bluuebunny/crossref_metadata_2025 huggingface dataset:
Electromyographic Correlates of Learning during Robotic Surgical Training in Virtual Reality
Authors: Suh Irene H.  , Mukherjee Mukul  , Schrack Ryan  , Park Shi-Hyun  , Chien Jung-hung  , Oleynikov Dmitry  , Siu Ka-Chun
Published: February 2025

The purpose of this study was to investigate the muscle activation and the muscle frequency response of the dominant arm muscles (flexor carpi radialis and extensor digitorum) and hand muscles (abductor pollicis and first dorsal interosseous) during robotic surgical skills training in a virtual environment. The virtual surgical training tasks consisted of bimanual carrying, needle passing and mesh alignment. The experimental group (n=5) was trained by performing four blocks of the virtual surgical tasks using the da Vinci™ surgical robot. During the pre- and post-training tests, all subjects were tested by performing a suturing task on a “life-like” suture pad. The control group (n=5) performed only the suturing task without any virtual task training. Differences between pre- and post-training tests were significantly greater in the virtual reality group, as compared to the control group in the muscle activation of the hand muscle (abductor pollicis) for both the suture tying and the suture running (p < 0.05). In conclusion, changes in electrographic activity shows that training in virtual reality leads to specific changes in neuromotor control of robotic surgical tasks.
A Hybrid Dynamic Deformation Model for Surgery Simulation
Authors: Tagawa Kazuyoshi  , Tanaka Hiromi T.
Published: February 2025

A hybrid dynamic deformation model that is capable of haptic interaction with dynamically deformable objects is presented. This approach is also capable of taking into account large deformation and topological changes of objects. The amount of computation required in this approach is proportional to the sum of the square of the number of shared nodes and the number of whole nodes of an online-remesh model. We implemented the approach in our prototype system and confirmed the feasibility and performance through experiments.
Improving Fiberoptic Intubation with a Novel Tongue Retraction Device
Authors: Boedeker Ben H.  , Bernhagen Mary  , Miller David J.  , Nicholas IV Thomas A.  , Linnaus Andrew  , Murray W.B.
Published: February 2025

This study examined the utility of a novel tongue retractor created with a wider working blade and a more ergonomic curve to provide jaw lift and tongue management with one hand during intubation. Anesthesia providers participated in simulated intubation of a difficult manikin using the novel tongue retractor with the Bonfils video fiberscope. Results show that the tongue retractor improved placement success and was well received by the study participants.
The Combined Use of Skype
Authors: Boedeker Ben H.  , Bernhagen Mary  , Miller David J.  , Miljkovic Nikola  , Kuper Gail M.  , Murray W. Bosseau
Published: February 2025

This study examined the feasibility of using SkypeTMtechnology in basic manikin intubation instruction of Nebraska National Air Guard personnel at a Casualty Training Exercise. Results show that the SkypeTMmonitor provided clear sound and visualization of the airway view to the trainees and the combination of VoIP technology and videolaryngoscopy for intubation training was highly valued by study participants.
An Integrated Surgical Communication Network – SurgON
Authors: Bucholz Richard D.  , Laycock Keith A.  , McDurmont Leslie L.  , MacNeil William R.
Published: February 2025

An integrated communication network, SurgON, has been developed to enable a surgeon to control multiple operating room systems and devices and monitor data streams from diverse sources via a single console. The system also enables the surgeon to grant access and control to remote observers and participants. A test configuration has been evaluated.
Decision Support and Automation Bias: Methodology and Preliminary Results of a Systematic Review
Authors: Goddard Kate  , Roudsari Abdul  , Wyatt Jeremy
Published: February 2025

Automation bias – or a tendency to over-rely on automation – is a subject which has been studied in a variety of academic fields. Clinical Decision Support Systems (CDSS) aim to benefit the clinical decision making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce, and as such the healthcare field has a gap in this research. This paper summarizes the methodology and preliminary results of a systematic review over a broad range of fields into the effects of over-reliance on automation. Results indicate that though automation bias is a significant phenomenon, it is not well defined, and there is a gap in the research which must be addressed to optimize the use of decision support.
Delivery of Psychosocial Care for Cancer Patients: A Pilot Investigation
Authors: Abrahamson Kathleen  , Durham Morgan  , Norton Kelli  , Anderson James G.
Published: February 2025

Psychosocial distress is common in cancer patients. Although common, psychosocial distress is frequently under-diagnosed and poorly managed in the U.S. health system. This paper describes 25 in-depth telephone interviews with health care professionals working within cancer care centers. Interview questions address perception of the psychosocial services offered within their cancer care organizations. Results indicate that access to psychosocial care is frequently dependent upon the subjective judgment of busy clinicians. Information technology could improve the delivery of psychosocial care by easing the administration of psychosocial assessments and increasing clinician contact with research evidence regarding distress management.
Application of Language Processing Techniques to Capture the Use of Nursing Clinical Terms from Narrative Statements: Report of a Pilot Study
Authors: Frisch Noreen  , Frisch Larry
Published: February 2025

Objective: The authors piloted the use of the “General Architecture for Text Engineering” (GATE) program in an analysis of writings from the nursing literature to determine if this standard language processing technique could be used to capture the use of complex nursing terms. This work was undertaken as an initial step in evaluating if widely-available natural language processing methods could be applied to narrative nursing notes in a way that a nursing diagnosis could be identified and extracted from a narrative text. Methods: For purposes of the pilot study, the complex nursing term “powerlessness”, which is identified as a NANDA-I nursing diagnosis, was selected as the test case. A PubMed search was performed on the term “powerlessness” limited to articles in the nursing literature that contained abstracts, resulting in 232 articles published between 1981 to 2010 meeting the criteria. Three-sentence extracts from each abstract were analyzed by applying GATE to identify noun and adjective roots occurring in close proximity to the index word, and then identifying if these proximal words reflected the standardized defining characteristics, adjectives and qualifiers of the diagnostic term. Results: The analysis resulted identification 2,174 unique terms. While a few terms coincided with the NANDA-I defining characteristics of “powerlessness”, most of the established defining characteristics were not reflected in the use of the term. Conclusions: Machine language processing techniques are promising in identifying meanings and contextual use of words related to nursing concepts, but the use of such words in published papers does not represent definitions found in standard nursing nomenclature. Nursing writers use terms that are also understood outside the disciplinary domain, making standardization and coding particularly challenging. Future research in Nursing should apply the techniques described to clinical reports and to evaluate the match between clinical usage and standardized meanings.
Strengths and Weaknesses of Using Conferencing Technologies to Support Drug Policy Knowledge Exchange
Authors: Househ Mowafa Said  , Kushniruk Andre W.  , Macclure Malcolm  , Carleton Bruce  , Cloutier-Fisher Denise
Published: February 2025

This paper outlines the experiences with and lessons learned from the use of conferencing technologies in supporting knowledge exchange groups. We discuss the strengths and weaknesses of these technologies when used to support distant knowledge exchange activities within drug policy groups. The strengths and weaknesses of face-to-face meetings are also discussed.
Sociotechnical Evaluation of a Clinical Transformation Project in a Specialized Cancer Care Centre
Authors: Bishop Margaret  , Barnett Jeff  , Vlachaki Maria T.  , Pai Howard
Published: February 2025

The radiation therapy (RT) department at the British Columbia Cancer Agency - Vancouver Island Centre (VIC) is responsible for delivering radiation treatments to cancer patients from Vancouver Island, which has a population base of approximately 750,000. The purpose of this analysis is to examine a process transformation project undertaken by a VIC clinical champion using a sociotechnical approach and identify factors that influenced the project outcome. Beginning in January 2009, a radiation oncologist at VIC initiated a project to transform the clinical process of generating prescriptions for radiation therapy. The project objective was to replace the paper-based process for radiation therapy (RT) prescriptions with an electronic process to achieve benefits such as increased legibility, accuracy, and accessibility of prescriptions. The electronic prescription (e-Rx) process was designed and developed by health informatics students from the University of Victoria, and the new process was trialed and implemented for approximately half of the new patients seen by the VIC RT department. This pilot implementation was brought to a halt two weeks later, due to concerns raised by the RT department. Using a sociotechnical approach, the authors identify several factors that negatively impacted the project's successful implementation: lack of leadership endorsement and organizational strategy, insufficient formal and informal organizational power of the clinical champion, underestimation of complexity, and inadequate management of the implementation process. Although these factors have been well documented in the literature for large-scale system implementation projects, understanding the way by which they influence smaller-scale process transformation projects in highly specialized clinical settings may help future project managers and coordinators to set such projects up for success.
eHealth in Switzerland – Building Consensus, Awareness and Architecture
Authors: Lovis Christian  , Looser Hansjorg  , Schmid Adrian  , Wagner Judith  , Wyss Stefan
Published: February 2025

This paper reports on the process of the Swiss national strategy to define and implement eHealth. Switzerland is a federal political organization with 26 cantons that are autonomous for the health legal framework. Switzerland must also provide support for four national languages. Thus, this experience addresses many challenges that are experienced at the European level in a much larger scale. Also, Switzerland benefits from the major projects ongoing in Europe, such as epSOS, to define its own strategy.
Patient Empowerment by Electronic Health Records: First Results of a Systematic Review on the Benefit of Patient Portals
Authors: Ammenwerth Elske  , Schnell-Inderst Petra  , Hoerbst Alexander
Published: February 2025

Patient portals provide patients with access to a provide-managed electronic health record (EHR). They may provide an interesting approach to increase patient empowerment. The objective of this paper is to provide a first overview of the state-of-the-art and the impact of patient portals. Based on a systematic literature search, we identified five evaluation studies on patient portals. These studies demonstrate only little effect of patient portals on patient empowerment.
Fully Connected Emergency Intervention for the Critical Home Care System
Authors: Nakik Draško  , Loškovska Suzana  , Trajkovik Vladimir
Published: February 2025

The Critical Home Care System – CHCS, we propose, achieves permanent advising, frequent control appointments and quick reaction to critical conditions by constant remote monitoring of patient's vital signs from the hospital, while staying at his home. Physicians react properly to the developing condition, contacting the patient or a member of the household, or sending an ambulance in an emergency. The CHCS additionally provides constant inspection of the patient's condition to the ambulance doctor in emergency situations and to the urgent centre staff to prepare better for accepting the patient, enabling a fully connected emergency intervention. In this paper we will concentrate on the data flow during the emergency intervention in this highly collaborative system.
Shallow Medication Extraction from Hospital Patient Records
Authors: Boytcheva Svetla
Published: February 2025

This paper presents methods for shallow Information Extraction (IE) from the free text zones of hospital Patient Records (PRs) in Bulgarian language in the Patient Safety through Intelligent Procedures in medication (PSIP) project. We extract automatically information about drug names, dosage, modes and frequency and assign the corresponding ATC code to each medication event. Using various modules for rule-based text analysis, our IE components in PSIP perform a significant amount of symbolic computations. We try to address negative statements, elliptical constructions, typical conjunctive phrases, and simple inferences concerning temporal constraints and finally aim at the assignment of the drug ACT code to the extracted medication events, which additionally complicates the extraction algorithm. The prototype of the system was used for experiments with a training corpus containing 1,300 PRs and the evaluation results are obtained using a test corpus containing 6,200 PRs. The extraction accuracy (f-score) for drug names is 98.42% and for dose 93.85%.
EU-ADR Healthcare Database Network vs. Spontaneous Reporting System Database: Preliminary Comparison of Signal Detection
Authors: Trifirò Gianluca  , Patadia Vaishali  , Schuemie Martijn J.  , Coloma Preciosa M.  , Gini Rosa  , Herings Ron  , Hippisley-Cox Julia  , Mazzaglia Giampiero  , Giaquinto Carlo  , Scotti Lorenza  , Pedersen Lars  , Avillach Paul  , Sturkenboom Miriam C.J.M.  , van der Lei Johan  , the EU-ADR group
Published: February 2025

The EU-ADR project aims to exploit different European electronic healthcare records (EHR) databases for drug safety signal detection. In this paper we report the preliminary results concerning the comparison of signal detection between EU-ADR network and two spontaneous reporting databases, the Food and Drug Administration and World Health Organization databases. EU-ADR data sources consist of eight databases in four countries (Denmark, Italy, Netherlands, and United Kingdom) that are virtually linked through distributed data network. A custom-built software (Jerboa©) elaborates harmonized input data that are produced locally and generates aggregated data which are then stored in a central repository. Those data are subsequently analyzed through different statistics (i.e. Longitudinal Gamma Poisson Shrinker). As potential signals, all the drugs that are associated to six events of interest (bullous eruptions - BE, acute renal failure - ARF, acute myocardial infarction - AMI, anaphylactic shock - AS, rhabdomyolysis - RHABD, and upper gastrointestinal bleeding - UGIB) have been detected via different data mining techniques in the two systems. Subsequently a comparison concerning the number of drugs that could be investigated and the potential signals detected for each event in the spontaneous reporting systems (SRSs) and EU-ADR network was made. SRSs could explore, as potential signals, a larger number of drugs for the six events, in comparison to EU-ADR (range: 630-3,393 vs. 87-856), particularly for those events commonly thought to be potentially drug-induced (i.e. BE: 3,393 vs. 228). The highest proportion of signals detected in SRSs was found for BE, ARF and AS, while for ARF, and UGIB in EU-ADR. In conclusion, it seems that EU-ADR longitudinal database network may complement traditional spontaneous reporting system for signal detection, especially for those adverse events that are frequent in general population and are not commonly thought to be drug-induced. The methodology for signal detection in EU-ADR is still under development and testing phase.
Effect of magnetic dipole coupling on optical binding energies between molecules
Authors: Salam A.
Published: February 2025

Within the framework of molecular quantum electrodynamics, the method of induced multipole moments is used to compute the laser-induced intermolecular energy shift between an electric dipole polarizable molecule and a magnetic dipole susceptible molecule, and between two magnetic dipole polarizable molecules. The physical viewpoint adopted in the calculation is one in which an applied electromagnetic field induces molecular multipole moments in each entity, which couple via the retarded resonant multipole-multipole interaction tensors. Expectation values taken over the ground electronic states of the material system, and a radiation field state containing n photons, leads directly to the coupling energy. Results are obtained for external radiation in a fixed orientation relative to the internuclear axis, with a thorough polarization analysis being carried out for linearly and circularly polarized radiation propagating in directions parallel and perpendicular to the separation distance vector, as well as for a freely tumbling molecular pair. Comparison is made with field-induced discriminatory energy shifts occurring between optically active molecules – which also involve coupling of electric and magnetic dipole moments, and the leading contribution to optical binding forces arising within the electric dipole approximation.
Virtual Reality Exposure Treatment of Agoraphobia: a Comparison of Computer Automatic Virtual Environment and Head-Mounted Display
Authors: Meyerbröker Katharina  , Morina Nexhmedin  , Kerkhof Gerard  , Emmelkamp Paul M.G.
Published: February 2025

In this study the effects of virtual reality exposure therapy (VRET) were investigated in patients with panic disorder and agoraphobia. The level of presence in VRET was compared between using either a head-mounted display (HMD) or a computer automatic virtual environment (CAVE). Results indicate that there was no relationship between the level of experienced presence and treatment outcome. Analyses indicate that VRET in general was more effective than no treatment. No differences in effectiveness were found between VRET using an HMD or CAVE.
Applications of Participatory Road Maintenance using “Do-nou” Technology in Kenya
Authors: Kimura Makoto  , Fukubayashi Yoshinori
Published: February 2025

The Do-nou (soilbags) technology, which uses geotextile materials readily available in rural areas, has been applied in maintenance of rural access roads in Kenya. Damaged sections of unpaved rural roads, where vehicles would have otherwise got stuck during the rainy season, were repaired and maintained voluntarily by organized local communities. Training on use of this technology was conducted with the aim of empowering the communities to be able constantly repair and maintain sections of many of their roads on their own. The geotechnical technology is being transferred to the communities and contributing the poverty reduction practically in the rural area of Kenya.
Geotechnical characterization and design considerations in the Moatize Coalfields, Mozambique
Authors: Davis Gary N.  , Vorster T.E.B.  , Braga Célia
Published: February 2025

The Moatize coalfields in the Tete Province of Mozambique are currently seeing an explosion of development. These new developments have been preceded by intensive geotechnical investigations in order to characterize founding conditions, and prepare geotechnical designs for new infrastructure in a relatively undeveloped area. This paper describes the findings of design-level geotechnical investigations and characterization for Vale's Moatize Coal Project primarily for the plant infrastructure. Specific geotechnical design considerations for the coal stockyard and primary crusher, which provided unique geotechnical challenges, are described
Instrumentation and Monitoring during Construction of the Ingula Power Caverns
Authors: Keyter G.J.  , Kellaway M.  , Taylor D.
Published: February 2025

An extensive programme of instrumentation and monitoring was carried out during construction of the Ingula hydro power caverns given the size of these excavations in Karoo mudrocks, for validation of assumptions made during design. In this paper, some of the monitoring results are compared to predicted convergence and an incident is reviewed where excessive overbreak in one of the side headings of the machine hall top heading resulted, locally, in undue roof deformation which necessitated remedial action to stabilize this part of the crown.
Compression index C
Authors: Bradvica I.  , Mitrović G.
Published: February 2025

The compressibility properties of Zagreb-area clays are evaluated based on oedometer consolidation test results for 177 undisturbed samples tested in the period between 2002 and 2007. The compression Cc and recompression Cr indexes are statistically correlated (linear regression) with the corresponding classification index properties. Each of these indexes is correlated with the liquid limit, natural moisture content, plastic limit, void ratio, and their combinations. Derived correlations are compared with similar correlations for clay found in other countries.
The effect of mechanical remoulding on the compression and strength characteristics of a Mercia Mudstone
Authors: Stallebrass S.E.  , Seward L.J.
Published: February 2025

A series of laboratory tests have been undertaken as part of a larger study into the effect of continuous flight auger pile installation on the soil-pile interface in the Mercia Mudstone Group [1]. This paper reports the results of stress path triaxial tests on bulk samples of the mudstone which have been subjected to varying amounts of mechanical remoulding representing the remoulding that occurs due to the action of the auger. In addition, the water content at which remoulding takes place has been varied. The tests were undertaken to investigate whether the silt sized aggregates of clay particles that exist [2] within this soil could be broken up by the mechanical remoulding and whether this would affect the compression and strength properties of the mudstone. It was found that both mechanical remoulding and the water content at which this is carried out affect the subsequent response of the soil.
Stiffness of the soil determined from in situ testing
Authors: Skutnik Z.  , Bajda M.  , Lech M.
Published: February 2025

The geotechnical engineering parameters determined from in situ testing are not affected by the level of disturbance and degradation then results of laboratory testing of soil samples obtained from conventional soil borings. In this paper talk will focus on the Piezocone Penetration Test (CPTU), Seismic Cone Penetration Test (SCPTU), Resistivity Cone Penetration Test (RCPTU) and Dilatometer Test (DMT). The tests were performed in the Warsaw area subsoil which is located within the tectonic unit known as the Mazovian Basin, a vast depression developed during the Tertiary glaciation's period. Tertiary comprises the Pliocene deposits represented by clays, silts and locally sands. Pliocene clay behavior constitutes a significant threat to foundation systems and underground structures. In DMT test the pressures required to expand the membrane provide a direct measurement of the soil modulus (stiffness). Shallow and deep foundation design can then be performed by using the derived geotechnical data. A main benefit of the dilatometer test is that it directly measures the soil modulus (stiffness). This parameter controls foundation design since almost all foundations are designed based on their potential for settlement and not bearing capacity (i.e. failure).
Use of a damage parameter to model the mechanical behavior of marls
Authors: Caldeira L.  , Maranha das Neves E.  , Cardoso R.
Published: February 2025

Hard soils/ soft rocks (HSSR) are natural materials where the bonds between particles have important contribution to their strength and stiffness. Progressive rupture of these bonds affects irreversibly the hydro-mechanical behavior of these materials. Most of the existing models follow the idea that bond degradation depends on accumulated plastic strains. Such is the case of the model used to describe the mechanical behavior observed in oedometer and isotropic compression tests performed on marls.
Modeling the oedometric behavior of an evolving marl under stress and suction cycles
Authors: Cardoso R.  , Alonso E.E.
Published: February 2025

Several oedometric tests were performed on specimens of marl, in which stress cycles were applied under different suctions. Evident signs of stiffness degradation were detected. Stronger degradation was observed in the samples subjected to suction cycles besides stress cycles The model adopted to reproduce the tests is defined for unsaturated bonded materials. Hardening depends on a damage parameter defined to account with accumulated plastic strains and suction.
In-situ and laboratory water retention characteristics in a silty sand dyke
Authors: Morales W.F.  , Mayor P.A.  , Springman S.M.  , Vogel A.
Published: February 2025

A discussion of the Soil Water Retention Curve (SWRC) parameters obtained both in the laboratory and in a field test is presented. The former was obtained from specimens reconstituted in an apparatus based on the axis-translation technique, while the latter was obtained from data measured by Time Domain Reflectometers (TDR), EnviroSmart™gauges (ESM) and suction tensiometers. Correlation was observed between both field and laboratory SWRCs, Air Entry Values (AEV), maximum and residual volumetric water contents. Concluding that, at least for the tested soil, the performed laboratory tests represent accurately the interaction between water and soil of the full scale engineering structure. A strong influence of soil density was confirmed. However, its in-situ determination and its control at the beginning of the tests give space for improvement.
Unsaturated behaviour of a cemented sand
Authors: Toll D.G.  , Ali Rahman Z.
Published: February 2025

A wide range of natural soils show the influence of the effects of structure in the form of weakly cemented bonds between particles. While there have been a number of studies of the effect of bonded structure on the soil behaviour in saturated conditions, there have been few studies of the behaviour of unsaturated bonded soils. In this paper, triaxial test results on an unsaturated artificially bonded sand are used to explore the effects of bonded structure. The artificial soil was produced by mixing sand and kaolin (87% sand: 13% kaolin) and then firing the mixture at 500°C in a furnace. At this temperature the kaolin changes in nature, forming a bond between the sand particles. Constant water content triaxial tests were carried out, using the axis translation technique to measure suctions during shearing. The results were analysed to investigate the effect of the suction and degree of saturation on strength at the Critical State. It was found that for the bonded soil, during the initial desaturation phase when the degree of saturation reduces considerably, the contribution of suction to strength represented by a stress ratio Mbor angle of friction (φb) was largely unaffected by desaturation. It was only when the suction increases sufficiently that the micro-voids within the cementing material start to desaturate that a reduction in Mband φbwas seen. This occurred at suctions in excess of the residual suction when the global degree of saturation was changing by very little.
Capacité portante des fondations superficielles avec et sans l'hypothèse de superposition
Authors: Mabrouki A.  , Benmeddour D.  , Mellas M.  , Frank R.
Published: February 2025

De nombreuses études ont été consacrées à la détermination de la capacité portante des fondations superficielles; ces études ont une allure identique puisqu'elles suivent la superposition des trois termes introduite par Terzaghi. Cette étude examine l'hypothèse de superposition de Terzaghi, par des calculs élasto-plastiques en utilisant les codes FLAC62D et FLAC3Den différences finies explicites. Deux types de semelles sont considérés, carrée et filante, et l'interface sol-fondation est supposée lisse ou rugueuse. L'effet d'une loi d'écoulement non-associée est également considéré dans cette étude.
3-D analysis of stone columns to support a roadway embankment on soft soil
Authors: Koch E.
Published: February 2025

Engineering structures are now often built on soft soils with low strength and high compressibility. Adding to the problem are low hydraulic conductivity and greater susceptibility to significant secondary compression. The reduced conductivity and prolonged secondary settlements can exacerbate construction problems and create intolerable delays. As a response to these problems, stone columns provide several positive benefits. They reduce settlement due to their innate stiffness as well as provide a shorter consolidation drainage path with resulting shorter time to pore pressure reduction. The degree of drainage and support however is difficult to estimate since the process is a complex interaction of columns, native soils and embankment placement. This study examines reinforcement effects of stone columns in a 3-dimensional setting. Effects of spacing, diameter and depth of penetration are examined with respect to requirements for increased stability for supporting a highway embankment. The results of this study will enable geotechnical engineers to better evaluate the benefits of stone columns when applied to embankment problems.
Nursing Information System: a Relevant Substitute of the Paper Nursing Record
Authors: Michel-Verkerke Margreet B.
Published: February 2025

Objective: A teaching hospital in the Netherlands has developed a Nursing Information System (NIS). After the NIS was implemented in six wards in March 2009, the NIS was evaluated. Since micro-relevance is a key-factor in adoption of Information Systems, the objective of this study is to reveal which aspects of the NIS are micro-relevant to nurses. Methods: A paper questionnaire was distributed among all 195 nurses, who used the system. Included in the research were 93 (47.7%) respondents. Also six NIS-users were interviewed, using the USE IT-model. Results: Nurses mainly used those functions of the NIS, which were essential for reporting or retrieving patient information. The NIS was appreciated for supplying unhampered access to complete, legible, structured patient data. Conclusions: For nurses the NIS is a good substitute for the paper record. The micro-relevance of other functionality than supplying information seems to be low.
Clinical Situations and Information Needs of Physicians During Treatment of Diabetes Mellitus Patients: a Triangulation Study
Authors: Hübner-Bloder Gudrun  , Duftschmid Georg  , Kohler Michael  , Rinner Christoph  , Saboor Samrend  , Ammenwerth Elske
Published: February 2025

Physicians should have access to the information they need to provide the most effective health care. Medical knowledge and patient-oriented information is dynamic and expanding rapidly so there is a rising risk of information overload. We investigated the information needs of physicians during treatment of Diabetes mellitus patients, using a combination of interviews, observations, literature research and analysis of recorded medical information in hospitals as part of a methodical triangulation. 446 information items were identified, structured in a set of 9 main categories each, as well as 6 time windows, 10 clinical situations and 68 brief queries. The physician's information needs as identified in this study will now be used to develop sophisticated query tools to efficiently support finding of information in an electronic health record.
A Constructivist approach? Using formative evaluation to inform the Electronic Prescription Service Implementation in Primary Care, England
Authors: Harvey Jasmine  , Avery Anthony  , Waring Justin  , Hibberd Ralph  , Barber Nicholas
Published: February 2025

As part of the National Programme for IT (NPfIT) in England, the Electronic Prescription Service (EPS) is being implemented in two releases. The first release placed barcodes on prescriptions and is widely implemented. Release two (EPS2), the electronic transmission of prescriptions between GP, pharmacy and the reimbursement body, has just started implementation. On the NPfIT agenda, community pharmacies have been predicted to benefit from changes in work practice following the full EPS implementation. The study focused on how the advanced EPS (EPS2) might alter dispensing work practice in community pharmacies on issues such as workflow and workload; and the bearing of these issues on improvement in quality of service and safety. This paper demonstrates how findings of the pre-implementation study were used to provide formative feedback to the implementers. A mixed ethnographical method that combined non- participant observations, shadowing and interviews, before and after implementation, was used to qualitatively study eight community pharmacies across three early adopter Primary Care Trusts (PCTs) in England. Key implementation issues were fed-back to the PCTs as part of the EPS2 rolling-out process. Staff access to dispensing terminals needs to be improved if electronic dispensing is to be encouraged. Also, as a safety issue, pharmacists are planning to print off electronic prescriptions (tokens) and dispense from them. Although safer, this could increase workload. The EPS2 could positively alter work practice by improving certain demanding aspects of dispensing whilst reducing human errors. For example, the high demand of customers handing in prescriptions and waiting for them to be dispensed could be reduced through automation. Also, the extreme variation in workload during various times of the day could be evened out to improve workflow and provide a better service; however, in order for this to be fully realized, technical issues such as number of staff per dispensing station and dispensing from tokens would need to be addressed.
A Pilot Assessment of Why Patients Choose Not to Participate in Self-Monitoring Oral Anticoagulant Therapy
Authors: Bonderup Morten Algy  , Hangaard Stine Veje  , Lilholt Pernille Heyckendorff  , Johansen Mette Dencker  , Hejlesen Ole K.
Published: February 2025

Patients suffering from heart diseases often face lifelong oral anticoagulant therapy. Traditionally, the patient's general practitioner takes care of the treatment. An alternative management scheme is a self-monitoring setup where the patient monitors and manages the oral treatment himself. Despite international evidence of reduced thrombosis risk and death rate among patients enrolled in self-monitoring, a majority of eligible patients deselect this opportunity. Little is about the causes if this. This study is a pilot assessment of why patients, located in the North Denmark Region, choose not to participate. The study is based on qualitative interviews with two nurses working in a medical practice and two patients participating in conventional anticoagulant therapy. The results of this study seem to suggest that at least some patients feel a lack of information to base their decision regarding self-monitoring or conventional management on and that the knowledge among the health personnel at the medical clinics should be increased.
Technical Data Evaluation of a Palliative Care Web-Based Documentation System
Authors: Hartz Tobias  , Brüntrup René  , Ückert Frank
Published: February 2025

A technical analysis of the web-based patient documentation system, eKernPäP, was conducted. The system is used by interdisciplinary pediatric palliative care teams in Germany to document outpatient care. The data of the system and the data of an external web analytic system have been evaluated. The results gave an overview how the system is used and what information is generated. A detailed analysis of singular forms showed that not all forms were filled in completely. With the help of the external web analytic system the navigation behavior of the users could be retraced. The users followed the given navigation from top to bottom. An existing exception in this pattern turned out to be misplacement and will be corrected in the next version. The technical analysis proved to be a good tool for improving a web-based documentation system.
End-to-End Security for Personal Telehealth
Authors: Koster Paul  , Asim Muhammad  , Petkovic Milan
Published: February 2025

Personal telehealth is in rapid development with innovative emerging applications like disease management. With personal telehealth people participate in their own care supported by an open distributed system with health services. This poses new end-to-end security and privacy challenges. In this paper we introduce new end-to-end security requirements and present a design for consent management in the context of the Continua Health Alliance architecture. Thus, we empower patients to control how their health information is shared and used in a personal telehealth eco-system.
Ontology-Based Automatic Generation of Computerized Cognitive Exercises
Authors: Leonardi Giorgio  , Panzarasa Silvia  , Quaglini Silvana
Published: February 2025

Computer-based approaches can add great value to the traditional paper-based approaches for cognitive rehabilitation. The management of a big amount of stimuli and the use of multimedia features permits to improve the patient's involvement and to reuse and recombine them to create new exercises, whose difficulty level should be adapted to the patient's performance. This work proposes an ontological organization of the stimuli, to support the automatic generation of new exercises, tailored on the patient's preferences and skills, and its integration into a commercial cognitive rehabilitation tool. The possibilities offered by this approach are presented with the help of real examples.
Service Oriented Data Integration for a Biomedical Research Network
Authors: Ganzinger Matthias  , Noack Tino  , Diederichs Sven  , Longerich Thomas  , Knaup Petra
Published: February 2025

In biomedical research, a variety of data like clinical, genetic, expression of coding or non-coding ribonucleic acid (RNA) transcripts, or proteomic data are processed to gain new insights into diseases and therapies. In transregional research networks, geographically distributed projects work on comparable research questions with data from different resources and in different formats. Providing an information platform that integrates the data of the projects can enable cross-project analysis and provides an overview of available data and resources (tissue, blood, etc.). For a German liver cancer research network consisting of 22 individual projects, we develop the integrated information platform pelican – platform enhancing liver cancer networked research. In our generic approach, data are made available to the research network by standardized data services based on technologies provided by the cancer Biomedical Informatics Grid (caBIG). It has shown that publishing service metadata in a corresponding repository is a major prerequisite for automated discovery, integration, and conversion of data records and data services. We identified data confidentiality and intellectual property considerations as major challenges while establishing such an integrated information platform. As a first result we implemented a working prototype to validate our approach.
The ONCO-I2b2 Project: Integrating Biobank Information and Clinical Data to Support Translational Research in Oncology
Authors: Segagni Daniele  , Tibollo Valentina  , Dagliati Arianna  , Perinati Leonardo  , Zambelli Alberto  , Priori Silvia  , Bellazzi Riccardo
Published: February 2025

The University of Pavia and the IRCCS Fondazione Salvatore Maugeri of Pavia (FSM), has recently started an IT initiative to support clinical research in oncology, called ONCO-i2b2. ONCO-i2b2, funded by the Lombardia region, grounds on the software developed by the Informatics for Integrating Biology and the Bedside (i2b2) NIH project. Using i2b2 and new software modules purposely designed, data coming from multiple sources are integrated and jointly queried. The core of the integration process stands in retrieving and merging data from the biobank management software and from the FSM hospital information system. The integration process is based on a ontology of the problem domain and on open-source software integration modules. A Natural Language Processing module has been implemented, too. This module automatically extracts clinical information of oncology patients from unstructured medical records. The system currently manages more than two thousands patients and will be further implemented and improved in the next two years.
Contextualization of Automatic Alerts During Electronic Prescription: Researchers' and Users' Opinions on Useful Context Factors
Authors: Ammenwerth Elske  , Hackl Werner O.  , Riedmann Daniel  , Jung Martin
Published: February 2025

Computerized Physician Order Entry (CPOE) Systems can reduce the number of medication errors and Adverse Drug Events (ADEs). However, studies have shown that users often override alerts, as they feel these are too unspecific for the given patient context. It is unclear, however, how alerts could be contextualized, that is adapted to the clinical context. Based on a literature search, we developed a list of 20 possible context factors. We asked 69 international CPOE researchers and 120 physicians from four hospitals in two countries to judge the usefulness of each factor. Researchers judged the following factors as most important: 1.) Severity of the effect, 2.) Clinical status of the patient, 3.) Probability of occurrence, 4.) Risk factors of the patient, 5.) Strength of evidence. Physicians judged the following factors as most important: Severity of the effect, clinical status of the patients, complexity of the case, and class of drug. These top-ranked context factors could be used to re-design the way alerts are presented in CPOE systems, to increase sensitivity of alerts, to reduce overriding rates, and to improve medication safety.
Impact of Alert Specifications on Clinicians' Adherence
Authors: Langemeijer M.M.  , Peute L.W.  , Jaspers M.W.M.
Published: February 2025

Computerized alerts provided by health care information systems have been shown to enhance clinical practice. However, clinicians still override more than half of the alerts. This indicates that certain aspects of alerts need improvement to fulfill their purpose of supporting clinicians in decision making. This paper reports on a systematic review on studies evaluating alert specifications and their impact on clinicians' alert adherence. The review revealed that use of colors and icons to distinguish different alert severity levels and presenting high severity alerts in an interruptive fashion increases clinicians adherence to alert recommendations. Alert message contents that lack clinical importance or provide incorrect texts increase alert non-adherence. Few studies have yet focused on the impact of alert specifications on clinicians' adherence. A research agenda is needed on alert specifications and their impact on clinicians' adherence in order to develop alerts that truly support clinician decision making.
Laboratory determination of the mechanical properties of granite rocks
Authors: Sosna K.
Published: February 2025

This research into the mechanical properties of granite rocks focuses on their porosity and deformability. The study specifically relates to the planned disposal of radioactive waste. Three granitoid types from the Variscan Bohemian Massif of Central Europe have been tested. The investigation boreholes reached depths of up to 100 meters. The porosity was obtained by weighing saturated and dry samples, with saturation provided by water immersion in a vacuum. Young's modulus and Poisson's ratio were determined in uniaxial compression. The shear and longitudinal deformation of each sample was measured using a resistive strain gauge fixed directly on the sample. The samples were subjected to five different loads followed by unloading. A constant gradient of vertical stress of 1 MPa.s−1was applied during the loading. P-wave and S-wave velocities were measured in three perpendicular directions. The apparatus consisted of four piezoelectric sensors, an ultrasonic pulsar, receivers, and a digital oscilloscope recorder. The frequency was 1MHz. Velocities were measured on naturally wet, saturated, and dried samples. Dynamic elastic modulus was calculated from the measured data. The static Young's modulus varied between 30–60 GPa, while the dynamic modulus rose to 90 GPa. The porosity of the samples varied from 0.6 to 1.4 %. P-wave velocities ranged from 4.4 to 6.9 km.s−1, while S-wave velocities ranged from 2.8 to 3.7 m.s−1. Both P-wave and S-wave velocities generally increase with depth in the borehole. Slight anisotropy was observed in several samples.
Policy Needs and Options for a Common Transatlantic Approach towards Measuring Adoption, Usage and Benefits of eHealth
Authors: Stroetmann Karl A.  , Middleton Blackford
Published: February 2025

The European Union (EU) sponsored ARGOS project analysed current eHealth policy thinking in both the EU and the USA, compared strategic challenges and outcomes in selected fields, and drafted roadmaps towards developing advanced global approaches for these issues. This policy brief focuses on better understanding the benefits and costs of eHealth investments, assessing their overall socio-economic impact, identifying challenges and success factors, as well as measuring and globally benchmarking the concrete usage of eHealth solutions. These are by now key policy priorities not only of national governments and the European Commission, but also of international institutions like WHO or OECD. There is a strong felt transatlantic need for stocktaking, identifying lessons learned, sharing of experience, and working together to advance these issues for the benefit of health systems. A growing number of national and international activities can be taken advantage of. Recommendations on how to proceed with such transatlantic activities are proposed.
An Investigation of Value Modelling for Commercial Aircraft
Authors: Hollingsworth Peter
Published: February 2025

One of the issues with commercial aircraft design is that most of the methods of developing and propagating requirements allow for nominally satisfying but less than ideal designs to be produced. There is a significant body of work that illustrates the issues that are inherent with the standard requirements flow-down approach. As an attempt to address this, a series of approaches variously named Value-Driven and Value-Centric Design have been proposed. In looking at commercial aircraft and engine design and operations several authors have suggested using a simplified Value model known as Surplus Value. This paper investigates the derivation of and assumptions that are inherent to the standard surplus value formulation. Further, several interesting and potentially useful outcomes of the standard model are investigated including the relationship with discount rate and maximum used programme duration or product life. Lastly, this paper attempts to remove one of the most restrictive assumptions in the basic surplus value formulation. This results in a more general formulation that incorporates basic sales and operating leases plus the ability to provide managed services. The resulting model is more general, but does require more user information to use.