title: Enhancing Clinical Decision Support Systems through Hospital Information System Integration and Machine Learning in a Context of the Emergency Department

authors: Jiang, Hongwei

abstract: This study conducts design science research (DSR) aimed at addressing the challenge of improving clinical decision support (CDS) in Emergency Departments (EDs). Making timely decisions by physicians to meet the diverse demands within hospital EDs is a challenge as the inadequacies of current Hospital Information Systems (HIS) can host fragmented Electronic Health Record (EHR) data across multiple sub-systems. The advancement of Information Technology (IT), notably machine learning (ML), brings new initiatives for addressing this issue. To tackle this complexity, this research deploys DSR to design a novel system integration architecture. This architecture provides a comprehensive framework that orchestrates HIS integration across multiple strata, encompassing the business, application, and technology layers, to facilitate the integration of ML-based Clinical Decision Support Systems (CDSS) within the ED setting. Two design artefacts are developed as outcomes of DSR: firstly, the development of the system integration architecture, and secondly, the creation of the ML-based CDSS. The former serves as a meticulously designed blueprint for HIS integration, ensuring the effective functioning of ML-based CDSS at the point of care. The latter represents a pioneering CDSS system, harnessing the power of ML algorithms to furnish real-time, context-aware decision support. The impact of the ML-based CDSS on ED efficiency is subjected to rigorous evaluation. This evaluation is conducted by leveraging historical Electronic Health Record (EHR) data within a simulated ED environment. The simulation, calibrated with parameters drawn from a real-world hospital ED setting, yields promising results. These findings underscore the feasibility and the manifold benefits of integrating ML-based CDSS to augment ED efficiency. Furthermore, this research makes a noteworthy contribution to the theoretical underpinnings of information system design. It achieves this by pioneering the development of a novel system integration architecture. This architecture serves as a bridge, alleviating the knowledge gap that traditionally separates HIS integration from ML-based CDSS. The study advances the understanding of strategic design and integration of hospital information systems to support ML and CDSS. Ultimately, this advancement holds the potential to catalyse substantial improvements in patient care and outcomes, especially within the intricate and high-stakes environment of the Emergency Department.

text: Enhancing Clinical Decision Support Systems through Hospital Information System Integration and Machine Learning in a Context of the Emergency Department This study conducts design science research (DSR) aimed at addressing the challenge of improving clinical decision support (CDS) in Emergency Departments (EDs). Making timely decisions by physicians to meet the diverse demands within hospital EDs is a challenge as the inadequacies of current Hospital Information Systems (HIS) can host fragmented Electronic Health Record (EHR) data across multiple sub-systems. The advancement of Information Technology (IT), notably machine learning (ML), brings new initiatives for addressing this issue. To tackle this complexity, this research deploys DSR to design a novel system integration architecture. This architecture provides a comprehensive framework that orchestrates HIS integration across multiple strata, encompassing the business, application, and technology layers, to facilitate the integration of ML-based Clinical Decision Support Systems (CDSS) within the ED setting. Two design artefacts are developed as outcomes of DSR: firstly, the development of the system integration architecture, and secondly, the creation of the ML-based CDSS. The former serves as a meticulously designed blueprint for HIS integration, ensuring the effective functioning of ML-based CDSS at the point of care. The latter represents a pioneering CDSS system, harnessing the power of ML algorithms to furnish real-time, context-aware decision support. The impact of the ML-based CDSS on ED efficiency is subjected to rigorous evaluation. This evaluation is conducted by leveraging historical Electronic Health Record (EHR) data within a simulated ED environment. The simulation, calibrated with parameters drawn from a real-world hospital ED setting, yields promising results. These findings underscore the feasibility and the manifold benefits of integrating ML-based CDSS to augment ED efficiency. Furthermore, this research makes a noteworthy contribution to the theoretical underpinnings of information system design. It achieves this by pioneering the development of a novel system integration architecture. This architecture serves as a bridge, alleviating the knowledge gap that traditionally separates HIS integration from ML-based CDSS. The study advances the understanding of strategic design and integration of hospital information systems to support ML and CDSS. Ultimately, this advancement holds the potential to catalyse substantial improvements in patient care and outcomes, especially within the intricate and high-stakes environment of the Emergency Department.

year: 2024

title: Metal complexes of sporidesmin D and dimethylgliotoxin, investigated by electrospray ionisation mass spectrometry

authors: Woodcock, Jane C.

subjects: Electrospray mass spectrometry

abstract: Electrospray ionisation mass spectrometry (ES-MS) has been used to probe the coordination chemistry of metabolites such as sporidesmin D (spdD), found in the saprophytic fungus Pithomyces chartarum, and the related bisdethiobis(methylthio)gliotoxin (dimethylgliotoxin, Megtx). SpdD forms complexes of the type [spdD+M(MeCN)]+ and [2spdD+M]+ (M=Cu, Ag) and, at higher cone voltages, [spdD+M]+. The bis(ligand) ion [2spdD+M]+ was observed at very high cone voltages, indicating it has appreciable stability; the proposed structure of this species has a four-coordinate metal ion with two bidentate spdD ligands, coordinated through their SMe groups. 1H NMR titrations of spdD with K+, Ag+ and Cu+ provided additional evidence for complex formation with the soft metals. SpdD forms only relatively weak complexes with Zn2+, Cd2+, Co2+ and Mn2+, in keeping with the known reduced tendency of these metals to form stable thioether complexes. ES-MS studies of Megtx showed similar results to spdD, with stable adducts formed with Cu+ and Ag+ ions. The X-ray crystal structure of spdD is also reported.

text: Metal complexes of sporidesmin D and dimethylgliotoxin, investigated by electrospray ionisation mass spectrometry Electrospray ionisation mass spectrometry (ES-MS) has been used to probe the coordination chemistry of metabolites such as sporidesmin D (spdD), found in the saprophytic fungus Pithomyces chartarum, and the related bisdethiobis(methylthio)gliotoxin (dimethylgliotoxin, Megtx). SpdD forms complexes of the type [spdD+M(MeCN)]+ and [2spdD+M]+ (M=Cu, Ag) and, at higher cone voltages, [spdD+M]+. The bis(ligand) ion [2spdD+M]+ was observed at very high cone voltages, indicating it has appreciable stability; the proposed structure of this species has a four-coordinate metal ion with two bidentate spdD ligands, coordinated through their SMe groups. 1H NMR titrations of spdD with K+, Ag+ and Cu+ provided additional evidence for complex formation with the soft metals. SpdD forms only relatively weak complexes with Zn2+, Cd2+, Co2+ and Mn2+, in keeping with the known reduced tendency of these metals to form stable thioether complexes. ES-MS studies of Megtx showed similar results to spdD, with stable adducts formed with Cu+ and Ag+ ions. The X-ray crystal structure of spdD is also reported.

year: 2001-04-01

title: Taku Ara, Taku Mahara: Pākehā Family Experiences of Kaupapa Māori and Bilingual Education

authors: Barnes, Alexander Louis

subjects: Kaupapa Maori

abstract: Kaupapa Māori (indigenous Māori-centred philosophies) initiatives have transformed various social, cultural and public projects in the domains of governance and constitutional issues, health, education, the environment, community development and research in Aotearoa – New Zealand. As a Pākehā graduate of te kōhanga reo and kura kaupapa Māori (Māori language immersion pre-school and primary school), this research is concerned with exploring the impact of kaupapa Māori and bilingual educational initiatives on my life and the lives of two other Pākehā families who share similar educational backgrounds. This foundational study utilises qualitative narrative inquiry methods as a means of understanding and analysing the implications for Pākehā as a result of their participation in kaupapa Māori and bilingual education. An intergenerational family approach is used in this research whereby the individual voices and experiences of young adults are heard equally alongside their parents’. Collectively understood, the themes represented in this research offer a unique means of understanding why Päkehä families decided to be involved in Māori immersion settings, and what these experiences mean to them now. One of the principle aims of this study is that it be used as a platform for dialogue amongst Pākehā, non-Māori and Māori about the future direction of bicultural education in Aotearoa – New Zealand.

text: Taku Ara, Taku Mahara: Pākehā Family Experiences of Kaupapa Māori and Bilingual Education Kaupapa Māori (indigenous Māori-centred philosophies) initiatives have transformed various social, cultural and public projects in the domains of governance and constitutional issues, health, education, the environment, community development and research in Aotearoa – New Zealand. As a Pākehā graduate of te kōhanga reo and kura kaupapa Māori (Māori language immersion pre-school and primary school), this research is concerned with exploring the impact of kaupapa Māori and bilingual educational initiatives on my life and the lives of two other Pākehā families who share similar educational backgrounds. This foundational study utilises qualitative narrative inquiry methods as a means of understanding and analysing the implications for Pākehā as a result of their participation in kaupapa Māori and bilingual education. An intergenerational family approach is used in this research whereby the individual voices and experiences of young adults are heard equally alongside their parents’. Collectively understood, the themes represented in this research offer a unique means of understanding why Päkehä families decided to be involved in Māori immersion settings, and what these experiences mean to them now. One of the principle aims of this study is that it be used as a platform for dialogue amongst Pākehā, non-Māori and Māori about the future direction of bicultural education in Aotearoa – New Zealand.

year: 2006