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ispartof: PRENATAL DIAGNOSIS vol:39 issue:5 pages:409-412 ispartof: location:England status: published

Intention Mining has the purpose to manipulate of large volumes of data, integrate information from different sources and formats and extract useful insights as facts from this data in order to discover users’ intentions. It is used in different fields: Robotics, Network forensics, Security, Bioinformatics, Learning, Map Visualization, Game, etc. There is actually a large variety of intention mining techniques applied to different domains as information retrieval, security, robotics, etc. However, no systematic review had been conducted on this recent research domain. There is a need to understand what is Intention Mining, what is its purpose, what are the existing techniques and tools to mine intentions. In this paper, we propose a comparison framework to structure and to describe the domain °of Intention Mining for a further complete systematic literature review of this field. We validate our comparison framework by applying it to five relevant approaches in the domain.

OBJECTIVE: To examine trends in patient experiences in the period 2014-2019, describe improvement strategies implemented by hospitals in the same period, and study associations between patient experiences and implemented strategies. DESIGN: Multi-center retrospective region-wide observational design. SETTING: Flanders, Belgium. PARTICIPANTS: 44 out of 46 Flemish acute-care hospitals publicly reporting patient experiences via the Flemish Patient Survey (FPS). MAIN OUTCOME MEASURE(S): Primary outcomes were the two global FPS ratings: percentage of patients rating the hospital 9 or 10 and percentage of patients definitely recommending the hospital. Secondary outcomes were the average top-box score percentages for each of the 8 remaining dimensions of the FPS. RESULTS: Between 2014 and 2019, there was a significant improvement in patients scoring the hospital 9 or 10 (56% to 61%) and patients definitely recommending (67% to 70%) the hospital. Significant increases in patient experiences over time were also observed in other dimensions, except for the dimension discharge. Hospital key informants reported various improvement strategies related to patient experiences with care and the FPS. Feedback to nursing wards (n = 44, 100%) and clinicians (n = 39, 89%) were most common. Overall, most improvement strategies were not or only weakly associated with patient experience ratings in 2019 and changes in ratings over time. Still, positive associations were discovered between the strategies 'nursing ward interventions' and 'hospital wide education' and recommendation of the hospital. CONCLUSIONS: Patient experiences have improved modestly in Flemish acute-care hospitals. Hospitals report to have invested in patient experience improvement strategies but positive associations between such strategies and FPS scores are weak, although there is potential in further exploring nursing ward interventions and hospital wide education. Hospitals should continue their efforts to improve the patient's experience, but with a more targeted approach, taking the lessons learned on the efficacy of strategies into consideration. ispartof: Plos One vol:15 issue:11 ispartof: location:United States status: published

OBJECTIVE: Due to the increased risk of antenatal brain lesions, we offer a third-trimester magnetic resonance imaging (MRI) scan to all patients who underwent an in utero intervention for twin-twin transfusion syndrome (TTTS). However, the usefulness of such a policy has not been demonstrated yet. Therefore, we determined the prevalence of antenatal brain lesions detected on third-trimester MRI and the proportion of lesions detected exclusively on MRI. MATERIALS AND METHODS: We conducted a retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS that underwent laser coagulation of the vascular anastomoses or fetal reduction by umbilical cord occlusion between 2010 and 2017. We reviewed the third-trimester MRI findings and compared those with the prenatal ultrasonography. RESULTS: Of the 141 patients treated with laser coagulation and 17 managed by cord occlusion, 112/141 (79%) and 15/17 (88%) patients reached 28 weeks. Of those, 69/112 (62%) and 11/15 (73%) underwent an MRI between 28 and 32 weeks. After laser coagulation, MRI detected an antenatal brain lesion in 6 of 69 pregnancies (9%) or in 6 of 125 fetuses (5%). In 4 cases (67%), the lesion was detected only on MRI. In the 11 patients treated with cord occlusion, no brain lesions were diagnosed. CONCLUSION: The prevalence of brain lesions detected by third-trimester MRI is higher compared to prenatal ultrasonography alone, making MRI a useful adjunct to detect antenatal brain lesions in twin pregnancies after in utero treatment for TTTS. KEY POINTS: • In utero interventions for twin-to-twin transfusion syndrome (TTTS) do not prevent the occurrence of antenatal brain lesions. • Fetal magnetic resonance imaging (MRI) has high accuracy in detecting anomalies of cortical development and can be a useful adjunct to ultrasonography in diagnosing certain brain abnormalities. • After laser coagulation of the anastomoses for TTTS, third-trimester MRI diagnosed a brain lesion that was not detected earlier on ultrasound scan in 6% of pregnancies. ispartof: EUROPEAN RADIOLOGY vol:31 issue:6 pages:4097-4103 ispartof: location:Germany status: published

There is an increasing interest in corporate sustainability and how companies should include it to satisfy user’s requirements concerning social, economic, and environmental impacts. Research about sustainability in computer science aims to offer methods, techniques and tools to lessen the impact of new technologies on the environment, to offer a better world, a smarter life, to the next generations. Information systems must participate in the collective effort to move towards sustainable development, and software and application companies must lead a CSR strategy to achieve this aim. Moreover, beyond an individual company approach, sustainability should be seen as an integral quality of any software (as well as safety, performance or reliability). All of this seem obvious at a time when applications and programs of all kinds are ubiquitous in everyday life. Nevertheless, the challenges of sustainable development have still not been considered in certain key sectors such as the development of information technology. A lot of ecolabels exist for a lot of different products, although not for software sustainability. We propose in this work an ecolabel for software sustainability, based on a set of relevant criteria found in different works.

International audience; Successful completion of the Industry 4.0 or Future Industry programs requires support for women and men to drive them. The challenge of aligning skills is complemented by the modernization of their practices and tools. All businesses are changing and change management techniques have become standard practice in most organizations. However, the so-called "traditional" methods are limited and it is now proposed change management methods called "agile", borrowing the philosophy of agile development methods to reduce the obstacles to change by injecting a bit of agility in their way of doing things. We first argue about this proposal with the results of a questionnaire to define the importance of people implication in a change project. We then propose a method based on the agile change model [1] by proposing tools adapted to each phase as well as an optimization of the experimentation phase. An evaluation of the proposed method is performed with a retrospective on a real case and the interview of an expert.

This thematic issue of the Complex Systems Informatics and Modeling Quarterly journal is dedicated to Information Science. It is a selection of the extended best papers presented at the 12th edition of the International IEEE Conference on Research Challenges in Information Science (RCIS’2018). The articles presented in this thematic issue contain at least 30% new material compared to the initial papers. The RCIS conference covers a wide spectrum of topics in the information science field: information search and discovery, requirement engineering, product lines, smart cities and Internet of Things, business processes, recommendation and prediction, security, social computing and Social Network Analysis, Human-Computer Interaction and systems engineering. After an additional reviewing process, the articles which have been finally selected present contributions of different types to the field of information science: models, architectures, frameworks, and surveys.

Kris Vanhaecht,1,2 Cathy Lodewijckx,1 Walter Sermeus,1 Marc Decramer,3,4 Svin Deneckere,1,5 Fabrizio Leigheb,6 Paulo Boto,7 Seval Kul,8 Deborah Seys,1 Massimiliano Panella1,6 1Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven – University of Leuven, 2Department of Quality Management, University Hospitals Leuven, 3Department of Clinical and Experimental Medicine, KU Leuven – University of Leuven, 4University Hospitals Leuven, Leuven, 5Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium; 6Department of TranslationalMedicine, University of Eastern Piedmont, Vercelli, Italy; 7Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal; 8Department of Biostatistics, School of Medicine, University of Gaziantep, Gaziantep, Turkey Purpose: Current in-hospital management of exacerbations of COPD is suboptimal, and patient outcomes are poor. The primary aim of this study was to evaluate whether implementation of a care pathway (CP) for COPD improves the 6months readmission rate. Secondary outcomes were the 30days readmission rate, mortality, length of stay and adherence to guidelines. Patients and methods: An international cluster randomized controlled trial was performed in Belgium, Italy and Portugal. General hospitals were randomly assigned to an intervention group where a CP was implemented or a control group where usual care was provided. The targeted population included patients with COPD exacerbation. Results: Twenty-two hospitals were included, whereof 11 hospitals (n=174 patients) were randomized to the intervention group and 11 hospitals (n=168 patients) to the control group. The CP had no impact on the 6months readmission rate. However, the 30days readmission rate was significantly lower in the intervention group (9.7%; 15/155) compared to the control group (15.3%; 22/144) (odds ratio =0.427; 95% confidence interval 0.222–0.822; P=0.040). Performance on process indicators was significantly higher in the intervention group for 2 of 24 main indicators (8.3%). Conclusion: The implementation of this in-hospital CP for COPD exacerbation has no impact on the 6months readmission rate, but it significantly reduces the 30days readmission rate. Keywords: COPD, care pathway, readmission, quality improvement, cluster randomized controlled trial

In 1872, in the wake of the diplomatic Iwakura Embassy, five Japanese True Pure Land priests undertook a mission with the purpose of observing the religious situation in Europe. The insights that J...

BACKGROUND: Adherence to guidelines for patients with proximal femur fracture is suboptimal. OBJECTIVE: To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. DESIGN: The European Quality of Care Pathways study is a cluster randomized controlled trial. SETTING: 26 hospitals in Belgium, Italy and Portugal. SUBJECTS: Older adults with a proximal femur fracture (n = 514 patients) were included. METHODS: Hospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures. RESULTS: In the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team. DISCUSSION: Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00962910. ispartof: Injury vol:49 issue:8 pages:1581-1586 ispartof: location:Netherlands status: Published online

Being related to the adoption of new beliefs, attitudes and, ultimately, behaviors, analyzing online communication is of utmost importance for medicine. Multiple health care, academic communities, such as information seeking and dissemination and persuasive technologies, acknowledge this need. However, in order to obtain understanding, a relevant way to model online communication for the study of behavior is required. In this paper, we propose an automatic method to reveal process models of interrelated speech intentions from conversations. Specifically, a domain-independent taxonomy of speech intentions is adopted, an annotated corpus of Reddit conversations is released, supervised classifiers for speech intention prediction from utterances are trained and assessed using 10-fold cross validation (multi-class, one-versus-all and multi-label setups) and an approach to transform conversations into well-defined, representative logs of verbal behavior, needed by process mining techniques, is designed. The experimental results show that: (1) the automatic classification of intentions is feasible (with Kappa scores varying between 0.52 and 1); (2) predicting pairs of intentions, also known as adjacency pairs, or including more utterances from even other heterogeneous corpora can improve the predictions of some classes; and (3) the classifiers in the current state are robust to be used on other corpora, although the results are poorer and suggest that the input corpus may not sufficiently capture varied ways of expressing certain speech intentions. The extracted process models of interrelated speech intentions open new views on grasping the formation of beliefs and behavioral intentions in and from speech, but in-depth evaluation of these conversational models is further required.

International audience; Understanding how sentences constitute conversations is still a matter of disagreement. The automatic analysis of corpora can bring new perspectives on this issue. We show that process mining, a computer science approach for analysing human behaviour, enables the inductive identification of within-turn regularities in digital conversations. We use speech acts as a way to discretise conversations and enable the analysis. To this end, we develop a fine-grained, corpus-independent classification of speech acts that we describe and validate. We perform a manual sentence-by-sentence multi-label contextual annotation of a corpus of digital conversations and we explore it with process mining. Our results suggest that speech act theory could be extended to include typicality conditions for sequences of utterances.

The increasing population with chronic diseases and highly engaged in online communication has triggered an urge in healthcare to understand this phenomenon. We propose an automatic approach to analyze the perceived intentions behind public tweets. Our long-term goal is to create high-level, behavioral models of the health information consumers and disseminators, relevant to studies in narrative medicine and health information dissemination. The contributions of this paper are: (1) a validated intention taxonomy, derived from pragmatics and empirically adjusted to Twitter public communication; (2) a tagged health-related corpus of 1100 tweets; (3) an effective approach to automatically discover intentions from text, using supervised machine learning with discourse features only, independent of domain vocabulary. Reasoning on the results, we claim the transferability of our solution to other healthcare corpora, enabling thus more extensive studies in the concerned domains.

An increased need for efficiency and effectiveness in today's healthcare system urges professionals to improve the organization of care. Care pathways are an important tool to achieve this. The overall aim of this study was to analyze if care pathways lead to better organization of care processes. For this, the Care Process Self-Evaluation tool (CPSET) was used to evaluate how healthcare professionals perceive the organization of care processes. Based on information from 2692 health care professionals gathered between November 2007 and October 2011 we audited 261 care processes in 108 organizations. Multilevel analysis was used to compare care processes without and with care pathways and analyze if care pathways led to better organization of care processes. A significant difference between care processes with and without care pathways was found. A care pathway in use led to significant better scores on the overall CPSET scale (p

International audience; Situational Method Engineering aims at constructing methods adapted to a given situation, either by a construction from a set of predefined method components or by a customization of an existing method using different techniques: configuration, extension, reduction, and so on. However, these techniques are still limited in practice, as considered complicated and heavy to implement. In this paper, we describe a practitioner experience of a gradual integration of different method components (issued from agile methods of software development). In a real case of a development company, we have practiced and observed the progressive introduction of agile method components instead of the construction or customization of methods in one go. We discuss the lessons learned from this experience and define different research perspectives.

International audience; The strategic transition of media organizations to personalized information delivery has urged the need for richer methods to analyze the customers. Though useful in supporting the creation of recommender strategies, the current data mining techniques create complex models requiring often an understanding of techniques in order to interpret the results. This situation together with the recommender technologies deluge and the particularities of the news industry pose challenges to the news organization in making decisions about the most suitable strategy. Therefore, we propose process mining as a high-level, end-to-end solution to provide insights into the consumers' behavior and content dynamics. Specifically, we explore if it allows news organizations to analyze independently and effectively their data in order to support them in defining recommender strategies. The solution was implemented in a case study with the third largest news provider in Norway and yielded preliminary positive results. To our knowledge, this is the first attempt to apply a process mining methodology and adapt the techniques to support media industry with the recommender strategies.

The aim of this paper was to perform a systematic overview of secondary literature studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO-host, and The Cochrane Library were searched. A total of six papers, corresponding to six secondary studies, were included but only four secondary studies were HF-specific and thus assessed. Secondary studies were evaluated for patients' clinical outcomes. There were wide differences among the studies that assessed the effects of CPs on HF patients, with some contrasting clinical outcomes reported. Secondary studies that were non-specific for CPs and included other multidisciplinary care approaches as well showed, in some cases, a shorter hospital length of stay (LOS) compared to usual care; studies that focused on promoting early mobilization showed better outcomes of mortality, morbidity, function, or service utilization; CPs mainly based on intensive occupational therapy and/or physical therapy exercises improved functional recovery and reduced LOS, with patients also discharged to a more favorable discharge destination; CPs principally focused on early mobilization improved functional recovery. A secondary study specifically designed for CPs showed lower odds of experiencing common complications of hospitalization after HF. In conclusion, although our overview suggests that CPs can reduce significantly LOS and can have a positive impact on different outcomes, data are insufficient for formal recommendations. To properly understand the effects of CPs for HF, a systematic review is needed of primary studies that specifically examined CPs for HF.

lodewijckx c., sermeus w., panella m., deneckere s., leigheb f., troosters t., boto p.a., mendes r.v., decramer m. & vanhaecht k. (2012) Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. Journal of Advanced Nursing69(2), 348–362. doi: 10.1111/j.1365-2648.2012.06013.x Abstract Aim. To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. Background. Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. Design. Delphi study. Methods. The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. Results. Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5–88·6%) and for the outcome indicators concerning understanding of therapy (91·4–85·7%) and self-management (88·6–88·2%). Conclusion. The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators.

We performed a systematic review for primary studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO host, and The Cochrane Library (Cochrane Central Register of Clinical Trials, Health Technology Assessment Database, NHS Economic Evaluation Database) were searched. Two researchers reviewed the literature independently. Primary studies that met predefined inclusion criteria were assessed for their methodological quality. A total of 15 publications were included: 15 primary studies corresponding with 12 main investigations. Primary studies were evaluated for clinical outcomes, process outcomes, and economic outcomes. The studies assessed a wide range of outcome measures. While a number of divergent clinical outcomes were reported, most studies showed positive results of process management and health-services utilization. In terms of mortality, the results provided evidence for a positive impact of CPs on in-hospital mortality. Most studies also showed a significantly reduced risk of complications, including medical complications, wound infections, and pressure sores. Moreover, time-span process measures showed that an improvement in the organization of care was achieved through the use of CPs. Conflicting results were observed with regard to functional recovery and mobility between patients treated with CPs compared to usual care. Although our review suggests that CPs can have positive effects in patients with HF, the available evidence is insufficient for formal recommendations. There is a need for more research on CPs with selected process and outcome indicators, for in-hospital and postdischarge management of HF, with an emphasis on well-designed randomized trials.

Aim Reducing variations by standardizing the key interventions in clinical processes is an effective tool to minimize the probability of medical errors. Thus, we determined whether variations exist in the key interventions included in care pathway documents (CPDs) of different organizations and in the timing of these interventions during the care process. Methods We invited members of the Belgian Dutch Clinical Pathway Network to send their CPDs for external review. We analysed 19 CPDs for total knee arthroplasty. International guidelines were consulted for definition of key interventions. Documentation of these interventions in the pathway documents was checked. Results From the 19 CPDs analysed, we retrieved 18 key interventions. Nine of these key interventions appeared in at least 80% of the care pathways. Only two key interventions appeared in all pathway documents. Nine out of 12 interventions that appeared in at least 80% of the pathway documents showed a variation of 1 day in the timing of care from the median timing. Conclusion We conclude that important variation exists in the included interventions and in their timing. The results of this study suggest that, before use in daily patient care, CPDs should be reviewed by peers and checked to ensure that all evidence-based key interventions are included and properly planned. Only in this way can pathways documents be used interprofessionally during the entire perioperative period in the search for optimal quality and patient safety.

The development and implementation of a care pathway is a complex intervention. One of the goals is to standardize the interprofessional teamwork. During the development of the care pathway, the team can use the 3-blackboard method to systematically define the goals, describe the organization of the care process and develop a list of topics for further analysis. The 3-blackboard method is a consensus development exercise which can be used for pathway projects but also during other quality and patient safety improvement exercises.

International audience; Variability has proved to be a central concept in different engineering domains, manufacturing, software development etc. in order to develop solutions that can be easily adapted to different organizational settings and different sets of customer at a low price. Teleological processes have, by nature, a high level of variability. Our position is that the integration of "context-awareness" in that kind of processes increases their intrinsic variability with specific criteria. We propose an indicator typology with an usage process and illustrate it with the MAP intentional process model.

In order to study the impact of interventions on multidisciplinary teamwork in care processes, relevant indicators need to be defined. In the present study, the authors performed a Delphi survey of a purposively selected expert panel consisting of scientific researchers and hospital managers. Thirty-six experts from 13 countries participated. Each participant rated a list of team indicators on a scale of 1–6. Consensus was sought in two consecutive rounds. The content validity index (CVI) varied from 8% to 92%. A final list of 19 indicators was generated: 5 on team context/structure, 8 on team process, and 6 on team outcomes. Most relevant team indicators were as follows: “team relations,” “quality of team leadership,” “culture/climate for teamwork,” “team perceived coordination of the care process,” and “team vision.” Scientific researchers and hospital managers that want to study and improve multidisciplinary teamwork in care processes should primarily focus on these team indicators.

The European Quality of Care Pathway (EQCP) study is the first, international, cluster randomized controlled trial launched to study the effect of the implementation of care pathways and to study why and under what circumstances pathways work. The study will be performed in Belgium, Italy, Ireland and Portugal and will include individual studies: a trial including chronic obstructive pulmonary disease patients, a trial including proximal femur fracture patients and a trial focusing on multidisciplinary teamwork within both populations. The study is managed by the European Pathway Association in close collaboration with a multidisciplinary team of the Catholic University Leuven (Belgium), the University of Eastern Piedmont (Italy), the National School of Public Health Lisbon (Portugal) and the Health Services Executive in Dublin (Ireland). This paper will describe the history, project management and overall approach of this international study.

e21107Background: Value based healthcare aims to increase value of patient care by optimizing health outcomes. It is critical to include measurement of patient/disease/treatment variables and outco...

The applicability of mobile, non-destructive techniques such as energy dispersive X-ray fluorescence spectroscopy, which reveals the elemental composition, and fibre-coupled Raman spectroscopy, offering molecular information, is applied to the central panel of the Wyts triptych, after Jan van Eyck. Using a combination of these direct techniques, vermilion (HgS), lead white (2PbCO3·Pb(OH)2), anatase (TiO2), massicot (PbO), zinc white (ZnO) and lead-tin yellow type I (Pb2SnO4) could be identified. X-ray fluorescence spectroscopy (XRF) measurements also confirmed the presence of cobalt. Also, copper was detected in different blue and green areas. For the brown and red colour, iron oxides were used. Apart from identifying pigments, the combination of these analytical techniques also gave information about restored parts and the layered structure of the panel. XRF maps of three different areas of the panel painting were recorded to get an idea of the changes the painting underwent during its past history. This research confirms the results of the visual analysis that the painting is a heavily restored copy of a lost original by Jan van Eyck. Copyright © 2010 John Wiley & Sons, Ltd.

Process mining has been successfully used in automatic knowledge discovery and in providing guidance or support. The known process mining approaches rely on processes being executed with the help of information systems thus enabling the automatic capture of process traces as event logs. However, there are many other fields such as Humanities, Social Sciences and Medicine where workers follow processes and log their execution manually in textual forms instead. The problem we tackle in this paper is mining process instance models from unstructured, text-based process traces. Using natural language processing with a focus on the verb semantics, we created a novel unsupervised technique TextProcessMiner that discovers process instance models in two steps: 1.ActivityMiner mines the process activities; 2.ActivityRelationshipMiner mines the sequence, parallelism and mutual exclusion relationships between activities. We employed technical action research through which we validated and preliminarily evaluated our proposed technique in an Archaeology case. The results are very satisfactory with 88% correctly discovered activities in the log and a process instance model that adequately reflected the original process. Moreover, the technique we created emerged as domain independent.

International audience; — Software implementation is one of the important steps in a software engineering process. It consists of integrating software based services or components in business alignment with the organizational view and acceptance from the users' perspectives. However, this step is complex and not supported in detail by the existing design and implementation methods. When implementing a software product in a customer organization with a specific context, the problem of the choice of the method or its adaptation is crucial to ensure the implementation success. Software producing organizations have difficulty with the creation of the most suitable implementation method for their software products. Situational Method Engineering (SME) proposes solutions to create methods adapted to the project at hand. We propose an approach to build an implementation method based on the association of method fragments, offering two advantages: it facilitates (a) the modeling of fragments by using the Process Deliverable Diagram formalism (PDD) that has proved its efficacy and simplicity, and (b) the selection of fragments by using metrics to analyze them. We illustrate our proposal with a case study to create an implementation method for a personal health management software product. Keywords— Software product implementation method, situational method engineering, method association, feature, method fragment, project situation

International audience; Understanding people's goals is a challenging issue that is met in many different areas such as security, sales, information retrieval, etc. Intention Mining aims at uncovering intentions from observations of actual activities. While most Intention Mining techniques proposed so far focus on mining individual intentions to analyze web engine queries, this paper proposes a generic technique to mine intentions from activity traces. The proposed technique relies on supervised learning and generates intentional models specified with the Map formalism. The originality of the contribution lies in the demonstration that it is actually possible to reverse engineer the underlying intentional plans built by people when in action, and specify them in models e.g. with intentions at different levels, dependencies, links with other concepts, etc. After an introduction on intention mining, the paper presents the Supervised Map Miner Method and reports two controlled experiments that were undertaken to evaluate precision, recall and F-Score. The results are promising since the authors were able to find the intentions underlying the activities as well as the corresponding map process model with satisfying accuracy, efficiency and performance.

Background Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table. Methods The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated. Results CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated. Conclusions The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams.

International audience; Learning humans' behavior from activity logs requires choos- ing an adequate machine learning technique regarding the situation at hand. This choice impacts signi cantly results reliability. In this paper, Hidden Markov Models (HMMs) are used to build intentional process models (Maps) from activity logs. Since HMMs parameters require to be learned, the main contribution of this paper is to compare supervised and unsupervised learning approaches of HMMs. After a theoretical compari- son of both approaches, they are applied on two controlled experiments to compare the Maps thereby obtained. The results demonstrate using su- pervised learning leads to a poor performance because it imposes binding conditions in terms of data labeling, introduces inherent humans' biases, provides unreliable results in the absence of ground truth, etc. Instead, unsupervised learning obtains e cient Maps with a higher performance and lower humans' effort.

International audience; Research on guidance and method engineering has highlighted that many method engineering issues, such as lack of flexibility or adaptation, are solved more effectively when intentions are explicitly specified. However, software engineering process models are most often described in terms of sequences of activities. This paper presents a novel approach, so-called Map Miner Method (MMM), designed to automate the construction of intentional process models from process logs. To do so, MMM uses Hidden Markov Models to model users' activities logs in terms of users' strategies. MMM also infers users' intentions and constructs fine-grained and coarse-grained intentional process models with respect to the Map metamodel syntax (i.e., metamodel that specifies intentions and strategies of process actors). These models are obtained by optimizing a new precision-fitness metric. The result is a software engineering method process specification aligned with state of the art of method engineering approaches. As a case study, the MMM is used to mine the intentional process associated to the Eclipse platform usage. Observations show that the obtained intentional process model offers a new understanding of software processes, and could readily be used for recommender systems.

International audience; Besides the benefits of flexible processes, practical implementations of process aware information systems have also revealed difficulties encountered by process participants during enactment. Several support and guidance solutions based on process mining have been proposed, but they lack a suitable semantics for human reasoning and decisions making as they mainly rely on low level activities. Applying design science, we created FlexPAISSeer, an intention mining oriented approach, with its component artifacts: 1) IntentMiner which discovers the intentional model of the executable process in an unsupervised manner; 2) In-tentRecommender which generates recommendations as intentions and confidence factors, based on the mined intentional process model and probabilistic calculus. The artifacts were evaluated in a case study with a Netherlands software company, using a Childcare system that allows flexible data-driven process enactment.

Process mining aims to discover, enhance or check the conformance of activity-oriented process models from event logs. A new field of research, called intention mining, recently emerged. This field has the same objectives as process mining but specifically addresses intentional process models (processes focused on the reasoning behind the activities). This paper aims to highlight the differences between these two fields of research and illustrates the use of mining techniques on a dataset of event logs, to discover an activity process model as well as an intentional process model.

International audience; The paper addresses the problem of the low quality of the process/product in the software development industry. In particular it deals with the issue of the low usage of software development methods, which is empirically proved to be one of the reasons for failures in software development projects and a contributor to the low quality of software. In this paper, we outline an approach that could help to improve the maturity of software development processes by circumventing the problems that hinder the use of disciplined approaches in the software development practice. The approach is based on the method engineering principles and represents a continuation of our past research in this field.

Situational Method Engineering (SME) is constantly looking for new ways to facilitate situation-specific method construction in practice. We have developed the notion of method family to attain this goal. Our inspiration comes from Software Product Line Engineering (SPLE), which is developing solutions that can be easily adapted to a specific context and by reusing existing knowledge. In this paper, we introduce the process guiding the construction of method families based on the analysis of the methods variability.

Background Optimization of the clinical care process by integration of evidence-based knowledge is one of the active components in care pathways. When studying the impact of a care pathway byusing a cluster-randomized design, standardization of the care pathway intervention is crucial. This methodology paper describes the development of the clinical content of an evidence-based care pathway for in-hospital management of chronic obstructive pulmonary disease (COPD) exacerbation in the context of a cluster-randomized controlled trial (cRCT) on care pathway effectiveness. Methods The clinical content of a care pathway for COPD exacerbation was developed based on recognized process design and guideline development methods. Subsequently, based on the COPD case study, a generalized eight-step method was designed to support the development of the clinical content of an evidence-based care pathway. Results A set of 38 evidence-based key interventions and a set of 24 process and 15 outcome indicators were developed in eight different steps. Nine Belgian multidisciplinary teams piloted both the set of key interventions and indicators. The key intervention set was judged by the teams as being valid and clinically applicable. In addition, the pilot study showed that the indicators were feasible for the involved clinicians and patients. Conclusions The set of 38 key interventions and the set of process and outcome indicators were found to be appropriate for the development and standardization of the clinical content of the COPD care pathway in the context of a cRCT on pathway effectiveness. The developed eight-step method may facilitate multidisciplinary teams caring for other patient populations in designing the clinical content of their future care pathways. ispartof: Trials vol:13 issue:1 pages:229- ispartof: location:England status: published

Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting.A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups. The intervention group implemented a CP. The control group provided usual care. A set of team input, process, and output indicators were used as effect measures. To analyze the results, we performed multilevel statistical analysis.Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better in conflict management [β=0.30 (0.11); 95% confidence interval (CI), 0.08 to 0.53]; team climate for innovation [β=0.29 (0.10); 95% CI, 0.09 to 0.49]; and level of organized care [β=5.56 (2.05); 95% CI, 1.35 to 9.76]. They also showed lower risk of burnout as they scored significantly lower in emotional exhaustion [β=-0.57 (0.21); 95% CI, -1.00 to -0.14] and higher in the level of competence (β=0.39; 95% CI, 0.15 to 0.64). No significant effect was found on relational coordination.CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.

Background Proximal femur fracture (PFF) is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP) study on PFF (NCT00962910) was designed to determine how care pathways (CP) for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. Methods/Design An international cluster-randomized controlled trial (cRCT) will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. Discussion The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. Trial registration number NCT00962910

BACKGROUND: Although care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP) study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process. Methods/design An international post-test-only cluster Randomised Controlled Trial (cRCT), combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal. Teams caring for proximal femur fracture (PFF) patients and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease (COPD) will be randomised into an intervention and control group. The intervention group will implement a care pathway for PFF or COPD containing three active components: a formative evaluation of the actual teams' performance, a set of evidence-based key interventions, and a training in care pathway-development. The control group will provide usual care. A set of team input, process and output indicators will be used as effect measures. The main outcome indicator will be relational coordination. Next to these, process measures during and after pathway development will be used to evaluate the implementation processes. In total, 132 teams have agreed to participate, of which 68 were randomly assigned to the intervention group and 64 to the control group. Based on power analysis, a sample of 475 team members per arm is required. To analyze results, multilevel analysis will be performed. DISCUSSION: Results from our study will enhance understanding on the active components of care pathways. Through this, preferred implementation strategies can be defined. Trail registration NCT01435538. ispartof: Implementation Science vol:7 issue:47 pages:1-12 ispartof: location:England status: published

International audience; Information Systems (IS) engineering (ISE) processes contain steps where decisions must be made. Moreover, the growing role of IS involves requirements for their engineering, such as quality, cost, time, and so on. On the one hand, considering these aspects implies that the number of researches dealing with decision-making (DM) in ISE increasingly grows. On the other hand, many DM methods exist and are applied in several fields of ISE. The main characteristic of these applications is that they resolve one DM problem at a time. We have developed a generic DM approach MADISE, which aims at guiding IS engineers through DM activities. The goal of this paper is to check the completeness and flexibility of MADISE by comparing it with the five well-known requirements prioritization approaches.

International audience; The role of variability in Software engineering grows increasingly as it allows developing solutions that can be easily adapted to a specific context and reusing existing knowledge. In order to deal with variability in the method engineering (ME) domain, we suggest applying the notion of method families. Method components are organized as a method family, which is configured in the given situation into a method line. In this paper, we motivate the concept of method families by comparing the existing approaches of ME. We detail then the concept of method families and illustrate it with a family of decision-making (DM) methods that we call MADISE.

Care pathways are often said to promote interprofessional teamwork. As no systematic review on pathway effectiveness has ever focused on how care pathways promote teamwork, the objective of this review was to study this relationship. We performed an extensive search of electronic databases and identified 26 relevant studies. In our analysis of these studies we identified 20 team indicators and found that care pathways positively affected 17 of these indicators. Most frequently positive effects were found on staff knowledge, interprofessional documentation, team communication and team relations. However, the level of evidence was rather low. We found Level II evidence for improved interprofessional documentation. We also found Level II evidence for increased workload; improved actual versus planned team size; and improved continuity of care. The studies most frequently mentioned the need for a multidisciplinary approach and educational training sessions in order for pathways to be successful. The systematic review revealed that care pathways have the potential to support interprofessional teams in enhancing teamwork. Necessary conditions are a context that supports teamwork and including appropriate active pathway components that can mediate an effect on team processes. To achieve this, each care pathway requires a clearly defined team approach customized to the individual teams’ needs.

This book constitutes the refereed proceedings of the 4th IFIP WG 8.1 Working Conference on Method Engineering, ME 2011, held in Paris, France, in April 2011. The 13 revised full papers and 6 short papers presented together with the abstracts of two keynote talks were carefully reviewed and selected from 30 submissions. The papers are organized in topical sections on situated method engineering, method engineering foundations, customized methods, tools for method engineering, new trends to build methods, and method engineering services.

The pattern notion has been widely used lately to define techniques allowing the existing knowledge reuse. A pattern solves a specific problem of a software system life cycle. There is three patterns types: the analysis patterns help to express the requirements, the design patterns solve specific design problems and the implementation patterns translate solutions into target languages [1]. The knowledge encapsulated in these modules are generally stored in classic library repositories that quickly become overcrowded. As a result, the difficulties to access an information increase and the user is quickly lost. It is often the same patterns (the simpler and the more widely used) that are used. This paper deals with this problem with a process meta-model, called Map P], that allows to guide engineers when using patterns.

Raman spectroscopy and X-ray fluorescence (XRF) spectroscopy are often used as complementary techniques that are well suited for the analysis of art objects because both techniques are fast, sensitive, and noninvasive and measurements can take place in situ. In most of these studies, both techniques are used separately, in the sense that the spectra are evaluated independently and single conclusions are obtained, considering both results. This paper presents a data fusion procedure for Raman and XRF data for the characterization of pigments used in porcelain cards. For the classification of the analyzed points of the porcelain cards principal component analysis (PCA) was used. A first attempt was made to develop a new procedure for the identification of the pigments using a database containing the fused Raman-XRF data of 24 reference pigments. The results show that the classification based on the fused Raman-XRF data is significantly better than the classifications based on the Raman data or the XRF data separately. © 2011 Society for Applied Spectroscopy.

Background In-hospital management of COPD exacerbation is suboptimal, and outcomes are poor. Care pathways are a possible strategy for optimizing care processes and outcomes. Objectives The aim of the literature review was to explore characteristics of existing care pathways for in-hospital management of COPD exacerbations and to address their impact on performance of care processes, clinical outcomes, and team functioning. Methods A literature search was conducted for articles published between 1990 and 2010 in the electronic databases of Medline, CINAHL, EMBASE, and Cochrane Library. Main inclusion criteria were (I) patients hospitalized for a COPD exacerbation; (II) implementation and evaluation of a care pathway; (III) report of original research, including experimental and quasi experimental designs, variance analysis, and interviews of professionals and patients about their perception on pathway effectiveness. Results Four studies with a quasi experimental design were included. Three studies used a pre–post test design; the fourth study was a non randomized controlled trial comparing an experimental group where patients were treated according to a care pathway with a control group where usual care was provided. The four studied care pathways were multidisciplinary structured care plans, outlining time-specific clinical interventions and responsibilities by discipline. Statistic analyses were rarely performed, and the trials used very divergent indicators to evaluate the impact of the care pathways. The studies described positive effects on blood sampling, daily weight measurement, arterial blood gas measurement, referral to rehabilitation, feelings of anxiety, length of stay, readmission, and in-hospital mortality. Conclusions Research on COPD care pathways is very limited. The studies described few positive effects of the care pathways on diagnostic processes and on clinical outcomes. Though due to limited statistical analysis and weak design of the studies, the internal validity of results is limited. Therefore, based on these studies the impact of care pathways on COPD exacerbation is inconclusive. These findings indicate the need for properly designed research like a cluster randomized controlled trial to evaluate the impact of COPD care pathways on performance of care processes, clinical outcomes, and teamwork.

BACKGROUND: Hospital treatment of chronic obstructive pulmonary disease (COPD) frequently does not follow published evidences. This lack of adherence can contribute to the high morbidity, mortality and readmissions rates. The European Quality of Care Pathway (EQCP) study on acute exacerbations of COPD (NTC00962468) is undertaken to determine how care pathways (CP) as complex intervention for hospital treatment of COPD affects care variability, adherence to evidence based key interventions and clinical outcomes. METHODS: An international cluster Randomized Controlled Trial (cRCT) will be performed in Belgium, Italy, Ireland and Portugal. Based on the power analysis, a sample of 40 hospital teams and 398 patients will be included in the study. In the control arm of the study, usual care will be provided. The experimental teams will implement a CP as complex intervention which will include three active components: a formative evaluation of the quality and organization of care, a set of evidence based key interventions, and support on the development and implementation of the CP. The main outcome will be six-month readmission rate. As a secondary endpoint a set of clinical outcome and performance indicators (including care process evaluation and team functioning indicators) will be measured in both groups. DISCUSSION: The EQCP study is the first international cRCT on care pathways. The design of the EQCP project is both a research study and a quality improvement project and will include a realistic evaluation framework including process analysis to further understand why and when CP can really work. TRIAL REGISTRATION NUMBER: NCT00962468. ispartof: Trials vol:11 issue:11 ispartof: location:England status: published

International audience; Variability has proved to be a central concept in different engineering domains to develop solutions that can be easily adapted to different organizational settings and different sets of customers at a low price. The MAP formalism has a high level of variability as it is expressed in an intentional manner through goals and strategies. However, a high level of variability means a high number of variation points. A process customization is then required to offer a better guidance. The Product lines have appeared with this management of variability and customization. Furthermore, we propose the Process line concept to represent the processes that may be customized to a given project. Our goal is to enhance the Map guidance by specifying the MIG (Map Indicator-based Guidance) approach. We suggest several guidance approaches based on an indicators' typology. We illustrate our proposal with an example from the requirement engineering field.