Accounting for some the highest arrival rates and widest varieties of medical conditions in a hospital, the emergency department is highly dependent on efficient operations strategies in order to function effectively and provide qualitative health care. This is especially true for the emergency department of Karolinska University Hospital in Huddinge from which real patient data has been obtained. In attempting to improve service levels, current operational structures are evaluated and several different scenarios are simulated mathematically in this study. After validating the adequacy of modeling the emergency department as a Jackson Network, the network is simulated for various combinations of patient flow parameters enabling the study of the effects of resource allocation strategies. The results indicate that the current organization of, and resources available to, the emergency department leaves room for improvement in terms of service levels. Resource levels needed for specific target levels of service are found and the optimal allocations of resources is discussed. Additionally, a brief literature review of operations strategies and how simulation tools can serve as decision support systems for operations strategy managers is conducted. / Akutmottagningen är en av de avdelningar på ett sjukhus som utsätts för högst ankomstintensiteter och bredast variationer av besöksorsaker vilket orsakar höga krav på att utveckla effektiva verksamhetsstrategier för att upprätthålla en kvalitativ sjukvård. Akutmottagningen på Karolinska Universitetssjukhuset i Huddinge har studerats genom patientdata. För att försöka förbättra servicenivåer och förkorta väntetider för patienter utvärderas verksamhetens organisation och struktur. En matematisk modell av verksamhetens organisation konstrueras och valideras, varefter effekterna av olika resursallokeringar analyseras genom matematiska simuleringar. Resultaten visar på att akutvården som den är organiserad idag lämnar utrymme för förbättring och optimering av resursallokering. Genom matematiska simuleringar identifieras marginella resursers specifika servicenivåer och relativa förändringar i servicenivåer. Slutligen kompletteras den matematiska analysen med en kortare litteraturstudie. Här presenteras hur simuleringar kan utgöra beslutsstödsystem för att planera resursallokering och introducera lean-strategier i sjukvården.

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<p>The agricultural data landscape is largely dysfunctional because of the industry’s highvariability  in  scale,  scope,  technological  adoption,  and  relationships.   Integrated  data  andmodels of agricultural sub-systems could be used to advance decision-making, but interoperability  challenges  prevent  successful  innovation.   In  this  work,  temporal  and  geospatial indexing  strategies  and  aggregation  were  explored  toward  the  development  of  functional data  structures  for  soils,  weather,  solar,  and  machinery-collected  yield  data  that  enhance data context, scalability, and sharability.</p> <p>The data structures were then employed in the creation of decision support tools including web-based  applications  and  visualizations.   One  such  tool  leveraged  a  geospatial  indexing technique called geohashing to visualize dense yield data and measure the outcomes of on-farm yield trials.  Additionally, the proposed scalable, open-standard data structures were used to drive a soil water balance model that can provide insights into soil moisture conditions critical to farm planning, logistics, and irrigation.  The model integrates SSURGO soil data,weather data from the Applied Climate Information System, and solar data from the National Solar Radiation Database in order to compute a soil water balance, returning values including runoff, evaporation, and soil moisture in an automated, continuous, and incremental manner.</p> <p>The approach leveraged the Open Ag Data Alliance framework to demonstrate how the data structures can be delivered through sharable Representational State Transfer Application Programming Interfaces and to run the model in a service-oriented manner such that it can be operated continuously and incrementally, which is essential for driving real-time decision support tools.  The implementations rely heavily on the Javascript Object Notation data schemas leveraged by Javascript/Typescript front-end web applications and back-end services delivered through Docker containers.  The approach embraces modular coding concepts and several levels of open source utility packages were published for interacting with data sources and supporting the service-based operations.</p> <p>By making use of the strategies laid out by this framework, industry and research canenhance data-based decision making through models and tools.  Developers and researchers will  be  better  equipped  to  take  on  the  data  wrangling  tasks  involved  in  retrieving  and parsing unfamiliar datasets, moving them throughout information technology systems, and understanding those datasets down to a semantic level.</p>

<p>Chronic low back pain is the second most prevalent chronic condition in Canadian primary care settings. The treatment and diagnosis of chronic pain is challenging for primary care clinicians. Their main challenges are lack of knowledge and their approach toward assessing and treating pain. Evidence based guidelines have been developed for neuropathic pain and low back pain.</p> <p>CDSSs for chronic diseases are becoming popular in primary care settings as a mean to implement CPGs. A CDSS prototype for diagnosis and treatment of chronic, non-cancer pain in primary care was developed at McMaster University. It is evident that poor usability can hinder the uptake of health information technologies.</p> <p>The objective of this study was to test the usability of Pain Assistant using think aloud protocols with SUS scores in 2 iterations. In this study 13 primary care providers including family physicians, nurse practitioners and residents used Pain Assistant to complete 3 different patient case scenarios. Participants were asked to comment on both barriers and facilitators of usability of Pain Assistant. Additionally time to complete patient case scenarios was calculated for each participant. A comparison questionnaire gathered user preference between introducing CPGs in paper format and computerized decision support system.</p> <p>This study showed that iterative usability testing of the Pain Assistant with participation of real-end users has the potential to uncover usability issues of the Pain Assistant. Problems of user interface were the main usability barrier in first testing iteration following by problems of content. Changes were made to system design for second round based on the issues came up in the first iteration. However, because of time constrains not all the changes were implemented for second round of testing. Most of the refinements were to resolve user interface issues. In the second iteration, the problems with the content of Pain Assistant were the major barrier. The changes to the system design were successful in resolving user interface problems since the changed issues did not come up again in second round. Pain Assistant had an above the average usability score however no significant changes seen in SUS score. The time needed to complete tasks remained identical in both iterations. In addition, participants preferred to have CPGs in electronic formats than paper. Further study after implementing all the system changes needed to determine the effectiveness of system refinements.</p> / Master of Science (MSc)

The purpose of the study was to describe the effects of an EMR on patient management in selected HIV clinics in Johannesburg. A quantitative, descriptive, cross-sectional study was undertaken in four HIV clinics in Johannesburg. The subjects (N=44) were the healthcare workers selected by stratified random sampling. Consent was requested from each subject and from the clinics in Johannesburg. Data was collected using structured questionnaires. Median age of subjects was 36, 82% were female. 86% had tertiary qualifications. 55% were clinicians. 52% had 2-3 years work experience. 80% had computer experience, 86% had over one year EMR experience. 90% used the EMR daily, 93% preferred EMR to paper. 93% had EMR training, 17% used EMR to capture clinical data. 87% perceived EMR to have more benefits; most felt doctor-patient relationship was not interfered with. 89% were satisfied with the EMR’s overall performance. The effects of EMR benefit HIV patient management. / Health Studies / MA (Public Health)

La tesi si basa sui principi della sostenibilità ambientale applicati al settore della viticultura. I principali obiettivi sono: i) analisi della letteratura riguardante gli indicatori agro-ambientali, ii) sviluppo di una metodologia innovativa per valutare l’impatto ambientale della viticultura e, iii) applicazione della metodologia in casi pratici. La parte introduttiva è dedicata all’analisi degli indicatori agro-ambientali e delle relative politiche europee, alle tematiche inerenti il vino sostenibile e i sistemi di supporto alle decisioni per una viticultura sostenibile. Nella seconda parte è presentata una rigorosa e completa metodologia per valutare il livello di sostenibilità in tutte le fasi della produzione di uva, usando sia indicatori agronomici sia l’approccio della valutazione del ciclo di vita (Life Cycle Assessment). Sono state identificate sei categorie di impatto: salute umana, aria, suolo, biodiversità, consumi energetici e uso dell’acqua. Ogni categoria è composta da sotto-indicatori, per un totale di 21 sotto-indicatori, ognuno dei quali avente un punteggio (da 0 a 5) e un peso relativo nel punteggio complessivo di sostenibilità (da 0 a 5). La terza parte riguarda l’applicazione della metodologia in casi studio all’interno del progetto europeo “InnoVine”. Il lavoro di ricerca è stato realizzato seguendo le linee guida di standard internazionali e documentate fonti di letteratura per la valutazione della prestazione ambientale ed elaborando metodologie originali per la raccolta dei dati, la quantificazione degli impatti e l’interpretazione dei risultati. Infine, i risultati ottenuti confermano: i) la validità della metodologia nel calcolare gli impatti delle differenti pratiche viticole sull’ambiente e, ii) la possibilità di implementare la metodologia in un sistema di supporto alle decisioni per una viticultura sostenibile. / The thesis focuses on environmental sustainability principles applied to the viticultural sector. The main goals are: (i) analysis of the literature background on agri-environmental indicators, (ii) development of an innovative methodology to assess environmental impacts of viticulture, and (iii) testing of the methodology in practical cases. The introduction is dedicated to the analysis of the agri-environmental indicators and the related EU policies, sustainable wine issues, and decision support systems for a sustainable viticulture. In the second part, a rigorous and complete methodology is developed to assess the sustainability level of viticulture in all the phases of the grape growing using both agronomic indicators and the Life Cycle Assessment approach. Six impact categories were identified: human health, air, soil, biodiversity conservation, energetic consumptions, and water use. Each category is composed by sub-indicators, for a total of 21 sub-indicators, each of them having a score (between 0 and 5) and a defined weight on the overall sustainability score (between 0 and 5). In the third part, the methodology was tested in practical cases within the European project “InnoVine”. The study is carried out following the guidelines from international standards and from documented literature sources for the assessment of the environmental performance and elaborating original methodologies for the input data collection, the quantification of the impacts, and the interpretation of the results. Finally, the results obtained confirm: i) the methodology validity in quantifying the impacts of different grape production practices on the environment, and ii) the possibility to implement the methodology in a decision support system for a sustainable viticulture.

各國政府為提高國際競爭優勢，紛紛積極推動「電子化政府」。我國電子化政府建設自八十六年起開始推動，迄今已經行政院擴大為e-Taiwan計畫。電子化政府推動之業務電腦化，帶動政府業務資訊系統的快速發展，其彙集而成之大型資料庫，為政府統計工作帶來莫大的發展契機。 本研究從電子化政府的過程、內政業務行政程序、知識挖掘及採勘方法，提出參考資料模型，可能的統計軟體工具以及電子化政府中知識發現的實驗架構。再者，本研究藉臺閩地區外籍與大陸配偶結婚登記資料集，運用各種群集分析如K-means、ANN、TwoStep等，並利用我國人口數時間序列採用多模式方法進行人口預測，並將前述分析結果回饋資料庫，最後，作者實現一個知識發現系統雛型，其中包含了前端資料庫、資料集、知識庫以及EIS使用介面。 本研究成果總結如下：(1)資料挖掘工作產出之知識，除真實呈現社會現象外，亦作為政府政策之指南；(2)在本研究發展之系統中，新興資料挖掘技術及傳統資料分析方法，二者相輔相成；(3)某些資料挖掘技術適合相符的資料型態，例如文中人口預測資料較適合指數平滑法勝於ANN，亦即，我們可以籍由多模式分析比較其結果，來達到更佳的效果；(4)藉由知識庫模型的建立達成知識創造、共享與管理的目標；(5)資料挖掘工作可以回饋改善資訊系統或業務缺失。 / In order to enhance international competitive advantages, most of the government authorities over the world are engaging in realizing their e-Government platforms. The ROC Government began to develope its e-Government- Infrastructure since 1997, and up-to-date is expanding the e-Taiwan Project as a whole by Executive Yuan. The computerization of administration processes within various government agencies push forward fast development of administration information systems via handling administrative works and lead to utmost opportunities for the government statistics by means of very large databases. Starting from a survey on developements of e-Government, administrative processes for interior affairs, and knowledge mining as well as discovery techniques, this study brings out reference data models, potential statistical softwaretools, and an experimental framework as a whole for knowledge discovery in the context of e-Government. In the next step, this study experiments with applying clustering techniques such as K-means, ANN, and Twostep on datamart regarding marriage of foreigners ( including citizens from Mainland China ) in Taiwan, and with employeeing multi-modes approach on population forecasting. The results of aforementioned analysises are feed into backend database. At last, this author carries out a prototype of knowledge discovery system which includes front-end data base, data marts, knowledge base and interfaces to EIS. The results of the research can be summarized as following: 1.Knowledge derived by means of data mining is capable to represent social events / affairs as well as to serve as a kind of guideline for developing government ploicies. 2. The modern data-ming techniques and classical data-analysis approaches complement with each other in the system developed in this research. 3. Certain mining technique is suitable of corresponding data pattern, for example, expotential smoothing is more suitable for our population data than ANN, which means that we may often achieve better result by multi-mode analysis and comprison with the outputs of different modes. 4. Knowledge creation, sharing, and management can be achieved by means of the knowledge discovery processes on the framework developed in this research. 5. We can figure out errorful raw data in the mining output and feedback to the data source to improve its quality.

Cette thèse vise à contribuer à la compréhension des cycle de vie d’une opération humanitaire (HOLC). Gestion de la chaîne d'approvisionnement humanitaire (HSCM) dans un contexte de mise en perspective et dans l’objectif de proposer un modèle décisionnel qui s'applique aux phases de HOLC lors d’une situation réelle. Cela inclut la mise en oeuvre du modèle proposé pour concevoir et développer un outil d'aide à la décision afin d'améliorer les performances de la logistique humanitaire tant dans les opérations de secours nationaux qu’internationaux.Cette recherche est divisée en trois phases. La première partie vise à présenter le sens de l'étude ; la zone de recherche prise en compte pour la gestion de la chaîne d'approvisionnement (SCM) doit être clairement définie. La première phase consiste à clarifier et définir le HSCM HL, la gestion de la chaîne d'approvisionnement commerciale (CSCM) et le SCM, ainsi que la relation entre ces différents éléments. La gestion du cycle de vie du projet (PLCM) et les différentes approches sont également présentés. La compréhension de la différence entre la gestion du cycle de vie du projet (PLM) et la PLCM est également nécessaire, cela ne peut être abordé dans la phase de cycle de vie de l'opération humanitaire. De plus, les modèles Multiple-Criteria Decision Making (MCDM) et l’aide à la décision concernant le HL sont analysés pour établir le fossé existant en matière de recherche. Les approches MCDM qui mettent en oeuvre le système d'aide à la décision (DSS) et la manière dont le MAS a été utilisé dans le contexte HSCM sont étudiées.La deuxième phase consiste en la proposition d’un modèle décisionnel fondé sur l’approche MCDM à l'appui de la décision du décideur avant qu'il/elle prenne des mesures. Ce modèle prévoit le classement des alternatives concernant l'entrepôt, le fournisseur et le transport au cours des phases de HOLC. Le modèle décisionnel proposé est réalisée en 3 scénarios. I. La décision en 4phases HOLC – opération de secours internationale de la Croix-Rouge Française (CRF). II. La décision en3phases HOLC – opération nationale dela Croix-Rouge thaïlandaise (TRC). III. La décision au niveau de la phase de réponse HOLC – opération internationale du TRC dans quatre pays. Dans cette phase, le scénario I et II sont réalisés étape par étape au travers de calculs numériques et formules mathématiques. Le scénario III sera présenté dans la troisième phase. Pour établir trois scénarios, les données internes recueillies lors des entretiens avec le chef de la logistique de la Croix-Rouge Française, et le vice-président de la fondation de la Coix-Rouge thaïlandaise, seront utilisées. Les données externes proviennent de chercheurs qui sont des experts dans le domaine HL ou le champ du HSCM, de la littérature, et de sources issues des organismes humanitaires (documents d’ateliers, rapports, informations publiées sur leurs sites officiels).Dans la troisième phase, une application Internet multi-critères (decision support system MCDSS WB) mettant en oeuvre le modèle proposé est élaborée. Afin d'atteindre une décision appropriée en temps réel, le WB-MCDSS est développé sur la base d’un protocole client-serveur et est simple à utiliser. Le dernier mais non le moindre ; une application de validation du modèle est réalisée à l'aide de l'approche de l'analyse de sensibilité. / This thesis aims to contribute to the understanding of HOLC in context of the HSCM and to propose a decision model which applies to the phases of HOLC the decision making regarding a real situation . This include the implementation of the proposed model to design and develop a decision support tool in order to improve the performance of humanitarian logistics in both national and international relief operations.This research is divided into three phases; the first phase is to clarify and define HL among HSCM, commercial supply chain management (CSCM) and SCM and their relationship. Project Life Cycle Management (PLCM) approaches are also presented. The difference between project life cycle management (PLM) and PLCM is also required to distinguish a clear understanding which can be addressed in the phase of humanitarian operation life cycle. Additionally, the literature of Multiple-Criteria Decision Making (MCDM) models and existing decision aid system for HL are analyzed to establish the research gap. The MCDM approaches which implement the decision support system (DSS) and lastly how DSS has been used in the HSCM context.The second phase is to propose a decision model based on MCDM approaches to support the decision of the decision maker before he/she takes action. This model provides the ranking alternatives to warehouse, supplier and transportation over the phases of HOLC. The proposed decision model is conducted in 3 scenarios; I. The decision in 4-phase HOLC, international relief operation of French Red Cross (FRC). II. The decision on 3-phase HOLC, national operation by the Thai Red Cross (TRC). III. The decision on response phase HOLC, international operation by the FRC in four countries. In this phase, the scenario I and II are performed step by step though numerical calculation and mathematical formulas. The scenario III will be presented in the third phase.In the third phase, an application of web-based multi-criteria decision support system (WB-MCDSS) which implement the proposed model is developed. The web-based multi-criteria decision support system is developed based on the integration of analytical hierarchy process (AHP) and TOPSIS approaches. In order to achieve an appropriate decision in a real time response, the WB-MCDSS is developed based on server-client protocol and is simple to operate. Last but not least, a validation application of the model is performed using the sensitivity analysis approach.

La prise en charge des flux des patients, en particulier les flux récurrents et consécutifs à des crises sanitaires (grippes, canicules, situations exceptionnelles) est l'un des problèmes les plus importants auquel les services des urgences (SU) doivent faire face. Pour gérer cet afflux de patients, les services des urgences nécessitent des ressources humaines et matérielles importantes, ainsi qu'un degré élevé de coordination entre ces ressources. Dans ces conditions, le personnel médical se voit confronté très fréquemment à des situations de tension qui compliquent très fortement sa tâche. L‘objet de cette thèse est de contribuer à l’amélioration de la gestion des situations de tension se produisant dans un service d’urgence en proposant un système d’aide à la décision, SAGEST (Système d’Aide à la décision pour la GEstion des Situations de Tensions), permettant i) le pilotage proactif du SU : prévision à court et/ou moyen terme de l'apparition de situations de tension et l'évolution du flux patients et la proposition d'actions de correction afin d'éviter l’occurrence de ces situations et ii) le pilotage réactif dans le cas où l'occurrence de la situation de tension n'a pas été détectée. Une architecture fonctionnelle du système SAGEST, s'appuyant sur le processus décisionnel du responsable du service d'urgence, est proposée. Les méthodologies et les modèles utilisés dans la construction des principales fonctions et de la base de connaissances sont décrits. Enfin, les résultats d’application des différents modèles du système SAGEST pour le service d’urgence pédiatrique (SUP) du centre hospitalier régional universitaire du Lille sont présentés et discutés. / The management of patient flow, especially the flow resulting from health (flu, heat waves and exceptional circumstances) is one of the most important problems to manage in the emergency department (ED). To handle the influx of patients, emergency departments require significant human and material resources, and a high degree of coordination between these resources. Under these conditions, the medical and the paramedical staffs are often confronted with strain situations which greatly complicate their task. The main purpose of this thesis is to contribute to improving the management of situations of tension occurring in the emergency department by providing a decision support system, SAGEST. This DSS allows i) a proactive control of the ED: predicting at short and/or medium-term the occurrence of potential strain situations and proposing corrective actions to prevent the occurrence of these situations, ii) a reactive control in the case of no-detection of the strain situation occurrence. A functional architecture of the SAGEST system, based on the manager’s decision making process is proposed. Used methodologies and models embedded in the main functions and the knowledge base of the SAGEST system are described. Finally, experiments and results of different models of SAGEST system applied to the paediatric emergency department (PED) of the Regional University Hospital of Lille are presented and discussed.

Digital nudging is a relatively new phenomenon that is increasingly mentioned and demanded in human-computer interaction. The concept originates from behavioral economics and aims to help individuals make better decisions that are beneficial to the individual as well as the society, by making subtle changes to the environment in which the decision is made. Nudging implies to pushing people in the right direction and affecting them in different types of decision making. Digital nudging aims at applying the user interface design element to guide people's decisions in digital environments. This thesis presents a study of digital nudging in the form of the six design principles in the user interface of e-commerce sites through the method cognitive walkthrough. It is based on theories of mainly digital nudging but also persuasive design and user experience with connections to psychological aspects. The conclusion of the study has shown that principles in digital nudging exists in e-stores interfaces. The study aims to develop frameworks for an alternative way of implementing digital nudging and to contribute to more knowledge in the field. / Digital nudging är ett relativt nytt fenomen som blir allt mer omtalat och efterfrågat inom människa-datorinteraktion. Begreppet har sitt ursprung från beteendeekonomi och syftar till att få individer att ta bättre beslut som är gynnsamma för den enskilda individen såväl som samhället, genom att göra subtila ändringar i den miljön där beslutet fattas. Nudging innebär att knuffa individer i rätt riktning och att på så sätt påverka individer i olika beslutsfattanden. Digital nudging avser tillämpning av designelement i användargränssnittet för att påverka människors beslutsfattande i digitala miljöer. Studien presenterar en undersökning av de sex designprinciperna inom digital nudging och hur de påträffas i e-butikers användargränssnitt genom metoden kognitiv genomgång. Undersökningen grundar sig på teorier om digital nudging och relaterad forskning som övertygande design och användarupplevelse med kopplingar till psykologiska aspekter. Slutsatsen av studien har visat att designprinciper inom digital nudging förekommer i e-butikers gränssnitt. Studien syftar till att ta fram ramverk för ett alternativt sätt att implementera digital nudging och för att bidra till mer kunskap inom området.