Renny Varghese Impact of an Electronic Medical Record Implementation on Drug Allergy Overrides in a Large Southeastern HMO Setting (Under the direction of Russell Toal, Associate Professor) Electronic medical records (EMRs) have become recognized as an important tool for improving patient safety and quality of care. Decision support tools such as alerting functions for patient medication allergies are a key part of reducing the frequency of serious medication problems. Kaiser Permanente Georgia (KPGA) implemented its EMR system in the primary care departments at Kaiser's twelve facilities in the greater metro Atlanta area over a six month period beginning in June 2005 and ending December 2005. The aim of this study is to analyze the impact of the EMR implementation on the number of drug allergy overrides within this large HMO outpatient setting. Research was conducted by comparing the rate of drug allergy overrides during pre and post EMR implementation. The timeline will be six months pre and post implementation. Observing the impact of the incidence rate of drug allergy alerts after the implementation provided insight into the effectiveness of EMRs in reducing contraindicated drug allergies. Results show that the incidence rate of drug allergy overrides per 1,000 filled prescriptions rose by a statistically significant 5.9% (ñ > 0.0002; 95% CI [-1.531, -0.767]) following the implementation. Although results were unexpected, several factors are discussed as to the reason for the increase. Further research is recommended to explore trends in provider behavior, KPGA specific facilities and departments, and in other KP regions and non-KP healthcare settings. INDEX WORDS: electronic medical records, drug allergy overrides, patient safety, medication errors, decision support tools, outpatient setting, primary care, computerized provider order entry

The diagnostic imaging (DI) literature identifies that unnecessary examinations are occurring. However, there is a gap in the research literature: little is known about how physicians order DI examinations and what efforts need to be undertaken to reduce the number of inappropriate orders made by physicians. Such research is needed in order to promote patient safety and improve utilization of limited health care resources Purpose: The purpose of this study is to explore how physicians order DI services, and what efforts could be made to reduce inappropriate DI ordering. Participants: 12 English speaking, non-radiologist physicians (general practitioners and specialists) participated in this study. Methods: Semi-structured key informant interviews were conducted with participants. Data from these interviews were analyzed using a grounded theory approach. Results: DI ordering practices (both appropriate and inappropriate) emerged as the dominant theme in this research, specifically in the context of prevalence, decision-making, information support, contributing factors, and solutions. Particularly, the majority of participants felt that DI is overused in the medical field and identified contacting physicians (colleagues, specialists, or radiologists) and consulting the literature (using UpToDate® or Google Scholar) as their top methods of information support used in challenging clinical scenarios. Meanwhile, participants suggested factors that contribute to inappropriate ordering: patient demand, legal liability, and duplicate ordering. The majority of participants believed education could reduce inappropriate ordering. Participants also identified increasing communication about requisitions and restricting DI ordering authority as potential solutions to reduce inappropriate ordering. Conclusion: From the interviews, ordering (both appropriate and inappropriate ordering) emerged as the overarching theme. Findings were compared and contrasted to the current literature. Overall, this study revealed how human factors, such as patient demand, influence how a physician orders DI. As well, the majority of participants relied on the patient to recall patient DI history; however, literature suggests this method is unreliable. This study also offers unique insight into the physician’s perspective of what would be effective for reducing inappropriate ordering. These findings contribute to the field of health informatics as any technology developed to reduce inappropriate ordering (such as a clinical decision support system) needs to consider these human factors to support user acceptance. Through findings from this study, further research gaps emerged that can guide future research. / Graduate

L'optimisation des processus de conception est une activité de recherche en pleine évolution, soulignée dans de nombreuses références et pratiques des entreprises dans l'objectif l'amélioration et le développement de produits nouveaux. Notre démarche s'inscrit dans la continuité de ces activités qui prend comme point de départ la diversité des processus de conception existants et la difficulté de réaliser un choix où une adaptation. D'ou notre problématique est résumée autour d'une question centrale que nous formulons de la manière suivante : comment optimiser le choix d'un processus de conception soumis à un environnement contraint ? La réponse à cette question est à travers la proposition d'un outil d'aide au choix qui converge vers l'installation d'un processus de conception. Cet outil est tridimensionnel, où la première dimension vise la préparation de la phase amont de conception, la deuxième dimension sélectionne un processus de conception sur une carte de classement et l'objectif de la troisième dimension est l'identification des métiers, outils et méthodes pour le développement des produits. La partie expérimentale de notre travail nous a conduit à valider l'outil développer et proposer comment l'exploiter par des concepteurs. L'optimisation est réalisée dans notre travail par la proposition de l'outil tridimensionnel d'un coté et de l'autre par l'exploitation des algorithmes d'optimisation pour la modélisation de l'outil. Des nouvelles pistes de recherche pour l'amélioration sont identifiées et proposées pour des futurs travaux. / The optimization of the design process is a research evolving highlighted in numerous references and business practices with the aim improving and developing new products. Our approach is a continuation of those activities that takes as its starting point the diversity of existing design processes and the difficulty of achieving a selection where adaptation. Hence our problem is summarized around a central question which we formulate as follows: how to optimize the choice of the design process subject to a constrained environment? The answer to this question is through the proposition of a tool Help in choosing which converges to the installation of a design process. This tool is three-dimensional, where the first dimension relates to the preparation of the upstream design phase, the second dimension selects a design process on a map classification and the objective of the third dimension is the identification of trades tools and methods for product development. The experimental part of our work has led us to validate the developed tool and propose how to use by designers. Optimization is achieved in our work by the proposal of a three-dimensional tool side and the other by the use of optimization algorithms for modeling tool. New avenues of research for improvement are identified and proposed for future work.

O número de estrangeiros interessados em aprender o português tem aumentado na última década, em consequência do crescimento da economia brasileira e do aumento da presença de multinacionais no Brasil. Esse fato se mostra pelo aumento do número de inscritos no exame de proficiência de português CELPE-Bras e de estudantes estrangeiros que ingressam nas universidades brasileiras. A maioria destes estudantes são de língua espanhola e precisam escrever seus textos acadêmicos em português. A proximidade das línguas portuguesa e espanhola apresenta-se tanto como um elemento positivo quanto como um obstáculo, pois oculta as diferenças e impede o domínio da língua portuguesa, mantendo, na fala e na escrita em português, interferências do espanhol. O maior número destas interferências acontece no nível lexical. Uma das alternativas para tratar os problemas em textos de aprendizes de uma língua é o emprego de ferramentas computacionais de pós-processamento e de suporte ao processo de escrita. No entanto, o número de recursos e ferramentas disponíveis para auxiliar a escrita de português como língua estrangeira é muito reduzido, diferentemente do cenário para a língua inglesa. Esta pesquisa propôs a criação de recursos e ferramentas de suporte à escrita no nível lexical como primeiro passo para a melhoria da qualidade linguística dos textos em português produzidos pelos nativos do espanhol. A Linguística de Córpus foi utilizada como metodologia para viabilizar a análise de erros de aprendizes. As ferramentas de auxílio utilizam léxicos bilíngues compilados por meio de técnicas de tradução, baseadas em alinhamento de córpus paralelos. Dado o número insuficiente de erros previamente anotados para suportar a detecção automática de erros, esta pesquisa propôs métodos baseados em modelo língua e na geração artificial de erros. A geração de erros artificiais se apresentou como um método eficiente para predizer erros lexicais dos aprendizes. As contribuições obtidas com a metodologia baseada em tradução automática para gerar auxílios à escrita entre línguas próximas, considerando a análise de erros lexicais extraídos de córpus de aprendizes, foco desta pesquisa, são: (i) do ponto de vista teórico, o levantamento e quantificação dos principais problemas causados pelas marcas do espanhol, deixadas nos textos acadêmicos em português escritos por nativos do espanhol; (ii) do ponto de vista de geração automática de recursos linguísticos, léxicos bilíngues de cognatos e falsos cognatos; léxico bilíngue de marcadores discursivos; léxico de expressões formulaicas que aparecem nos textos científicos e léxico bilíngue de verbos relacionados com pesquisa científica em português e, (iii) do ponto de vista da criação de subsídios para a área de auxílio à escrita científica, o projeto e avaliação de auxílios para suportar a escrita científica em português por nativos do espanhol. / In the last decade, as a result of Brazilian economic growth and the increased presence of multinationals in the country, the interest of foreigners in learning Portuguese rose. This fact is also noted by the number of students enrolled in the Portuguese proficiency exam, CELPE-Bras and the number of foreigner students entering at the Brazilian Universities. Most of these students are Spanish speakers and need to write the dissertation or thesis in Portuguese. The similarity between Portuguese and Spanish is considered as a positive element that often becomes an obstacle, because similarity and closeness frequently conceal differences and hinder learners from mastering the Portuguese, keeping interferences from their native Spanish both when speaking and writing in Portuguese. The largest number of this interference occurs at the lexical level. One alternative to deal with errors of second language learners is the use of computational post-edit tools and tools to support the writing process. However, the number of resources and tools available to help improve Portuguese writing as a foreign language is very small, unlike the scenario into English. This research proposed the creation of resources and writing support tools at the lexical level as a first step to improving the linguistic quality of the texts produced by Portuguese native Spanish. Corpus linguistics was used as a methodology to enable the learners error analysis. The writing support tools use bilingual lexicons compiled through translation techniques based on alignment parallel corpus. Given the insufficient number of errors previously annotated to support automatic error detection, this research proposed methods based on language model and artificial generation of errors. The generation of artificial errors introduced himself as an efficient method for predicting lexical errors of learners. The contributions obtained with the methodology based on automatic translation to generate written supports between similar languages, considering lexical error, extracted by the analysis of learners corpus, focus of this research are: (i) the theoretical point of view, the survey and quantification of the main problems caused by the Spanish marks, left in the academic texts written in Portuguese by native Spanish; (ii) the automatic generation of language resources point of view, bilingual lexicons of cognates and false cognates; bilingual lexicon of discourse markers; bilingual lexicon of formulaic expressions that appear in scientific texts and bilingual lexicon of verbs related to scientific research in Portuguese and, (iii) the point of view of creating subsidies for the area of support scientific writing, design and evaluation of aid to support scientific writing in Portuguese by native Spanish speakers.

This diploma theses is focused on problems of educational support tools for pupils of 1 st grade of The Elementary Special School. A theoretical part deals with problems of the mental handicap, mainly factors that significantly influence ability of education, and with a contemporary legislation of education of children with spetial educational needs. Furthermore it describes teaching programmes and didactic tools which are used at The Elementary Special Schools. Research target of the study is to find out a teacher's opinion about current teaching supports for given type of school and a survey of teacher's experience with use of new methods especially in relation to pupils who are usually integrated to their classes. Innovated teaching supports created on the basis of previous experience are subsequently verified in praxis and results of verification are partially documented by examples. According to research, current educational supports are convenient for pupils who cope with stipulated schoolwork easily. The other pupils have considerable difficulties to manage schoolwork therefore they need adapted teaching materials for their educational abilities. There are some examples of these materials in the attachment. KEYWORDS: mental disability, special education needs, elementary special school,...

Distributed infrastructures (e.g., water networks and electric Grids) are difficult to manage due to their scale, lack of accessibility, complexity, ageing and uncertainties in knowledge of their structure. In addition they are subject to loads that can be highly variable and unpredictable and to accidental events such as component failure, leakage and malicious tampering. To support in-field operations and central management of these infrastructures, the availability of consistent and up-to-date knowledge about the current state of the network and how it would respond to planned interventions is argued to be highly desirable. However, at present, large-scale infrastructures are “data rich but knowledge poor”. Data, algorithms and tools for network analysis are improving but there is a need to integrate them to support more directly engineering operations. Current ICT solutions are mainly based on specialized, monolithic and heavyweight software packages that restrict the dissemination of dynamic information and its appropriate and timely presentation particularly to field engineers who operate in a resource constrained and less reliable environments. This thesis proposes a solution to these problems by recognizing that current monolithic ICT solutions for infrastructure management seek to meet the requirements of different human roles and operating environments (defined in this work as field and central sides). It proposes an architectural approach to providing dynamic, predictive, user-centric, device and platform independent access to consistent and up-to-date knowledge. This architecture integrates the components required to implement the functionalities of data gathering, data storage, simulation modelling, and information visualization and analysis. These components are tightly coupled in current implementations of software for analysing the behaviour of networks. The architectural approach, by contrast, requires they be kept as separate as possible and interact only when required using common and standard protocols. The thesis particularly concentrates on engineering practices in clean water distribution networks but the methods are applicable to other structural networks, for example, the electricity Grid. A prototype implementation is provided that establishes a dynamic hydraulic simulation model and enables the model to be queried via remote access in a device and platform independent manner.This thesis provides an extensive evaluation comparing the architecture driven approach with current approaches, to substantiate the above claims. This evaluation is conducted by the use of benchmarks that are currently published and accepted in the water engineering community. To facilitate this evaluation, a working prototype of the whole architecture has been developed and is made available under an open source licence.

The presented thesis deals with the development of microregion Rakovnicko with regard to the area of tourism. The main objective of the study was to find out what kind of options has the surveyed region for supporting business activities in the field of tourism. The operational objective was to describe the limits of business development in this area. The objectives were obtained through analysis of the state of particular business support tools. The analysis covered the past and the current state of support tools, and the final conclusion was drawn within each of them.

The purpose of this study was to increase the knowledge for both academia and practitioners on how to integrate sustainability aspects in product development by studying current research and comparing these findings to empirical material retrieved from an industrial company. Seco, which functioned as the case company of this study, was used as the source for the empirical data collection. The study used a deductive research approach, which implicates that the literature has steered the collection of the empirical material. In the literature, eight key drivers and seven challenges for sustainable product development were identified to be significantly important. The drivers were categorized as either internal or external for an organization and the challenges were all categorised as internal. Of these eight drivers, one internal and one external driver was identified at Seco to be particularly important. The internal driver was the corporate sustainability strategy from Sandvik Group, which is the corporation Seco is part of, and the external driver was upcoming and existing regulations. Moreover, all six challenges were found to be relevant for Seco. These were handling trade-off situations, short-term economic thinking, lack of information in early phases of product development, measuring sustainability, sustainability strategy remains at the strategic level, and perceived risk of implementing sustainability. This study also examined what attributes that are important in decision support tools to enable the integration of sustainability aspects in product development. To identify important attributes in this study, Seco’s current decision support tools at the strategic, tactical, and operational planning levels were analysed by putting the theoretical framework in relation to the empirical material. From the analysis, the initial seven attributes from the theoretical framework were complemented with the following five attributes identified as important: a top-down approach that focuses on integrating sustainability on all planning levels of the product development process, enabling follow-up on strategic decisions, reduce the room for free interpretations, reduce the complexity and amount of time to use decision support tools, and lastly methodologies to support the collection of the required information to use decision support tools. Thus, it is emphasized that researchers and practitioners continue to develop new and existing decision support tools so that the sustainability of products can be defined and measured. A focus on developing methodologies that guides how the required information can be obtained to use decision support that incorporates all life-cycle phases of a product is also identified as important.

During last three decades, companies have offshored their manufacturing activities across international borders in order to pursue lower manufacturing costs. Despite having accomplished their purpose, companies have also suffered from issues, especially poor quality of products and a poor response to customer demand. Therefore, companies consider relocating some of the manufacturing activities back to the home country, a process that is known as manufacturing reshoring. There is paucity of scholarly attention on how manufacturing reshoring decisions are evaluated and supported. Therefore, the purpose of this thesis is to develop decision-support tools to evaluate manufacturing reshoring decisions. In order to fulfil this, it is important to know how industry experts reason while making manufacturing reshoring decisions (RQ1), and how their reasoning can be modeled into decision-support tools (RQ2). Therefore, three studies were conducted including a multiple case study and two modeling studies. The multiple case study addressed the criteria that are considered by the industry experts in these decisions, while the two modeling studies, based on fuzzy logic and analytical hierarchy process (AHP), used a part of these criteria to develop decision-support tools. The findings indicate that a holistic set of criteria were considered by industry experts in arriving at a manufacturing reshoring decision. A large portion of these criteria occur within competitive priority category and among them, high importance is given to quality, while low importance to sustainability. Fuzzy logic modeling was used to model the criteria from the perspective of competitive priority at an overall level. Three fuzzy logic concepts were developed to capture industry experts’ reasoning and facilitate modeling of manufacturing reshoring decisions. Furthermore, two configurations and sixteen settings were developed, of which, the best ones were identified. AHP-based tools were used to capture experts’ reasoning of the competitive priority criteria by comparing the criteria. It was observed that fuzzy logic-based tools are able to better emulate industry experts’ reasoning of manufacturing reshoring. This research contributes to theory with a holistic framework of reshoring decision criteria, and to practice with decision-support tools for evaluation of manufacturing reshoring decisions. / Under de tre senaste decennierna har många företag flyttat sin produktion till lågkostnadsländer för att kunna utnyttja lägre lönekostnader. Många gånger har företagen genom denna åtgärd lyckats sänka sin tillverkningskostnad men samtidigt drabbats av oförutsedda problem kopplat till exempelvis produkt-kvalitet och möjligheten att kundanpassa produkter. Hanteringen av problemen har lett till ytterligare kostnader som många gånger överstigit besparingen i tillverkningskostnad. Detta har lett till att allt fler företag börjat flytta tillbaka sin produktion till hemlandet, så kallad reshoring. Reshoring är ett ungt område där det saknas forskning gällande bland annat hur den här typen av beslut på bästa sätt kan utvärderas och vilken typ av beslutstöd som kan underlätta den här typen av beslut. Därför är syftet med den här avhandlingen är att utveckla beslutsstödverktyg för utvärdering av reshoring beslut. För att uppfylla syftet har två forskningsfrågor formulerats. Den första frågan handlar om hur industriexperter resonerar kring reshoring beslut (RQ1) medan den andra frågan handlar om hur deras resonemang kan modelleras i beslutsstödverktyg (RQ2). Tre studier har genomförts för att besvara forskningsfrågorna, en fallstudie och två modelleringsstudier. Fallstudien fokuserar på att identifiera vilka kriterier som industriexperter beaktar medan modelleringsstudierna fokuserar på att utveckla beslutstödsverktyg där en del av dessa kriterier beaktas, med hjälp av fuzzy logic och analytical hierarchy process (AHP). Resultaten från forskningen visar att industriexperter bedömer reshoring beslut utifrån ett holistiskt perspektiv. En stor del av dessa beslutskriterier finns inom konkurrenskraft kategorin och inom dessa, har industriexperterna lagt högst vikt på kvalitet och lägst vikt på hållbarhet. Genom fuzzy logic modellering modellerades kriterierna på en övergripande nivå. Tre nya fuzzy logic koncept utvecklades för att fånga experternas resonemang. Dessutom utvecklades två konfigurationer med sexton olika inställningar, och de bästa identifierades. AHP-baserade verktyg utvecklades för att fånga experternas resonemang om kriterierna för konkurrenskraft prioriteringar. Fuzzy logic-baserade verktyg kan bättre fånga experternas resonemang kring reshoring beslut. Denna forskning bidrar till teori med en holistisk lista över beslutskriterier för reshoring beslut, och till praktik med beslutsstöd verktyg för utvärdering av reshoring beslut.

Increasing awareness of anthropogenic impacts on the planet has lead to efforts to reduce negative environmental impacts in product development for several decades. Benefits to companies who focus on sustainability initiatives have been put forth more recently, leading to many efforts to incorporate sustainability considerations in their product innovation processes. The majority of current sustainability considerations in industry constrain design space by emphasizing reduced material and energy flows across the product’s life cycle. However, there is also an opportunity to use awareness of sustainability to bring attention to new facets of design space and to drive innovation. Specifically there is an opportunity for product-service systems (PSS) to be a vehicle through which sustainability-driven innovation occurs. A framework for strategic sustainable development (FSSD) provides the basis for understanding sustainability in this work, and provides clarity with regard to how to think about sustainable products and service innovations. The “backcasting” approach included in this framework also provides insight into how incremental and radical approaches could be aligned within the product innovation working environment. This thesis explores how sustainability considerations can be better integrated into existing product innovation working environments in order to drive innovation processes within firms, with a specific emphasis on opportunities that occur as sustainability knowledge leads to innovation through a product-service system approach. It endeavors to contribute to both theory development within the emerging sustainable PSS design research area, and also to advance the state of practice within industry by connecting dots between the state of theory and the state of practice. Society’s opportunity to become more sustainable and industry’s desire for innovation in order to lead to or increase profitability are often in conflict. However, this thesis argues that knowledge of global social and ecological sustainability can be used to drive innovation processes, and that there are win-win opportunities that can often be achieved through a PSS approach. There is some, but not sufficient, support for the inclusion of sustainability considerations in the product innovation process, and even fewer tools to support the use of sustainability to drive innovation. In response, an approach to providing support that brings together the FSSD and various approaches to systems modeling and simulation is presented. Opportunities to use sustainability-friendly attributes of existing products through a PSS-approach are also presented.