Patient wait times and care service times are key performance measures for care processes in hospitals. Managing the quality of care delivered by these processes in real-time is challenging. A key challenge is to correlate source medical events to infer the care process states that define patient wait times and care service times. Commercially available complex event processing engines do not have built in support for the concept of care process state. This makes it unnecessarily complex to define and maintain rules for inferring states from source medical events in a care process. Another challenge is how to present the data in a real-time BI dashboard and the underlying data model to use to support this BI dashboard. Data representation architecture can potentially lead to delays in processing and presenting the data in the BI dashboard. In this research, we have investigated the problem of real-time monitoring of care processes, performed a gap analysis of current information system support for it, researched and assessed available technologies, and shown how to most effectively leverage event driven and BI architectures when building information support for real-time monitoring of care processes. We introduce a state monitoring engine for inferring and managing states based on an application model for care process monitoring. A BI architecture is also leveraged for the data model to support the real-time data processing and reporting requirements of the application’s portal. The research is validated with a case study to create a real-time care process monitoring application for an Acute Coronary Syndrome (ACS) clinical pathway in collaboration with IBM and Osler hospital. The research methodology is based on design-oriented research.

Les mutations technologiques à l’œuvre dans les systèmes aéronautiques ont profondément modifié les interactions entre l’homme et la machine. Au fil de cette évolution, les opérateurs se sont retrouvés face à des systèmes de plus en plus complexes, de plus en plus automatisés et de plus en plus opaques. De nombreuses tragédies montrent à quel point la supervision des systèmes par des opérateurs humains reste un problème sensible. En particulier, de nombreuses évidences montrent que l’automatisation a eu tendance à éloigner l’opérateur de la boucle de contrôle des systèmes, créant un phénomène dit de sortie de boucle (OOL). Ce phénomène se caractérise notamment par une diminution de la conscience de la situation et de la vigilance de l’opérateur, ainsi qu’une complaisance et une sur-confiance dans les automatismes. Ces difficultés déclenchent notamment une baisse des performances de l’opérateur qui n’est plus capable de détecter les erreurs du système et de reprendre la main si nécessaire. La caractérisation de l’OOL est donc un enjeux majeur des interactions homme-système et de notre société en constante évolution. Malgré plusieurs décennies de recherche, l’OOL reste difficile à caractériser, et plus encore à anticiper. Nous avons dans cette thèse utilisé les théories issues des neurosciences, notamment sur le processus de détection d’erreurs, afin de progresser sur notre compréhension de ce phénomène dans le but de développer des outils de mesure physiologique permettant de caractériser l’état de sortie de boucle lors d’interactions avec des systèmes écologiques. En particulier, l’objectif de cette thèse était de caractériser l’OOL à travers l’activité électroencéphalographique (EEG) dans le but d’identifier des marqueurs et/ou précurseurs de la dégradation du processus de supervision du système. Nous avons dans un premier temps évalué ce processus de détection d’erreurs dans des conditions standards de laboratoire plus ou moins complexes. Deux études en EEG nous ont d’abord permis : (i) de montrer qu’une activité cérébrale associée à ce processus cognitif se met en place dans les régions fronto-centrales à la fois lors de la détection de nos propres erreurs (ERN-Pe et FRN-P300) et lors de la détection des erreurs d’un agent que l’on supervise, (complexe N2-P3) et (ii) que la complexité de la tâche évaluée peut dégrader cette activité cérébrale. Puis nous avons mené une autre étude portant sur une tâche plus écologique et se rapprochant des conditions de supervision courantes d’opérateurs dans l’aéronautique. Au travers de techniques de traitement du signal EEG particulières (e.g., analyse temps-fréquence essai par essai), cette étude a mis en évidence : (i) l’existence d’une activité spectrale θ dans les régions fronto-centrales qui peut être assimilée aux activités mesurées en condition de laboratoire, (ii) une diminution de l’activité cérébrale associée à la détection des décisions du système au cours de la tâche, et (iii) une diminution spécifique de cette activité pour les erreurs. Dans cette thèse, plusieurs mesures et analyses statistiques de l’activité EEG ont été adaptées afin de considérer les contraintes des tâches écologiques. Les perspectives de cette thèse ouvrent sur une étude en cours dont le but est de mettre en évidence la dégradation de l’activité de supervision des systèmes lors de la sortie de boucle, ce qui permettrait d’identifier des marqueurs précis de ce phénomène permettant ainsi de le détecter, voire même, de l’anticiper. / The ongoing technological mutations occuring in aeronautics have profoundly changed the interactions between men and machines. Systems are more and more complex, automated and opaque. Several tragedies have reminded us that the supervision of those systems by human operators is still a challenge. Particularly, evidences have been made that automation has driven the operators away from the control loop of the system thus creating an out-of-the-loop phenomenon (OOL). This phenomenon is characterized by a decrease in situation awareness and vigilance, but also complacency and over-reliance towards automated systems. These difficulties have been shown to result in a degradation of the operator’s performances. Thus, the OOL phenomenon is a major issue of today’s society to improve human-machine interactions. Even though it has been studied for several decades, the OOL is still difficult to characterize, and even more to predict. The aim of this thesis is to define how cognitive neurosciences theories, such as the performance monitoring activity, can be used in order to better characterize the OOL phenomenon and the operator’s state, particularly through physiological measures. Consequently, we have used electroencephalographic activity (EEG) to try and identify markers and/or precursors of the supervision activity during system monitoring. In a first step we evaluated the error detection or performance monitoring activity through standard laboratory tasks, with varying levels of difficulty. We performed two EEG studies allowing us to show that : (i) the performance monitoring activity emerges both for our own errors detection but also during another agent supervision, may it be a human agent or an automated system, and (ii) the performance monitoring activity is significantly decreased by increasing task difficulty. These results led us to develop another experiment to assess the brain activity associated with system supervision in an ecological environment, resembling everydaylife aeronautical system monitoring. Thanks to adapted signal processing techniques (e.g. trial-by-trial time-frequency decomposition), we were able to show that there is : (i) a fronto-central θ activité time-locked to the system’s decision similar to the one obtained in laboratory condition, (ii) a decrease in overall supervision activity time-locked to the system’s decision, and (iii) a specific decrease of monitoring activity for errors. In this thesis, several EEG measures have been used in order to adapt to the context at hand. As a perspective, we have developped a final study aiming at defining the evolution of the monitoring activity during the OOL. Finding markers of this degradation would allow to monitor its emersion, and even better, predict it.

Wireless personal area networks have emerged as an important communication infrastructure in areas such as at-home healthcare and home automation, independent living and assistive technology, as well as sports and wellness. Wireless personal area networks, including body sensor networks, are becoming more mature and are considered to be a realistic alternative as communication infrastructure for demanding services. However, to transmit data from e.g., an ECG in wireless networks is also a challenge, especially if multiple sensors compete for access. Contention-based networks offer simplicity and utilization advantages, but the drawback is lack of predictable performance. Recipients of data sent in wireless sensor networks need to know whether they can trust the information or not. Performance measurements, monitoring and control is of crucial importance for medical and healthcare applications in wireless sensor networks. This thesis focuses on development, prototype implementation and evaluation of a performance management system with performance and admission control for wireless sensor networks. Furthermore, an implementation of a new method to compensate for clock drift between multiple wireless sensor nodes is also shown. Errors in time synchronization between nodes in Bluetooth networks, resulting in inadequate data fusion, are also analysed. / <p>QC 20120529</p>

Globally, a wealth of educational data has been collected on learner performance in a bid to improve and monitor the quality of education. Unfortunately, the data seem to have had only limited influence on learning and teaching in classrooms. This thesis aimed to bridge this gap between the availability of learner performance data and their use in informing planning and action in schools. A design research approach was used to optimise the feedback system for the South African Monitoring system for Primary schools (SAMP). Design research aims to produce both an intervention to address a complex real-world challenge and to develop design guidelines to support other designers faced with similar challenges in their own context. In this research, the process of developing and improving the feedback system was also used to examine ways of facilitating the use of the feedback. Multiple cycles of design, implementation and evaluation of four different prototypes of the feedback system were conducted, employing evaluations from both experts (e.g. Dutch and South African academics, research and educational psychologists, instrument designers and teacher trainers) as well as school users (teachers, principals and HoDs). Mixed methods were employed throughout the study, with different sub-samples of school users sampled from the population of 22 schools (English, Afrikaans and Sepedi) in the Tshwane region participating in SAMP. The various research cycles incorporated interviews, observations, journals, questionnaires, the Delphi technique and expert evaluations to examine not only data-use, but also aspects such as problem-solving, planning, data-literacy and attitudes towards evidence-based practice in the schools. Data was analysed using Rasch Modelling, descriptive statistics and computer-aided qualitative data analysis. The study showed that an effective feedback system facilitates appropriate use through a gradual process of enlightenment, is flexible and responsive to user inputs, values collaboration and includes instrument, reporting and support components in its design. An optimum feedback system also positively influences school feedback and monitoring culture by providing opportunities for positive experiences with feedback and increasing data-literacy. This improves the chances of feedback being used for planning, decision-making and action in the schools. An effective feedback system must also offer a comprehensive package to accommodate different users, with various levels of data sophistication, functioning in diverse contexts. The research also showed that an effective feedback system mediates thinking about educational instruction and curriculum and can therefore be a potent change agent. Use of clear, simple, intuitive data presentation in the feedback system allows for experiential learning to increase user data-literacy. The design research approach employed in this study offers an appropriate and powerful approach to adapting, developing and optimising a feedback system. User involvement in design research ensures greater contextualisation and familiarity with the system, while engendering trust and a greater sense of ownership, all of which increase the receptiveness and responsiveness of users to feedback. Finally, the research also contributed design guidelines for other developers of feedback systems, an integrated conceptual framework for use of monitoring feedback and a functioning feedback system employed by 22 schools in the Tshwane region. / Thesis (PhD)--University of Pretoria, 2010. / Science, Mathematics and Technology Education / unrestricted

[pt] A falta de consciência da doença, também denominada anosognosia, é um sintoma comum da Doença de Alzheimer (DA). Sua estrutura funcional e seus mecanismos subjacentes, contudo, não são inteiramente compreendidos. O nível de consciência possui grande relevância para o sucesso do tratamento e para o fardo do cuidador. Outro fator de considerável impacto nas relações interpessoais e, portanto, no bem-estar dos pacientes e cuidadores, é o processamento emocional. A presente tese explora esses tópicos através de quatro artigos. No Artigo 1, utiliza-se a modelagem de equações estruturais (SEM, do inglês structural equation modeling) em uma grande amostra de pessoas com DA para investigar a natureza da relação entre função cognitiva, estado de humor e funcionalidade na previsão do nível de consciência da condição. Os resultados demonstraram que uma menor funcionalidade cognitiva e um maior nível de estado depressivo de humor influenciaram negativamente a capacidade dos pacientes de realizar atividades da vida cotidiana, o que, por sua vez, se mostrou associada a uma maior consciência da doença. O Artigo 2 investigou as origens executivas e mnemônicas da anosognosia na DA, utilizando uma tarefa de tempo de reação e medindo a consciência a respeito da performance na tarefa. Os dados demonstraram que o monitoramento online dos pacientes estava preservado, enquanto o monitoramento a médio e longo prazo esteve comprometido. Tal achado foi corroborado por resultados de dados eletrofisiológicos. Dessa forma, os resultados fortalecem as evidências favoráveis a uma natureza mnemônica, e não executiva, da anosognosia na DA, o que se mostra de acordo com o Cognitive Awareness Model (CAM). O Artigo 3 investigou a reatividade emocional a imagens negativas, auto-relevantes e neutras utilizando medidas de excitação e valência, gravações de expressões faciais e dados eletrofisiológicos. A reatividade emocional dos pacientes de DA foi similar à de jovens adultos, mas as respostas eletrofisiológicas foram elevadas quando comparadas às de idosos saudáveis, o que pode ser explicado por uma falta de mecanismos de controle cognitivo. A apatia esteve associada a menores respostas eletrofisiológicas a figuras negativas, e a consciência de prejuízos sociais se relacionou com maiores níveis de excitação em imagens auto-relevantes. Por sua vez, o Artigo 4 discutiu como a DA afeta as habilidades emocionais através de uma revisão de literatura sobre a empatia desses pacientes. Os aspectos afetivos da empatia deste grupo clínico estiveram relativamente preservados, enquanto foram apresentados déficits nos componentes cognitivos. Os prejuízos relacionados aos componentes afetivos foram principalmente atribuídos a um declínio cognitivo geral. Nossos achados ressaltam que diferentes fatores influenciam a consciência da doença na DA, enfatizando o papel de sintomas neuropsiquiátricos, do funcionamento cognitivo e das atividades da vida diária. Além disso, processos executivos pareceram estar preservados, ao passo que dificuldades em atualizar e consolidar esse conhecimento podem ser uma possível causa de anosognosia na DA. Ademais, sugerimos que as habilidades emocionais são amplamente preservadas em pacientes de DA. Tais resultados são de grande importância para a prática clínica. Pesquisas translacionais são necessárias para implementar os achados de pesquisas em abordagens terapêuticas específicas. / [en] Lack of awareness of condition, also termed anosognosia, is a common symptom in Alzheimer s disease (AD). However, its functional structure and underlying mechanisms are not fully understood. Level of awareness has great relevance for treatment success and caregiver burden. Another factor that has considerable impact on interpersonal relationships and thus on well-being of patients and caregivers is emotional processing. The current thesis explores these topics through four articles. In Article 1, structural equation modeling (SEM) was used in a large sample of people with AD (PwAD) to investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness. Results showed that lower cognitive function and higher level of depressive mood state negatively influenced PwAD s ability to perform daily living activities, which in turn were associated with better awareness. Article 2 investigated executive and mnemonic origins of anosognosia in AD, with a reaction time task being applied to examine awareness of task performance. The findings demonstrated that online monitoring was preserved, while medium- and long-term monitoring were impaired. This was supported by results from electrophysiological data. The results strengthen the evidence for a mnemonic rather than executive nature of anosognosia in PwAD in accordance with the Cognitive Awareness Model (CAM). Article 3 investigated emotional reactivity to negative, self-relevant, and neutral pictures using ratings of arousal and valence, facial expression recordings and electrophysiological data. Emotional reactivity of PwAD was similar to young adults, but electrophysiological responses were elevated compared to healthy older adults, which might be explained by a lack of cognitive control mechanisms. Apathy was associated with reduced electrophysiological responses for negative pictures, and awareness of social impairments was linked to higher arousal ratings of self-relevant pictures. Article 4 discussed how higher emotional abilities are affected by AD, through a review of the literature on empathy in this clinical group. PwAD showed a pattern of relatively preserved affective aspects and impairments in cognitive components of empathy, whereby impairments in affective components can mainly be attributed to a general cognitive decline. Our findings highlight that different factors influence awareness in AD, emphasizing the role of neuropsychiatric symptoms (NPS), cognitive functioning and activities of daily living. Moreover, executive processes seem to be preserved, whereas impairments in updating and consolidation of this knowledge seem to be a possible cause for anosognosia in AD. Furthermore, we suggested that emotional abilities are largely preserved in PwAD. Our results have great significance for clinical practice. Translational research is needed to implement research findings into specific therapeutic approaches.

No description available.

For adaptive goal-directed action, the brain needs to monitor action performance and detect errors. The corresponding information may be conveyed via different sensory modalities; for instance, visual and proprioceptive body position cues may inform about current manual action performance. Thereby, contextual factors such as the current task set may also determine the relative importance of each sensory modality for action guidance. Here, we analyzed human behavioral, functional magnetic resonance imaging (fMRI), and magnetoencephalography (MEG) data from two virtual reality-based hand–target phase-matching studies to identify the neuronal correlates of performance monitoring and error processing under instructed visual or proprioceptive task sets. Our main result was a general, modality-independent response of the bilateral frontal operculum (FO) to poor phase-matching accuracy, as evident from increased BOLD signal and increased source-localized gamma power. Furthermore, functional connectivity of the bilateral FO to the right posterior parietal cortex (PPC) increased under a visual versus proprioceptive task set. These findings suggest that the bilateral FO generally monitors manual action performance; and, moreover, that when visual action feedback is used to guide action, the FO may signal an increased need for control to visuomotor regions in the right PPC following errors.

Para poder satisfacer la demanda de mayores anchos de banda y los requisitos de los nuevos servicios, se espera que se produzca una evolución de las redes ópticas hacia arquitecturas reconfigurables dinámicamente. Esta evolución subraya la importancia de ofrecer soluciones en la que la escalabilidad y la flexibilidad sean las principales directrices. De acuerdo a estas características, las redes ópticas de conmutación de paquetes (OPS) proporcionan altas capacidades de transmisión, eficiencia en ancho de banda y excelente flexibilidad, además de permitir el procesado de los paquetes directamente en la capa óptica. En este escenario, la solución all-optical label switching (AOLS) resuelve el cuello de botella impuesto por los nodos que realizan el procesado en el dominio eléctrico. A pesar de los progresos en el campo del networking óptico, las redes totalmente ópticas todavía se consideran una solución lejana . Por tanto, es importante desarrollar un escenario de migración factible y gradual desde las actuales redes ópticas basadas en la conmutación de circuitos (OCS). Uno de los objetivos de esta tesis se centra en la propuesta de escenarios de migración basados en redes híbridas que combinan diferentes tecnologías de conmutación. Además, se analiza la arquitectura de una red OPS compuesta de nodos que incorporan nuevas funcionalidades relacionadas con labores de monitorización y esquemas de recuperación. Las redes ópticas permiten mejorar la transparencia de la red, pero a costa de aumentar la complejidad de las tareas de gesión. En este escenario, la monitorización óptica de prestaciones (OPM) surge como una tecnología capaz de facilitar la administración de las redes OPS, en las que cada paquete sigue su propia ruta en la red y sufre un diferente nivel de degradación al llegar a su destino. Aquí reside la importancia de OPM para garantizar los requisitos de calidad de cada paquete. / Vilar Mateo, R. (2010). Optical performance monitoring in optical packet-switched networks [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/8926

Performance measurement and runtime tuning tools are both vital in the HPC software ecosystem and use similar techniques: the analyzed application is interrupted at specific events and information on the current system state is gathered to be either recorded or used for tuning. One of the established performance measurement tools is Score-P. It supports numerous HPC platforms and parallel programming paradigms. To extend Score-P with support for different back-ends, create a common framework for measurement and tuning of HPC applications, and to enable the re-use of common software components such as implemented instrumentation techniques, this paper makes the following contributions: (I) We describe the Score-P metric plugin interface, which enables programmers to augment the event stream with metric data from supplementary data sources that are otherwise not accessible for Score-P. (II) We introduce the flexible Score-P substrate plugin interface that can be used for custom processing of the event stream according to the specific requirements of either measurement, analysis, or runtime tuning tasks. (III) We provide examples for both interfaces that extend Score-P’s functionality for monitoring and tuning purposes.

Performance measurement and runtime tuning tools are both vital in the HPC software ecosystem and use similar techniques: the analyzed application is interrupted at specific events and information on the current system state is gathered to be either recorded or used for tuning. One of the established performance measurement tools is Score-P. It supports numerous HPC platforms and parallel programming paradigms. To extend Score-P with support for different back-ends, create a common framework for measurement and tuning of HPC applications, and to enable the re-use of common software components such as implemented instrumentation techniques, this paper makes the following contributions: (I) We describe the Score-P metric plugin interface, which enables programmers to augment the event stream with metric data from supplementary data sources that are otherwise not accessible for Score-P. (II) We introduce the flexible Score-P substrate plugin interface that can be used for custom processing of the event stream according to the specific requirements of either measurement, analysis, or runtime tuning tasks. (III) We provide examples for both interfaces that extend Score-P’s functionality for monitoring and tuning purposes.