs in the U.S. and Japan. The state-of-the-art research in progress related to parallel execution of expert systems was surveyed. The survey is divided into three major sections: (1) multiprocessors for parallel expert systems; (2) parallel languages for symbolic computations; and (3) measurements of parallelism of expert system. Results to date indicate that the parallelism achieved for these systems is small. In order to obtain greater speed-ups, data parallelism and application parallelism must be exploited.

Fault isolation detection expert (FIDEX). Part 1: Expert system diagnostics for a 30/20 Gigahertz satellite transponder

NASA Technical Reports Server (NTRS)

Durkin, John; Schlegelmilch, Richard; Tallo, Donald

1992-01-01

LeRC has recently completed the design of a Ka-band satellite transponder system, as part of the Advanced Communication Technology Satellite (ACTS) System. To enhance the reliability of this satellite, NASA funded the University of Akron to explore the application of an expert system to provide the transponder with an autonomous diagnosis capability. The results of this research was the development of a prototype diagnosis expert system called FIDEX (fault-isolation and diagnosis expert). FIDEX is a frame-based expert system that was developed in the NEXPERT Object development environment by Neuron Data, Inc. It is a MicroSoft Windows version 3.0 application, and was designed to operate on an Intel i80386 based personal computer system.

Ethical Expert Systems

PubMed Central

Victoroff, Michael S.

1985-01-01

The title is a double entendre. The discussion approaches expert systems from two directions: “What ethical hazards are created by expert systems in medicine?” and “Would it be ethical to design an expert system for solving problems in bioethics?” Computers present new ethical problems to society, some of which are unprecedented. These can be categorized under several rubrics. The paper describes a rudimentary scheme for understanding ethical issues raised by computers, in general, and medical expert systems, in particular. It focuses on bioethical implications of AI in medicine; explores norms, assumptions and taboos; and highlights certain ethical pitfalls. Principles are elucidated, for building ethically sound systems. Finally, a proposal is discussed, for the design of an expert system for moral problem solving, and the ethical implications of this notion are analyzed.

A decision-making framework for total ownership cost management of complex systems: A Delphi study

NASA Astrophysics Data System (ADS)

King, Russel J.

This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, M.; Kempner, L. Jr.; Mueller, W. III

The concept of an Expert System is not new. It has been around since the days of the early computers when scientists had dreams of robot automation to do everything from washing windows to automobile design. This paper discusses an application of an expert system and addresses software development issues and various levels of expert system development form a structural engineering viewpoint. An expert system designed to aid the structural engineer in first order inelastic analysis of latticed steel transmission powers is presented. The utilization of expert systems with large numerical analysis programs is discussed along with the software developmentmore » of such a system.« less

CLEAR: Communications Link Expert Assistance Resource

NASA Technical Reports Server (NTRS)

Hull, Larry G.; Hughes, Peter M.

1987-01-01

Communications Link Expert Assistance Resource (CLEAR) is a real time, fault diagnosis expert system for the Cosmic Background Explorer (COBE) Mission Operations Room (MOR). The CLEAR expert system is an operational prototype which assists the MOR operator/analyst by isolating and diagnosing faults in the spacecraft communication link with the Tracking and Data Relay Satellite (TDRS) during periods of realtime data acquisition. The mission domain, user requirements, hardware configuration, expert system concept, tool selection, development approach, and system design were discussed. Development approach and system implementation are emphasized. Also discussed are system architecture, tool selection, operation, and future plans.

Practice-as-Inquiry in Higher Education

ERIC Educational Resources Information Center

Johnson, Genevieve Marie

2007-01-01

Practice-as-inquiry refers to the blending of instructional practice with systematic curricular inquiry. College and university teachers, while experts in their disciplines, typically are not specialists in instructional practice. Practice-as-inquiry (also referred to as teacher-as-researcher) may function as a mechanism of continuous teaching…

Knowledge Preservation for Design of Rocket Systems

NASA Technical Reports Server (NTRS)

Moreman, Douglas

2002-01-01

An engineer at NASA Lewis RC presented a challenge to us at Southern University. Our response to that challenge, stated circa 1993, has evolved into the Knowledge Preservation Project which is here reported. The stated problem was to capture some of the knowledge of retiring NASA engineers and make it useful to younger engineers via computers. We evolved that initial challenge to this - design a system of tools such that, with this system, people might efficiently capture and make available via commonplace computers, deep knowledge of retiring NASA engineers. In the process of proving some of the concepts of this system, we would (and did) capture knowledge from some specific engineers and, so, meet the original challenge along the way to meeting the new. Some of the specific knowledge acquired, particularly that on the RL- 10 engine, was directly relevant to design of rocket engines. We considered and rejected some of the techniques popular in the days we began - specifically "expert systems" and "oral histories". We judged that these old methods had too high a cost per sentence preserved. That cost could be measured in hours of labor of a "knowledge professional". We did spend, particularly in the grant preceding this one, some time creating a couple of "concept maps", one of the latest ideas of the day, but judged this also to be costly in time of a specially trained knowledge-professional. We reasoned that the cost in specialized labor could be lowered if less time were spent being selective about sentences from the engineers and in crafting replacements for those sentences. The trade-off would seem to be that our set of sentences would be less dense in information, but we found a computer-based way around this seeming defect. Our plan, details of which we have been carrying out, was to find methods of extracting information from experts which would be capable of gaining cooperation, and interest, of senior engineers and using their time in a way they would find worthy (and, so, they would give more of their time and recruit time of other engineers as well). We studied these four ways of creating text: 1) the old way, via interviews and discussions - one of our team working with one expert, 2) a group-discussion led by one of the experts themselves and on a topic which inspires interaction of the experts, 3) a spoken dissertation by one expert practiced in giving talks, 4) expropriating, and modifying for our system, some existing reports (such as "oral histories" from the Smithsonian Institution).

International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus.

PubMed

Kleinmann, Jean-François; Tubach, Florence; Le Guern, Véronique; Mathian, Alexis; Richez, Christophe; Saadoun, David; Sacre, Karim; Sellam, Jérémie; Seror, Raphaèle; Amoura, Zahir; Andres, Emmanuel; Audia, Sylvain; Bader-Meunier, Brigitte; Blaison, Gilles; Bonnotte, Bernard; Cacoub, Patrice; Caillard, Sophie; Chiche, Laurent; Chosidow, Olivier; Costedoat-Chalumeau, Nathalie; Daien, Claire; Daugas, Eric; Derdèche, Nairouz; Doria, Andrea; Fain, Olivier; Fakhouri, Fadi; Farge, Dominique; Gabay, Cem; Guillo, Sylvie; Hachulla, Eric; Hajjaj-Hassouni, Najia; Hamidou, Mohamed; Houssiau, Frédéric A; Jourde-Chiche, Noémie; Koné-Paut, Isabelle; Ladjouz-Rezig, Aïcha; Lambotte, Olivier; Lipsker, Dan; Mariette, Xavier; Martin-Silva, Nicolas; Martin, Thierry; Maurier, François; Meckenstock, Roderich; Mékinian, Arsène; Meyer, Olivier; Mohamed, Shirine; Morel, Jacques; Moulin, Bruno; Mulleman, Denis; Papo, Thomas; Poindron, Vincent; Puéchal, Xavier; Punzi, Leonardo; Quartier, Pierre; Sailler, Laurent; Smail, Amar; Soubrier, Martin; Sparsa, Agnès; Tazi-Mezalek, Zoubida; Zakraoui, Leith; Zuily, Stéphane; Sibilia, Jean; Gottenberg, Jacques-Eric

2017-06-01

Despite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE. The recommendations were developed by a formal consensus method. This method aims to formalize the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations. A total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation. Overall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience. Copyright © 2017 Elsevier B.V. All rights reserved.

Design and implementation of a status at a glance user interface for a power distribution expert system

NASA Technical Reports Server (NTRS)

Liberman, Eugene M.; Manner, David B.; Dolce, James L.; Mellor, Pamela A.

1993-01-01

Expert systems are widely used in health monitoring and fault detection applications. One of the key features of an expert system is that it possesses a large body of knowledge about the application for which it was designed. When the user consults this knowledge base, it is essential that the expert system's reasoning process and its conclusions be as concise as possible. If, in addition, an expert system is part of a process monitoring system, the expert system's conclusions must be combined with current events of the process. Under these circumstances, it is difficult for a user to absorb and respond to all the available information. For example, a user can become distracted and confused if two or more unrelated devices in different parts of the system require attention. A human interface designed to integrate expert system diagnoses with process data and to focus the user's attention to the important matters provides a solution to the 'information overload' problem. This paper will discuss a user interface to the power distribution expert system for Space Station Freedom. The importance of features which simplify assessing system status and which minimize navigating through layers of information will be discussed. Design rationale and implementation choices will also be presented.

Training Surgical Residents With a Haptic Robotic Central Venous Catheterization Simulator.

PubMed

Pepley, David F; Gordon, Adam B; Yovanoff, Mary A; Mirkin, Katelin A; Miller, Scarlett R; Han, David C; Moore, Jason Z

Ultrasound guided central venous catheterization (CVC) is a common surgical procedure with complication rates ranging from 5 to 21 percent. Training is typically performed using manikins that do not simulate anatomical variations such as obesity and abnormal vessel positioning. The goal of this study was to develop and validate the effectiveness of a new virtual reality and force haptic based simulation platform for CVC of the right internal jugular vein. A CVC simulation platform was developed using a haptic robotic arm, 3D position tracker, and computer visualization. The haptic robotic arm simulated needle insertion force that was based on cadaver experiments. The 3D position tracker was used as a mock ultrasound device with realistic visualization on a computer screen. Upon completion of a practice simulation, performance feedback is given to the user through a graphical user interface including scoring factors based on good CVC practice. The effectiveness of the system was evaluated by training 13 first year surgical residents using the virtual reality haptic based training system over a 3 month period. The participants' performance increased from 52% to 96% on the baseline training scenario, approaching the average score of an expert surgeon: 98%. This also resulted in improvement in positive CVC practices including a 61% decrease between final needle tip position and vein center, a decrease in mean insertion attempts from 1.92 to 1.23, and a 12% increase in time spent aspirating the syringe throughout the procedure. A virtual reality haptic robotic simulator for CVC was successfully developed. Surgical residents training on the simulation improved to near expert levels after three robotic training sessions. This suggests that this system could act as an effective training device for CVC. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

TARGET: Rapid Capture of Process Knowledge

NASA Technical Reports Server (NTRS)

Ortiz, C. J.; Ly, H. V.; Saito, T.; Loftin, R. B.

1993-01-01

TARGET (Task Analysis/Rule Generation Tool) represents a new breed of tool that blends graphical process flow modeling capabilities with the function of a top-down reporting facility. Since NASA personnel frequently perform tasks that are primarily procedural in nature, TARGET models mission or task procedures and generates hierarchical reports as part of the process capture and analysis effort. Historically, capturing knowledge has proven to be one of the greatest barriers to the development of intelligent systems. Current practice generally requires lengthy interactions between the expert whose knowledge is to be captured and the knowledge engineer whose responsibility is to acquire and represent the expert's knowledge in a useful form. Although much research has been devoted to the development of methodologies and computer software to aid in the capture and representation of some types of knowledge, procedural knowledge has received relatively little attention. In essence, TARGET is one of the first tools of its kind, commercial or institutional, that is designed to support this type of knowledge capture undertaking. This paper will describe the design and development of TARGET for the acquisition and representation of procedural knowledge. The strategies employed by TARGET to support use by knowledge engineers, subject matter experts, programmers and managers will be discussed. This discussion includes the method by which the tool employs its graphical user interface to generate a task hierarchy report. Next, the approach to generate production rules for incorporation in and development of a CLIPS based expert system will be elaborated. TARGET also permits experts to visually describe procedural tasks as a common medium for knowledge refinement by the expert community and knowledge engineer making knowledge consensus possible. The paper briefly touches on the verification and validation issues facing the CLIPS rule generation aspects of TARGET. A description of efforts to support TARGET's interoperability issues on PCs, Macintoshes and UNIX workstations concludes the paper.

Executive system software design and expert system implementation

NASA Technical Reports Server (NTRS)

Allen, Cheryl L.

1992-01-01

The topics are presented in viewgraph form and include: software requirements; design layout of the automated assembly system; menu display for automated composite command; expert system features; complete robot arm state diagram and logic; and expert system benefits.

Expert Systems in Reference Services.

ERIC Educational Resources Information Center

Roysdon, Christine, Ed.; White, Howard D., Ed.

1989-01-01

Eleven articles introduce expert systems applications in library and information science, and present design and implementation issues of system development for reference services. Topics covered include knowledge based systems, prototype development, the use of artificial intelligence to remedy current system inadequacies, and an expert system to…

12. Children and Adolescents: Standards of Medical Care in Diabetes-2018.

PubMed

2018-01-01

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. © 2017 by the American Diabetes Association.

[Interprofessional education for patient-centred practice: development of outcome-focused competencies for a Bachelor Programme Interprofessional Health Care].

PubMed

Mahler, Cornelia; Karstens, Sven; Roos, Marco; Szecsenyi, Joachim

2012-01-01

Health care systems in Germany and around the world are faced with demographic change and the need of providing health services in increasingly complex health care surroundings. A highly qualified workforce is needed to face the challenges ahead and to coordinate health care. In addition, there is evidence that interprofessional education strengthens interprofessional collaboration which can lead to improved health outcomes. The University of Heidelberg, Medical Faculty, decided to develop a bachelor programme integrating specific health professions and interprofessional qualifications into the curriculum. The manuscript describes the identification process of the outcome-focused competencies for this bachelor degree. The six-step curriculum model by Kern et al. was applied. An expert panel identified major tasks and health care fields for which the students should be qualified for. These results were transferred into a questionnaire and distributed among targeted learners as well as practitioners, experts and employers in different health care fields for relevance ratings. Also, individuals were interviewed to receive additional information and to generate further ideas. Thirteen different practice fields, five tasks and thirteen topics common to all health care professions were collected. The subsequent survey comprising 66 items was completed by 139 targeted learners as well as 82 practitioners and experts. All identified practice fields were rated as relevant for future professional life. Top ratings were "supervising procedures" (targeted learners) and "interprofessional communication and coordination" (practitioners, experts and employers). The results were discussed and consented in the expert panel and learner outcomes/objectives were categorized according to the CanMED roles. A thorough needs assessment was performed setting the foundation for the further development of the curriculum. The identified competencies are in line with the five core competencies defined by the WHO which are necessary for interprofessional collaboration: patient-centred care, partnering, quality improvement, information and communication technology, and public health perspective. The application of the CanMED framework proved to be suitable. It may be used as common terminology to help define interfaces with curricula of other health professions. The interprofessional development of the bachelor programme fostered a deeper understanding between health professionals and can therefore be regarded as a first step in improving interprofessional collaboration. Copyright © 2012. Published by Elsevier GmbH.

A demonstration of expert systems applications in transportation engineering : volume III, evaluation of the prototype expert system TRANZ.

DOT National Transportation Integrated Search

1990-01-01

The validation and evaluation of an expert system for traffic control in highway work zones (TRANZ) is described. The stages in the evaluation process consisted of the following: revisit the experts, selectively distribute copies of TRANZ with docume...

The Energy Forum of Sri Lanka: Working toward appropriate expertise

NASA Astrophysics Data System (ADS)

Nieusma, Dean

Taking my cue from the knowledge base and practices comprising appropriate technology development, and building on politics of expertise scholarship, this dissertation develops the concept of appropriate expertise: the combination of social and technical competences required to address marginalization through technological interventions. The dissertation asks what appropriate expertise looks like "on the ground" in the context of development as practiced by an exceptional group of technology designers from the Energy Forum of Sri Lanka: What design goals did they strive toward? What challenges did they face? What strategies did they employ? In an effort to answer these questions, the dissertation looks at how these designers interacted across a range of contexts with a broad spectrum of people and institutions, each with its own expertise to draw upon. In particular, it looks at how they situated their work in a highly contoured field of social power, where different types of expertise were used as resources for reinforcing or resisting existing power relations. I use the concept relations of expertise to denote the structure of expert interactions across multiple contexts of activity. Although this concept links to broad political-economic conditions that order varied expert practices, my analytic focus is at a different level: the situated experiences of expert practitioners. By starting with ground-level practices and understandings, I argue that creating new relations of expertise---that is, changing the nature of the interactions among experts and between experts and those they work with---is the key way my informants worked to legitimate marginalized perspectives and thereby empower marginalized social groups around technology-development practices. Appropriate expertise enables the creation of appropriate technologies, but it does more. It enables the creation of new relations of expertise, both through inspiring new forms of interpersonal interaction surrounding technology development and through incremental modification of existing decision-making structures to allow a more diverse group stakeholders to come together around technology decision making in the context of development.

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

PubMed

Breivik, H; Bang, U; Jalonen, J; Vigfússon, G; Alahuhta, S; Lagerkranser, M

2010-01-01

Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info.

Cooperative analysis expert situation assessment research

NASA Technical Reports Server (NTRS)

Mccown, Michael G.

1987-01-01

For the past few decades, Rome Air Development Center (RADC) has been conducting research in Artificial Intelligence (AI). When the recent advances in hardware technology made many AI techniques practical, the Intelligence and Reconnaissance Directorate of RADC initiated an applications program entitled Knowledge Based Intelligence Systems (KBIS). The goal of the program is the development of a generic Intelligent Analyst System, an open machine with the framework for intelligence analysis, natural language processing, and man-machine interface techniques, needing only the specific problem domain knowledge to be operationally useful. The development of KBIS is described.

[Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel].

PubMed

Granacher, U; Muehlbauer, T; Gschwind, Y J; Pfenninger, B; Kressig, R W

2014-08-01

The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

Priority setting in health care: trends and models from Scandinavian experiences.

PubMed

Hofmann, Bjørn

2013-08-01

The Scandinavian welfare states have public health care systems which have universal coverage and traditionally low influence of private insurance and private provision. Due to raises in costs, elaborate public control of health care, and a significant technological development in health care, priority setting came on the public agenda comparatively early in the Scandinavian countries. The development of health care priority setting has been partly homogeneous and appears to follow certain phases. This can be of broader interest as it may shed light on alternative models and strategies in health care priority setting. Some general trends have been identified: from principles to procedures, from closed to open processes, and from experts to participation. Five general approaches have been recognized: The moral principles and values based approach, the moral principles and economic assessment approach, the procedural approach, the expert based practice defining approach, and the participatory practice defining approach. There are pros and cons with all of these approaches. For the time being the fifth approach appears attractive, but its lack of true participation and the lack of clear success criteria may pose significant challenges in the future.

An SQL query generator for CLIPS

NASA Technical Reports Server (NTRS)

Snyder, James; Chirica, Laurian

1990-01-01

As expert systems become more widely used, their access to large amounts of external information becomes increasingly important. This information exists in several forms such as statistical, tabular data, knowledge gained by experts and large databases of information maintained by companies. Because many expert systems, including CLIPS, do not provide access to this external information, much of the usefulness of expert systems is left untapped. The scope of this paper is to describe a database extension for the CLIPS expert system shell. The current industry standard database language is SQL. Due to SQL standardization, large amounts of information stored on various computers, potentially at different locations, will be more easily accessible. Expert systems should be able to directly access these existing databases rather than requiring information to be re-entered into the expert system environment. The ORACLE relational database management system (RDBMS) was used to provide a database connection within the CLIPS environment. To facilitate relational database access a query generation system was developed as a CLIPS user function. The queries are entered in a CLlPS-like syntax and are passed to the query generator, which constructs and submits for execution, an SQL query to the ORACLE RDBMS. The query results are asserted as CLIPS facts. The query generator was developed primarily for use within the ICADS project (Intelligent Computer Aided Design System) currently being developed by the CAD Research Unit in the California Polytechnic State University (Cal Poly). In ICADS, there are several parallel or distributed expert systems accessing a common knowledge base of facts. Expert system has a narrow domain of interest and therefore needs only certain portions of the information. The query generator provides a common method of accessing this information and allows the expert system to specify what data is needed without specifying how to retrieve it.

Cataloging Expert Systems: Optimism and Frustrated Reality.

ERIC Educational Resources Information Center

Olmstadt, William J.

2000-01-01

Discusses artificial intelligence and attempts to catalog expert systems. Topics include the nature of expertise; examples of cataloging expert systems; barriers to implementation; and problems, including total automation, cataloging expertise, priorities, and system design. (LRW)

Soviet Use of Spetznaz Forces

DTIC Science & Technology

1986-03-01

the remainder of the 12 team composed of functional specialists . These would include a demolitions expert» radio operator» weapons expert, and...reconnaissance expert. Cross-training is practiced to various degrees in case a specialist in one field is lost, another who has cross-*trained can take...vulnerable to assault by Spetznaz. (1: 12 > 23 V. SPET2NA2 VULNERABILITIES One of the flrat vulnerabilities Is the Spetznaz soldier himself. He Is

Adiponectin, Leptin, and Yoga Practice

PubMed Central

Kiecolt-Glaser, Janice K.; Christian, Lisa M.; Andridge, Rebecca; Hwang, Beom Seuk; Malarkey, William B.; Belury, Martha A.; Emery, Charles F.; Glaser, Ronald

2012-01-01

To address the mechanisms underlying hatha yoga’s potential stress-reduction benefits, we compared adiponectin and leptin data from well-matched novice and expert yoga practitioners. These adipocytokines have counter-regulatory functions in inflammation; leptin plays a proinflammatory role, while adiponectin has anti-inflammatory properties. Fifty healthy women (mean age=41.32, range=30-65), 25 novices and 25 experts, provided fasting blood samples during three separate visits. Leptin was 36% higher among novices compared to experts, P = .008. Analysis of adiponectin revealed a borderline effect of yoga expertise, P = .08; experts’ average adiponectin levels were 28% higher than novices across the three visits. In contrast, experts’ average adiponectin to leptin ratio was nearly twice that of novices, P = .009. Frequency of self-reported yoga practice showed significant negative relationships with leptin; more weeks of yoga practice over the last year, more lifetime yoga sessions, and more years of yoga practice were all significantly associated with lower leptin, with similar findings for the adiponectin to leptin ratio. Novices and experts did not show even marginal differences on behavioral and physiological dimensions that might represent potential confounds, including BMI, central adiposity, cardiorespiratory fitness, and diet. Prospective studies addressing increased risk for type II diabetes, hypertension, and cardiovascular disease have highlighted the importance of these adipocytokines in modulating inflammation. Although these health risks are clearly related to more extreme values then we found in our healthy sample, our data raise the possibility that longer-term and/or more intensive yoga practice could have beneficial health consequences by altering leptin and adiponectin production. PMID:22306535

Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

PubMed

Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

2014-07-01

Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

Development of an instructional expert system for hole drilling processes

NASA Technical Reports Server (NTRS)

Al-Mutawa, Souhaila; Srinivas, Vijay; Moon, Young Bai

1990-01-01

An expert system which captures the expertise of workshop technicians in the drilling domain was developed. The expert system is aimed at novice technicians who know how to operate the machines but have not acquired the decision making skills that are gained with experience. This paper describes the domain background and the stages of development of the expert system.

Enabling the mission through trans-atlantic remote mentored musculoskeletal ultrasound: case report of a portable hand-carried tele-ultrasound system for medical relief missions.

PubMed

Kirkpatrick, Andrew W; Blaivas, Michael; Sargsyan, Ashot E; McBeth, Paul B; Patel, Chirag; Xiao, Zhengwen; Pian, Linping; Panebianco, Nova; Hamilton, Douglas R; Ball, Chad G; Dulchavsky, Scott A

2013-07-01

Modern medical practice has become extremely dependent upon diagnostic imaging technologies to confirm the results of clinical examination and to guide the response to therapies. Of the various diagnostic imaging techniques, ultrasound is the most portable modality and one that is repeatable, dynamic, relatively cheap, and safe as long as the imaging provided is accurately interpreted. It is, however, the most user-dependent, a characteristic that has prompted the development of remote guidance techniques, wherein remote experts guide distant users through the use of information technologies. Medical mission work often brings specialist physicians to less developed locations, where they wish to provide the highest levels of care but are often bereft of diagnostic imaging resources on which they depend. Furthermore, if these personnel become ill or injured, their own care received may not be to the standard they have left at home. We herein report the utilization of a compact hand-carried remote tele-ultrasound system that allowed real-time diagnosis and follow-up of an acutely torn adductor muscle by a team of ultrasonographers, surgeons, and physicians. The patient was one of the mission surgeons who was guided to self-image. The virtual network of supporting experts was located across North America, whereas the patient was in Lome, Togo, West Africa. The system consisted of a hand-carried ultrasound, the output of which was digitized and streamed to the experts within standard voice-over-Internet-protocol software with an embedded simultaneous videocamera image of the ultrasonographer's hands using a customized graphical user interface. The practical concept of a virtual tele-ultrasound support network was illustrated through the clinical guidance of multiple physicians, including National Aeronautics and Space Administration Medical Operations remote guiders, Olympic team-associated surgeons, and ultrasound-focused emergentologists.

Role of dental expert in forensic odontology

PubMed Central

Verma, Anoop K.; Kumar, Sachil; Rathore, Shiuli; Pandey, Abhishek

2014-01-01

Forensic dentistry has become an integral part of forensic science over the past 100 years that utilizes dental or oro-facial findings to serve the judicial system. This has been due to the dedication of people like Gustafson's, Keiser-Nielson, and Suzuki for this field. They established the essential role which forensic dentistry plays mainly in the identification of human remains. The tooth has been used as weapons and under certain circumstances, may leave information about the identity of the biter. Dental professionals have a major role to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognize mal practice, negligence, fraud or abuse, and identity of unknown individuals. This paper will try to summarize the various roles of dental experts in forensic medicine. PMID:25298709

An Algorithm Using Twelve Properties of Antibiotics to Find the Recommended Antibiotics, as in CPGs.

PubMed

Tsopra, R; Venot, A; Duclos, C

2014-01-01

Clinical Decision Support Systems (CDSS) incorporating justifications, updating and adjustable recommendations can considerably improve the quality of healthcare. We propose a new approach to the design of CDSS for empiric antibiotic prescription, based on implementation of the deeper medical reasoning used by experts in the development of clinical practice guidelines (CPGs), to deduce the recommended antibiotics. We investigated two methods ("exclusion" versus "scoring") for reproducing this reasoning based on antibiotic properties. The "exclusion" method reproduced expert reasoning the more accurately, retrieving the full list of recommended antibiotics for almost all clinical situations. This approach has several advantages: (i) it provides convincing explanations for physicians; (ii) updating could easily be incorporated into the CDSS; (iii) it can provide recommendations for clinical situations missing from CPGs.

A parallel expert system for the control of a robotic air vehicle

NASA Technical Reports Server (NTRS)

Shakley, Donald; Lamont, Gary B.

1988-01-01

Expert systems can be used to govern the intelligent control of vehicles, for example the Robotic Air Vehicle (RAV). Due to the nature of the RAV system the associated expert system needs to perform in a demanding real-time environment. The use of a parallel processing capability to support the associated expert system's computational requirement is critical in this application. Thus, algorithms for parallel real-time expert systems must be designed, analyzed, and synthesized. The design process incorporates a consideration of the rule-set/face-set size along with representation issues. These issues are looked at in reference to information movement and various inference mechanisms. Also examined is the process involved with transporting the RAV expert system functions from the TI Explorer, where they are implemented in the Automated Reasoning Tool (ART), to the iPSC Hypercube, where the system is synthesized using Concurrent Common LISP (CCLISP). The transformation process for the ART to CCLISP conversion is described. The performance characteristics of the parallel implementation of these expert systems on the iPSC Hypercube are compared to the TI Explorer implementation.

Innovation on Energy Power Technology (22)Challenge to Development of Expert System stored Knowledge of Expert Power Network Operators

NASA Astrophysics Data System (ADS)

Sakaguchi, Hideharu

Do you remember an expert system? I think there are various impressions about the system. For example, some might say “It reminds me of old days”. On the other hand, some might say “It was really troublesome”. About 25 years ago, from late 1980s to the middle of 1990s, when the Showa era was about to change into the Heisei Era, artificial intelligence boomed. Research and development for an expert system which was equipped with expertise and worked as smart as expert, was advanced in various fields. Our company also picked up the system as the new system which covered weak point of conventional computer technology. We started research and development in 1984, and installed an expert system in a SCADA system, which started operating in March 1990 in the Fukuoka Integrated Control Center. In this essay, as an electric power engineer who involved in development at that time, I introduce the situation and travail story about developing an expert system which support restorative actions from the outage and overload condition of power networks.

Cooperating Expert Systems For Space Station Power Distribution Management

NASA Astrophysics Data System (ADS)

Nguyen, T. A.; Chiou, W. C.

1987-02-01

In a complex system such as the manned Space Station, it is deem necessary that many expert systems must perform tasks in a concurrent and cooperative manner. An important question arise is: what cooperative-task-performing models are appropriate for multiple expert systems to jointly perform tasks. The solution to this question will provide a crucial automation design criteria for the Space Station complex systems architecture. Based on a client/server model for performing tasks, we have developed a system that acts as a front-end to support loosely-coupled communications between expert systems running on multiple Symbolics machines. As an example, we use two ART*-based expert systems to demonstrate the concept of parallel symbolic manipulation for power distribution management and dynamic load planner/scheduler in the simulated Space Station environment. This on-going work will also explore other cooperative-task-performing models as alternatives which can evaluate inter and intra expert system communication mechanisms. It will be served as a testbed and a bench-marking tool for other Space Station expert subsystem communication and information exchange.

Learning SAS’s Perl Regular Expression Matching the Easy Way: By Doing

DTIC Science & Technology

2015-01-12

Doing 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Paul Genovesi 5d. PROJECT NUMBER 5e. TASK NUMBER 5f...regex_learning_tool allows both beginner and expert to efficiently practice PRX matching by selecting and processing only the match records that the user is interested...perl regular expression and/or source string. The regex_learning_tool allows both beginner and expert to efficiently practice PRX matching by

The VCU Pressure Ulcer Summit: Collaboration to Operationalize Hospital-Acquired Pressure Ulcer Prevention Best Practice Recommendations.

PubMed

Brindle, C Tod; Creehan, Sue; Black, Joyce; Zimmermann, Deb

2015-01-01

This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best practice recommendations to sustain organizational culture change in hospital-acquired pressure ulcer prevention, to develop a hospital-acquired pressure ulcer severity score, and to address topics related to the unavoidable pressure ulcer.

A software engineering approach to expert system design and verification

NASA Technical Reports Server (NTRS)

Bochsler, Daniel C.; Goodwin, Mary Ann

1988-01-01

Software engineering design and verification methods for developing expert systems are not yet well defined. Integration of expert system technology into software production environments will require effective software engineering methodologies to support the entire life cycle of expert systems. The software engineering methods used to design and verify an expert system, RENEX, is discussed. RENEX demonstrates autonomous rendezvous and proximity operations, including replanning trajectory events and subsystem fault detection, onboard a space vehicle during flight. The RENEX designers utilized a number of software engineering methodologies to deal with the complex problems inherent in this system. An overview is presented of the methods utilized. Details of the verification process receive special emphasis. The benefits and weaknesses of the methods for supporting the development life cycle of expert systems are evaluated, and recommendations are made based on the overall experiences with the methods.

Development of an expert system prototype for determining software functional requirements for command management activities at NASA Goddard

NASA Technical Reports Server (NTRS)

Liebowitz, J.

1986-01-01

The development of an expert system prototype for software functional requirement determination for NASA Goddard's Command Management System, as part of its process of transforming general requests into specific near-earth satellite commands, is described. The present knowledge base was formulated through interactions with domain experts, and was then linked to the existing Knowledge Engineering Systems (KES) expert system application generator. Steps in the knowledge-base development include problem-oriented attribute hierarchy development, knowledge management approach determination, and knowledge base encoding. The KES Parser and Inspector, in addition to backcasting and analogical mapping, were used to validate the expert system-derived requirements for one of the major functions of a spacecraft, the solar Maximum Mission. Knowledge refinement, evaluation, and implementation procedures of the expert system were then accomplished.

Third CLIPS Conference Proceedings, volume 1

NASA Technical Reports Server (NTRS)

Riley, Gary (Editor)

1994-01-01

Expert systems are computed programs which emulate human expertise in well defined problem domains. The potential payoff from expert systems is high: valuable expertise can be captured and preserved, repetitive and/or mundane tasks requiring human expertise can be automated, and uniformity can be applied in decision making processes. The C Language Integrated Production Systems (CLIPS) is an expert system building tool, developed at the Johnson Space Center, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The development of CLIPS has helped to improve the ability to deliver expert systems technology throughout the public and private sectors for a wide range of applications and diverse computing environments.

CLIPS: An expert system building tool

NASA Technical Reports Server (NTRS)

Riley, Gary

1991-01-01

The C Language Integrated Production System (CLIPS) is an expert system building tool, which provides a complete environment for the development and delivery of rule and/or object based expert systems. CLIPS was specifically designed to provide a low cost option for developing and deploying expert system applications across a wide range of hardware platforms. The commercial potential of CLIPS is vast. Currently, CLIPS is being used by over 3,300 individuals throughout the public and private sector. Because the CLIPS source code is readily available, numerous groups have used CLIPS as a basis for their own expert system tools. To date, three commercially available tools have been derived from CLIPS. In general, the development of CLIPS has helped to improve the ability to deliver expert system technology throughout the public and private sectors for a wide range of applications and diverse computing environments.

Expert Opinions on Nutrition Issues in Clinical Dentistry.

ERIC Educational Resources Information Center

Palmer, Carole A.; And Others

1990-01-01

A survey of 79 experts in dental nutrition sought consensus on the appropriate scope of nutrition in clinical dentistry. Results support the need for greater attention to nutrition issues in dental schools and better models for nutrition interventions in dental practice. (Author/MSE)

The American Nurses Association Code of Ethics: a reflection on the ethics of respect and human dignity with nurse as expert.

PubMed

Milton, Constance L

2003-10-01

The American Nurses Association Code of Ethics for Nurses calls for the nurse to practice with compassion and respect for every individual. What are the ethics and challenges of practicing professional nursing with expertise and educating a new generation of nurses while incorporating the interpretive statements into practice? This column differentiates the traditional biomedical views on human dignity and respect while exploring the embedded ethics of respect and self-determination and what it truly means to be an expert of nursing from the theoretical perspective of the human becoming school of thought.

Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

PubMed

Batra, U; Parikh, P M; Prabhash, K; Tongaonkar, H B; Chibber, P; Dabkara, D; Deshmukh, C; Ghadyalpatil, N; Hingmire, S; Joshi, A; Raghunath, S K; Rajappa, S; Rajendranath, R; Rawal, S K; Singh, Manisha; Singh, R; Somashekhar, S P; Sood, R

2016-01-01

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

System of experts for intelligent data management (SEIDAM)

NASA Technical Reports Server (NTRS)

Goodenough, David G.; Iisaka, Joji; Fung, KO

1993-01-01

A proposal to conduct research and development on a system of expert systems for intelligent data management (SEIDAM) is being developed. CCRS has much expertise in developing systems for integrating geographic information with space and aircraft remote sensing data and in managing large archives of remotely sensed data. SEIDAM will be composed of expert systems grouped in three levels. At the lowest level, the expert systems will manage and integrate data from diverse sources, taking account of symbolic representation differences and varying accuracies. Existing software can be controlled by these expert systems, without rewriting existing software into an Artificial Intelligence (AI) language. At the second level, SEIDAM will take the interpreted data (symbolic and numerical) and combine these with data models. at the top level, SEIDAM will respond to user goals for predictive outcomes given existing data. The SEIDAM Project will address the research areas of expert systems, data management, storage and retrieval, and user access and interfaces.

System of Experts for Intelligent Data Management (SEIDAM)

NASA Technical Reports Server (NTRS)

Goodenough, David G.; Iisaka, Joji; Fung, KO

1992-01-01

It is proposed to conduct research and development on a system of expert systems for intelligent data management (SEIDAM). CCRS has much expertise in developing systems for integrating geographic information with space and aircraft remote sensing data and in managing large archives of remotely sensed data. SEIDAM will be composed of expert systems grouped in three levels. At the lowest level, the expert systems will manage and integrate data from diverse sources, taking account of symbolic representation differences and varying accuracies. Existing software can be controlled by these expert systems, without rewriting existing software into an Artificial Intelligence (AI) language. At the second level, SEIDAM will take the interpreted data (symbolic and numerical) and combine these with data models. At the top level, SEIDAM will respond to user goals for predictive outcomes given existing data. The SEIDAM Project will address the research areas of expert systems, data management, storage and retrieval, and user access and interfaces.

TES: A modular systems approach to expert system development for real-time space applications

NASA Technical Reports Server (NTRS)

Cacace, Ralph; England, Brenda

1988-01-01

A major goal of the Space Station era is to reduce reliance on support from ground based experts. The development of software programs using expert systems technology is one means of reaching this goal without requiring crew members to become intimately familiar with the many complex spacecraft subsystems. Development of an expert systems program requires a validation of the software with actual flight hardware. By combining accurate hardware and software modelling techniques with a modular systems approach to expert systems development, the validation of these software programs can be successfully completed with minimum risk and effort. The TIMES Expert System (TES) is an application that monitors and evaluates real time data to perform fault detection and fault isolation tasks as they would otherwise be carried out by a knowledgeable designer. The development process and primary features of TES, a modular systems approach, and the lessons learned are discussed.

Assessing Residents' Readiness for OR Autonomy: A Qualitative Descriptive Study of Expert Surgical Teachers' Best Practices.

PubMed

Chen, Xiaodong Phoenix; Sullivan, Amy M; Alseidi, Adnan; Kwakye, Gifty; Smink, Douglas S

Providing resident autonomy in the operating room (OR) is one of the major challenges for surgical educators today. The purpose of this study was to explore what approaches expert surgical teachers use to assess residents' readiness for autonomy in the OR. We particularly focused on the assessments that experts make prior to conducting the surgical time-out. We conducted semistructured in-depth interviews with expert surgical teachers from March 2016 to September 2016. Purposeful sampling and snowball sampling were applied to identify and recruit expert surgical teachers from general surgery residency programs across the United States to represent a range of clinical subspecialties. All interviews were audio-recorded, deidentified, and transcribed. We applied the Framework Method of content analysis, discussed and reached final consensus on the themes. We interviewed 15 expert teachers from 9 institutions. The majority (13/15) were Program or Associate Program Directors; 47% (7/15) primarily performed complex surgical operations (e.g., endocrine surgery). Five themes regarding how expert surgical teachers determine residents' readiness for OR autonomy before the surgical time-out emerged. These included 3 domains of evidence elicited about the resident (resident characteristics, medical knowledge, and beyond the current OR case), 1 variable relating to attending characteristics, and 1 variable composed of contextual factors. Experts obtained one or more examples of evidence, and adjusted residents' initial autonomy using factors from the attending variable and the context variable. Expert surgical teachers' assessments of residents' readiness for OR autonomy included 5 key components. Better understanding these inputs can contribute to both faculty and resident development, enabling increased resident autonomy and preparation for independent practice. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Autonomous Control of Nuclear Power Plants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Basher, H.

2003-10-20

A nuclear reactor is a complex system that requires highly sophisticated controllers to ensure that desired performance and safety can be achieved and maintained during its operations. Higher-demanding operational requirements such as reliability, lower environmental impacts, and improved performance under adverse conditions in nuclear power plants, coupled with the complexity and uncertainty of the models, necessitate the use of an increased level of autonomy in the control methods. In the opinion of many researchers, the tasks involved during nuclear reactor design and operation (e.g., design optimization, transient diagnosis, and core reload optimization) involve important human cognition and decisions that maymore » be more easily achieved with intelligent methods such as expert systems, fuzzy logic, neural networks, and genetic algorithms. Many experts in the field of control systems share the idea that a higher degree of autonomy in control of complex systems such as nuclear plants is more easily achievable through the integration of conventional control systems and the intelligent components. Researchers have investigated the feasibility of the integration of fuzzy logic, neural networks, genetic algorithms, and expert systems with the conventional control methods to achieve higher degrees of autonomy in different aspects of reactor operations such as reactor startup, shutdown in emergency situations, fault detection and diagnosis, nuclear reactor alarm processing and diagnosis, and reactor load-following operations, to name a few. With the advancement of new technologies and computing power, it is feasible to automate most of the nuclear reactor control and operation, which will result in increased safety and economical benefits. This study surveys current status, practices, and recent advances made towards developing autonomous control systems for nuclear reactors.« less

The consultant nurse - expert practitioner and much more.

PubMed

Mitchell, Theresa; Butler-Williams, Carole; Easton, Karen; Ingledew, Ian; Parkin, Donna; Wade, Sharon; Warner, Richard

The consultant nurse (CN) role is usually described in terms of four domains devised by the Department of Health - clinical practice, education and training, leadership, and research and service development. This study set out to explicate the diversity and complexity of CN roles in an NHS trust; to describe aspects of extraordinary practice and to identify perceived differences between this role and other advanced practice roles. Accounts were written by six CNs and subjected to concept mapping to facilitate identification of extraordinary practice. Four themes emerged: entrepreneurial activity and innovation; clinical autonomy and role dynamism; influential national and international research conduct; consultancy and education across discipline boundaries. These included descriptions of higher order skills that surpass usual requirements of 'expert' or 'advanced' practice. Comparisons with other advanced practice roles are drawn from the literature and data collected in this study. Differences between the roles have implications for sustainability.

Autonomously acquiring declarative and procedural knowledge for ICAT systems

NASA Technical Reports Server (NTRS)

Kovarik, Vincent J., Jr.

1993-01-01

The construction of Intelligent Computer Aided Training (ICAT) systems is critically dependent on the ability to define and encode knowledge. This knowledge engineering effort can be broadly divided into two categories: domain knowledge and expert or task knowledge. Domain knowledge refers to the physical environment or system with which the expert interacts. Expert knowledge consists of the set of procedures and heuristics employed by the expert in performing their task. Both these areas are a significant bottleneck in the acquisition of knowledge for ICAT systems. This paper presents a research project in the area of autonomous knowledge acquisition using a passive observation concept. The system observes an expert and then generalizes the observations into production rules representing the domain expert's knowledge.

Expert networks in CLIPS

NASA Technical Reports Server (NTRS)

Hruska, S. I.; Dalke, A.; Ferguson, J. J.; Lacher, R. C.

1991-01-01

Rule-based expert systems may be structurally and functionally mapped onto a special class of neural networks called expert networks. This mapping lends itself to adaptation of connectionist learning strategies for the expert networks. A parsing algorithm to translate C Language Integrated Production System (CLIPS) rules into a network of interconnected assertion and operation nodes has been developed. The translation of CLIPS rules to an expert network and back again is illustrated. Measures of uncertainty similar to those rules in MYCIN-like systems are introduced into the CLIPS system and techniques for combining and hiring nodes in the network based on rule-firing with these certainty factors in the expert system are presented. Several learning algorithms are under study which automate the process of attaching certainty factors to rules.

RAMBOT: A Connectionist Expert System That Learns by Example.

ERIC Educational Resources Information Center

Mozer, Michael C.

One solution to the problem of getting expert knowledge into expert systems would be to endow the systems with powerful learning procedures that could discover appropriate behaviors by observing an expert in action. A promising source of such learning procedures can be found in recent work on connectionist networks, which are massively parallel…

International classification of functioning, disability and health categories for spinal cord injury nursing in China.

PubMed

Li, Kun; Yan, Tiebin; You, Liming; Li, Rui; Ross, Amy Miner

2015-01-01

To explore a set of International Classification of Functioning, Disability and Health (ICF) categories that cover the spinal cord injury (SCI) nursing practice in China through a national expert survey. An internet-based email survey was used. An original set of ICF categories specifically for SCI nursing has been developed from the preliminary studies based on an international perspective. For cultural adaptation in China, a national expert survey was conducted with Chinese experts on SCI nursing to identify the ICF categories that were specifically for SCI nursing in China. The ICF categories which received more than 80% support from the experts would be reported. Twenty-nine Chinese experts on SCI nursing participated. There were 81 ICF categories which received more than 80% agreement among the experts, including 33 Body Functions categories, eight Body Structures, 24 Activities and Participation, six Environmental Factors and 10 Personal Factors items. A set of ICF categories that cover the SCI nursing practice in China was identified. It reflects the main issues that Chinese nurses focus on in caring SCI patients. These categories can facilitate Chinese nurses to use the ICF in multidisciplinary teamwork and improve the participation of nurses in the team. Implications for Rehabilitation In China, nurses lack of an effective model or tool to communicate with the other health professionals in the rehabilitation team for spinal cord injury (SCI) patients. International Classification of Functioning, Disability and Health (ICF) is a tool for multidisciplinary use, which can promote the communication and collaboration in the healthcare team by establishing a common language across different disciplines and sectors. This set of ICF categories developed from this study can serve as a roadmap for important items for use in clinical practice of Chinese SCI nursing.

Experts' opinions on terminology for complementary and integrative medicine - a qualitative study with leading experts.

PubMed

Holmberg, Christine; Brinkhaus, Benno; Witt, Claudia

2012-11-14

Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term "integrative medicine" with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a "conventional framework of thinking". The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general. We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda. Overall the current terminology was seen as a problem, although most experts agreed that the term "integrative medicine" (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine. The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.

Quality and content of dental practice websites.

PubMed

Nichols, L C; Hassall, D

2011-04-09

To investigate the quality and content of dental practice websites by constructing an audit framework based on regulations, guidance and expert advice, and applying this framework to a random sample of UK dental practices' websites. An audit framework was constructed and in-depth data collected from a random sample of 150 UK dental practices. Thirty-five percent of dental practices in this study were found to have websites. Compliance with rules and regulations regarding dental practice websites was generally poor. Use of advised content for practice promotion was variable. Many websites were poorly optimised. Eighty-nine percent of the websites advertised tooth whitening, despite the issues surrounding its legality; 25% of the websites advertised Botox even though advertising of prescription only medicines is illegal. Some websites gave misleading information about the specialist status of their dentists. Those responsible for dental practice websites need to be aware of a wide range of regulations and guidance, and are advised to follow expert advice on content and optimisation in order to maximise the potential of their websites.

[Artificial intelligence--the knowledge base applied to nephrology].

PubMed

Sancipriano, G P

2005-01-01

The idea that efficacy efficiency, and quality in medicine could not be reached without sorting the huge knowledge of medical and nursing science is very common. Engineers and computer scientists have developed medical software with great prospects for success, but currently these software applications are not so useful in clinical practice. The medical doctor and the trained nurse live the 'information age' in many daily activities, but the main benefits are not so widespread in working activities. Artificial intelligence and, particularly, export systems charm health staff because of their potential. The first part of this paper summarizes the characteristics of 'weak artificial intelligence' and of expert systems important in clinical practice. The second part discusses medical doctors' requirements and the current nephrologic knowledge bases available for artificial intelligence development.

Tools and technologies for expert systems: A human factors perspective

NASA Technical Reports Server (NTRS)

Rajaram, Navaratna S.

1987-01-01

It is widely recognized that technologies based on artificial intelligence (AI), especially expert systems, can make significant contributions to the productivity and effectiveness of operations of information and knowledge intensive organizations such as NASA. At the same time, these being relatively new technologies, there is the problem of transfering technology to key personnel of such organizations. The problems of examining the potential of expert systems and of technology transfer is addressed in the context of human factors applications. One of the topics of interest was the investigation of the potential use of expert system building tools, particularly NEXPERT as a technology transfer medium. Two basic conclusions were reached in this regard. First, NEXPERT is an excellent tool for rapid prototyping of experimental expert systems, but not ideal as a delivery vehicle. Therefore, it is not a substitute for general purpose system implementation languages such a LISP or C. This assertion probably holds for nearly all such tools on the market today. Second, an effective technology transfer mechanism is to formulate and implement expert systems for problems which members of the organization in question can relate to. For this purpose, the LIghting EnGineering Expert (LIEGE) was implemented using NEXPERT as the tool for technology transfer and to illustrate the value of expert systems to the activities of the Man-System Division.

[Evaluation of practices in the management of scabies in children].

PubMed

Lê, M-S; Richard, M-A; Baumstarck, K; Hesse, S; Gaudy-Marqueste, C; Grob, J-J; Mallet, S

2017-05-01

Scabies has been on the rise in France in recent years and has posed therapeutic problems, mainly due to the withdrawal of benzyl benzoate. The objective of this study was to describe prescribing practices for scabies in children. A national survey was conducted by means of a standardized questionnaire covering various clinical situations of scabies and the drugs used preferentially according to age, which was sent out between December 2014 and March 2015 to members of the clinical research group of the French Society of Paediatric Dermatology. Of the 38 experts contacted, 20 replied. For a typical case of scabies, 55% of the experts initially prescribed oral ivermectin for children aged 6 years, 15% prescribed ivermectin in children aged 2 years, and 5% in infants aged 3 months. Ivermectin was more widely prescribed after failure of prior treatment or recurrence of scabies, on skin lesions or impetigo, if precarious, especially for profuse hyperkeratotic scabies. A total of 35% of the experts reported no prescribing restrictions with regard to patient age or weight. Discrepancies were observed concerning the mode of administration and the time between consecutive doses. Esdepallethrin remained the preferred local treatment among the experts (38% of all topical prescriptions) except in asthmatic children, while permethrin was the least-prescribed topical agent. This study confirms the heterogeneity of our practices. Formal expert recommendations are awaited, particularly concerning the use of ivermectin in infants. Copyright © 2017. Published by Elsevier Masson SAS.

An Expert System Solution for the Quantitative Condition Assessment of Electrical Distribution Systems in the United States Air Force

DTIC Science & Technology

1991-09-01

Distribution system ... ......... 4 2. Architechture of an Expert system .. .............. 66 vi List of Tables Table Page 1. Prototype Component Model...expert system to properly process work requests Ln civil engineering (8:23). Electric Power Research Institute (EPRI). EPRI is a private organization ...used (51) Training Level. The level of training shop technicians receive, and the resulting proficiency, are important in all organizations . Experts 1

Research on an expert system for database operation of simulation-emulation math models. Volume 2, Phase 1: Results

NASA Technical Reports Server (NTRS)

Kawamura, K.; Beale, G. O.; Schaffer, J. D.; Hsieh, B. J.; Padalkar, S.; Rodriguez-Moscoso, J. J.

1985-01-01

A reference manual is provided for NESS, a simulation expert system. This manual gives user information regarding starting and operating NASA expert simulation system (NESS). This expert system provides an intelligent interface to a generic simulation program for spacecraft attitude control problems. A menu of the functions the system can perform is provided. Control repeated returns to this menu after executing each user request.

Development of a coupled expert system for the spacecraft attitude control problem

NASA Technical Reports Server (NTRS)

Kawamura, K.; Beale, G.; Schaffer, J.; Hsieh, B.-J.; Padalkar, S.; Rodriguezmoscoso, J.; Vinz, F.; Fernandez, K.

1987-01-01

A majority of the current expert systems focus on the symbolic-oriented logic and inference mechanisms of artificial intelligence (AI). Common rule-based systems employ empirical associations and are not well suited to deal with problems often arising in engineering. Described is a prototype expert system which combines both symbolic and numeric computing. The expert system's configuration is presented and its application to a spacecraft attitude control problem is discussed.

How To Establish Effective Book Marketing and Distribution Systems in Asia/Pacific. Report of the Regional Training Course on Book Production in Asia/Pacific (Tokyo, Japan, September 21-October 9, 1994).

ERIC Educational Resources Information Center

Asian Cultural Centre for UNESCO, Tokyo (Japan).

The participants in this 1994 regional training course examined the issue of book distribution and marketing. They focused on book marketing together with the development of distribution in order to prepare practical action plans for improvement. Twenty-three experts from 20 countries in Asia/Pacific and Africa analyzed problems, exchanged…

An Expert System for Diagnosing Eye Diseases using Forward Chaining Method

NASA Astrophysics Data System (ADS)

Munaiseche, C. P. C.; Kaparang, D. R.; Rompas, P. T. D.

2018-02-01

Expert System is a system that seeks to adopt human knowledge to the computer, so that the computer can solve problems which are usually done by experts. The purpose of medical expert system is to support the diagnosis process of physicians. It considers facts and symptoms to provide diagnosis. This implies that a medical expert system uses knowledge about diseases and facts about the patients to suggest diagnosis. The aim of this research is to design an expert system application for diagnosing eye diseases using forward chaining method and to figure out user acceptance to this application through usability testing. Eye is selected because it is one of the five senses which is very sensitive and important. The scope of the work is extended to 16 types of eye diseases with 41 symptoms of the disease, arranged in 16 rules. The computer programming language employed was the PHP programming language and MySQL as the Relational Database Management System (RDBMS). The results obtained showed that the expert system was able to successfully diagnose eye diseases corresponding to the selected symptoms entered as query and the system evaluation through usability testing showed the expert system for diagnosis eye diseases had very good rate of usability, which includes learnability, efficiency, memorability, errors, and satisfaction so that the system can be received in the operational environment.

Expert Witness: A system for developing expert medical testimony

NASA Technical Reports Server (NTRS)

Lewandowski, Raymond; Perkins, David; Leasure, David

1994-01-01

Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

[Development of expert diagnostic system for common respiratory diseases].

PubMed

Xu, Wei-hua; Chen, You-ling; Yan, Zheng

2014-03-01

To develop an internet-based expert diagnostic system for common respiratory diseases. SaaS system was used to build architecture; pattern of forward reasoning was applied for inference engine design; ASP.NET with C# from the tool pack of Microsoft Visual Studio 2005 was used for website-interview medical expert system.The database of the system was constructed with Microsoft SQL Server 2005. The developed expert system contained large data memory and high efficient function of data interview and data analysis for diagnosis of various diseases.The users were able to perform this system to obtain diagnosis for common respiratory diseases via internet. The developed expert system may be used for internet-based diagnosis of various respiratory diseases,particularly in telemedicine setting.

Development of a rational scale to assess the harm of drugs of potential misuse.

PubMed

Nutt, David; King, Leslie A; Saulsbury, William; Blakemore, Colin

2007-03-24

Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm, with an expert delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion. We also included five legal drugs of misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) for reference. The process proved practicable, and yielded roughly similar scores and rankings of drug harm when used by two separate groups of experts. The ranking of drugs produced by our assessment of harm differed from those used by current regulatory systems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.

Knowledge-based systems for power management

NASA Technical Reports Server (NTRS)

Lollar, L. F.

1992-01-01

NASA-Marshall's Electrical Power Branch has undertaken the development of expert systems in support of further advancements in electrical power system automation. Attention is given to the features (1) of the Fault Recovery and Management Expert System, (2) a resource scheduler or Master of Automated Expert Scheduling Through Resource Orchestration, and (3) an adaptive load-priority manager, or Load Priority List Management System. The characteristics of an advisory battery manager for the Hubble Space Telescope, designated the 'nickel-hydrogen expert system', are also noted.

Medical Oversight, Educational Core Content, and Proposed Scopes of Practice of Wilderness EMS Providers: A Joint Project Developed by Wilderness EMS Educators, Medical Directors, and Regulators Using a Delphi Approach.

PubMed

Millin, Michael G; Johnson, David E; Schimelpfenig, Tod; Conover, Keith; Sholl, Matthew; Busko, Jonnathan; Alter, Rachael; Smith, Will; Symonds, Jennifer; Taillac, Peter; Hawkins, Seth C

2017-01-01

A disparity exists between the skills needed to manage patients in wilderness EMS environments and the scopes of practice that are traditionally approved by state EMS regulators. In response, the National Association of EMS Physicians Wilderness EMS Committee led a project to define the educational core content supporting scopes of practice of wilderness EMS providers and the conditions when wilderness EMS providers should be required to have medical oversight. Using a Delphi process, a group of experts in wilderness EMS, representing educators, medical directors, and regulators, developed model educational core content. This core content is a foundation for wilderness EMS provider scopes of practice and builds on both the National EMS Education Standards and the National EMS Scope of Practice Model. These experts also identified the conditions when oversight is needed for wilderness EMS providers. By consensus, this group of experts identified the educational core content for four unique levels of wilderness EMS providers: Wilderness Emergency Medical Responder (WEMR), Wilderness Emergency Medical Technician (WEMT), Wilderness Advanced Emergency Medical Technician (WAEMT), and Wilderness Paramedic (WParamedic). These levels include specialized skills and techniques pertinent to the operational environment. The skills and techniques increase in complexity with more advanced certification levels, and address the unique circumstances of providing care to patients in the wilderness environment. Furthermore, this group identified that providers having a defined duty to act should be functioning with medical oversight. This group of experts defined the educational core content supporting the specific scopes of practice that each certification level of wilderness EMS provider should have when providing patient care in the wilderness setting. Wilderness EMS providers are, indeed, providing health care and should thus function within defined scopes of practice and with physician medical director oversight.

Reference standards, judges, and comparison subjects: roles for experts in evaluating system performance.

PubMed

Hripcsak, George; Wilcox, Adam

2002-01-01

Medical informatics systems are often designed to perform at the level of human experts. Evaluation of the performance of these systems is often constrained by lack of reference standards, either because the appropriate response is not known or because no simple appropriate response exists. Even when performance can be assessed, it is not always clear whether the performance is sufficient or reasonable. These challenges can be addressed if an evaluator enlists the help of clinical domain experts. 1) The experts can carry out the same tasks as the system, and then their responses can be combined to generate a reference standard. 2)The experts can judge the appropriateness of system output directly. 3) The experts can serve as comparison subjects with which the system can be compared. These are separate roles that have different implications for study design, metrics, and issues of reliability and validity. Diagrams help delineate the roles of experts in complex study designs.

Bayesian Islamic medication expert system (B-IMES)

NASA Astrophysics Data System (ADS)

Daud, Hanita; Razali, Radzuan; Jung, Low Tan; Zaida, Shahnaz

2015-12-01

This paper discusses on the development of an expert system (ES) that applies Bayesian Probability concept for Islamic Medication practice that is made available on web platform. This ES allows user to choose sickness such as headache, stomachache, toothache and etc that he/she may have and list of symptoms related to the sickness will appear for the user to choose. Once symptom(s) is/are chosen the diagnosis is being carried out to suggest percentage of possible specific sickness such as classic migraine, common migraine, tension headache and etc if headache was chosen. This diagnosis is being carried out using Bayes' Theorem and the ES will suggest the treatments or therapy that he/she needs to perform in reference to Muslim Holy Quran and Hadith. This ES was developed to preserve Islamic medication and to create awareness among the young generation and make it accessible at anytime and anywhere and to save users time to meet Islamic Medication practitioners who are not easily available in Malaysia and other parts of the world.

Mathematical modeling of control subsystems for CELSS: Application to diet

NASA Technical Reports Server (NTRS)

Waleh, Ahmad; Nguyen, Thoi K.; Kanevsky, Valery

1991-01-01

The dynamic control of a Closed Ecological Life Support System (CELSS) in a closed space habitat is of critical importance. The development of a practical method of control is also a necessary step for the selection and design of realistic subsystems and processors for a CELSS. Diet is one of the dynamic factors that strongly influences, and is influenced, by the operational states of all major CELSS subsystems. The problems of design and maintenance of a stable diet must be obtained from well characterized expert subsystems. The general description of a mathematical model that forms the basis of an expert control program for a CELSS is described. The formulation is expressed in terms of a complete set of time dependent canonical variables. System representation is dynamic and includes time dependent storage buffers. The details of the algorithm are described. The steady state results of the application of the method for representative diets made from wheat, potato, and soybean are presented.

Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries.

PubMed

Petersen, Inge; Evans-Lacko, Sara; Semrau, Maya; Barry, Margaret M; Chisholm, Dan; Gronholm, Petra; Egbe, Catherine O; Thornicroft, Graham

2016-01-01

In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify "best practice" and "good practice" interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs. A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify "best practice" at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising "good practice". At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate "best practice" interventions with sufficient evidence from "good practice" interventions with limited but promising evidence. At the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered "best practice". Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as "good practice". At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as "best practice". The following were all identified as "good practice": Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2-14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders. Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral engagement and the need for further research on interventions at these levels in LMICs is highlighted.

Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system.

PubMed

Ong, Rob S G; Post, Johan; van Rooij, Harry; de Haan, Jan

2008-02-13

Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged drastically. No figures about the influence of the use of an expert system during triage on call duration and triage decisions in out of hours care in the Netherlands are available. Electronically registered data concerning call duration and triage decisions were collected in two cooperatives. One in Tilburg, a cooperative in a Southern city of the Netherlands using an expert system, and one in Groningen, a cooperative in a Northern city not using an expert system. Some other relevant information about the care process was collected additionally. Data about call duration was compared using an independent sample t-test. Data about call decisions was compared using Chi Square. The mean call time in the cooperative using the TAS expert system is 4.6 minutes, in the cooperative not using the expert system 3.9 minutes. A significant difference of 0.7 minutes (0.4 - 1.0, 95% CI) minutes. In the cooperative with an expert system a larger percentage of patients is handled by the assistant, patients are less often referred to a telephone consultation with the GP and are less likely to be offered a visit by the GP.A quick interpretation of the impact of the difference in triage decisions, show that these may be large enough to support the hypothesis that longer call duration is compensated for by less contacts with the GP (by telephone or face-to-face). There is no proof, however, that these differences are caused by the use of the triage system. The larger amount of calls handled by the assistant may be partly caused by the fact that the assistants in the cooperative with an expert system more often consult the GP during triage. And it is not likely that the larger amount of home visits in Groningen can be attributed to the absence of an expert system. The expert system only offers advice whether a GP should be seen, not in which way (by consultation in the office or by home visit). The differences in call times between a cooperative using an expert system and a cooperative not using an expert system are small; 0.4 - 1.0 min. Differences in triage decisions were found, but it is not proven that these can be contributed to the use of an expert system.

Call-duration and triage decisions in out of hours cooperatives with and without the use of an expert system

PubMed Central

Ong, Rob SG; Post, Johan; van Rooij, Harry; de Haan, Jan

2008-01-01

Background Cooperatives delivering out of hours care in the Netherlands are hesitant about the use of expert systems during triage. Apart from the extra costs, cooperatives are not sure that quality of triage is sufficiently enhanced by these systems and believe that call duration will be prolonged drastically. No figures about the influence of the use of an expert system during triage on call duration and triage decisions in out of hours care in the Netherlands are available. Methods Electronically registered data concerning call duration and triage decisions were collected in two cooperatives. One in Tilburg, a cooperative in a Southern city of the Netherlands using an expert system, and one in Groningen, a cooperative in a Northern city not using an expert system. Some other relevant information about the care process was collected additionally. Data about call duration was compared using an independent sample t-test. Data about call decisions was compared using Chi Square. Results The mean call time in the cooperative using the TAS expert system is 4.6 minutes, in the cooperative not using the expert system 3.9 minutes. A significant difference of 0.7 minutes (0.4 – 1.0, 95% CI) minutes. In the cooperative with an expert system a larger percentage of patients is handled by the assistant, patients are less often referred to a telephone consultation with the GP and are less likely to be offered a visit by the GP. A quick interpretation of the impact of the difference in triage decisions, show that these may be large enough to support the hypothesis that longer call duration is compensated for by less contacts with the GP (by telephone or face-to-face). There is no proof, however, that these differences are caused by the use of the triage system. The larger amount of calls handled by the assistant may be partly caused by the fact that the assistants in the cooperative with an expert system more often consult the GP during triage. And it is not likely that the larger amount of home visits in Groningen can be attributed to the absence of an expert system. The expert system only offers advice whether a GP should be seen, not in which way (by consultation in the office or by home visit). Conclusion The differences in call times between a cooperative using an expert system and a cooperative not using an expert system are small; 0.4 – 1.0 min. Differences in triage decisions were found, but it is not proven that these can be contributed to the use of an expert system. PMID:18271970

The Potential of Computer-Based Expert Systems for Special Educators in Rural Settings.

ERIC Educational Resources Information Center

Parry, James D.; Ferrara, Joseph M.

Knowledge-based expert computer systems are addressing issues relevant to all special educators, but are particularly relevant in rural settings where human experts are less available because of distance and cost. An expert system is an application of artificial intelligence (AI) that typically engages the user in a dialogue resembling the…

Fire Effects, Education, and Expert Systems

Treesearch

Robert E. Martin

1987-01-01

Predicting the effects of fires in the year 2000 and beyond will be enhanced by the use of expert systems. Although our predictions may have broad confidence limits, expert systems should help us to improve the predictions and to focus on the areas where improved knowledge is most needed. The knowledge of experts can be incorporated into previously existing knowledge...

42 CFR 423.120 - Access to covered Part D drugs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... pharmacists. (ii) Includes at least one practicing physician and at least one practicing pharmacist who are... manufacturers. (iii) Includes at least one practicing physician and one practicing pharmacist who are experts...)), authorized prescribers, network pharmacies, and pharmacists prior to the date such change becomes effective...

Stress, inflammation, and yoga practice.

PubMed

Kiecolt-Glaser, Janice K; Christian, Lisa; Preston, Heather; Houts, Carrie R; Malarkey, William B; Emery, Charles F; Glaser, Ronald

2010-02-01

To address the mechanisms underlying hatha yoga's potential stress-reduction benefits, we compared inflammatory and endocrine responses of novice and expert yoga practitioners before, during, and after a restorative hatha yoga session, as well as in two control conditions. Stressors before each of the three conditions provided data on the extent to which yoga speeded an individual's physiological recovery. A total of 50 healthy women (mean age, 41.32 years; range, 30-65 years), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during three separate visits. The yoga session boosted participants' positive affect compared with the control conditions, but no overall differences in inflammatory or endocrine responses were unique to the yoga session. Importantly, even though novices and experts did not differ on key dimensions, including age, abdominal adiposity, and cardiorespiratory fitness, novices' serum interleukin (IL)-6 levels were 41% higher than those of experts across sessions, and the odds of a novice having detectable C-reactive protein (CRP) were 4.75 times as high as that of an expert. Differences in stress responses between experts and novices provided one plausible mechanism for their divergent serum IL-6 data; experts produced less lipopolysaccharide-stimulated IL-6 in response to the stressor than novices, and IL-6 promotes CRP production. The ability to minimize inflammatory responses to stressful encounters influences the burden that stressors place on an individual. If yoga dampens or limits stress-related changes, then regular practice could have substantial health benefits.

Expert opinion on "best practices" in the delivery of health care services to immigrants in Denmark.

PubMed

Jensen, Natasja Koitzsch; Nielsen, Signe Smith; Krasnik, Allan

2010-08-01

Delivery of health care to immigrants is an emerging field of interest. Immigrants are frequently characterised by health outcomes that are inferior to those of other groups with regard to morbidity and mortality. In addition, health professionals report difficulties associated with the encounter with immigrant patients. A Delphi process with eight Danish experts from the field of immigrant health was performed as part of an EU project. The objective of the Delphi process was to investigate expert opinion on "best practice in the delivery of healthcare to immigrants". Initially, 60 factors were suggested by the experts. Next, these factors were summarised into 32 factors that the experts were invited to rate and, if possible, agree on. The top 11 factors identified in the Delphi process were access to interpreters, quality of interpretation, ensuring medication compliance, having sufficient consultation time, coherence of offers, interdisciplinary collaboration, allocation of resources, the role of the practitioner, acknowledgement of the individual patient, education of health professionals and students and access to telephone interpretation to supplement other services. The Delphi process can be a valuable tool in the investigation of expert opinion and may thereby help to guide future policy directives. In the light of the importance experts placed on access to interpreters and on the quality of the interpretation services offered, it seems as an untenable strategy to introduce as from June 2011 self-payment for interpretation services provided to immigrants who have stayed in the country for more than seven years.

Expert system development methodology and the transition from prototyping to operations: FIESTA, a case study

NASA Technical Reports Server (NTRS)

Happell, Nadine; Miksell, Steve; Carlisle, Candace

1989-01-01

A major barrier in taking expert systems from prototype to operational status involves instilling end user confidence in the operational system. The software of different life cycle models is examined and the advantages and disadvantages of each when applied to expert system development are explored. The Fault Isolation Expert System for Tracking and data relay satellite system Applications (FIESTA) is presented as a case study of development of an expert system. The end user confidence necessary for operational use of this system is accentuated by the fact that it will handle real-time data in a secure environment, allowing little tolerance for errors. How FIESTA is dealing with transition problems as it moves from an off-line standalone prototype to an on-line real-time system is discussed.