Fabrizio L. Ricci

Mefisto: a functional model for statistical entities

There have been numerous proposals aimed at correcting the deficiency in existing database models in order to manipulate statistical data. The manipulation of these data, such as statistical tables that are widely used in many statistical database application areas, is examined. A functional model Mefisto, which is based on a data structure called statistical entity and on a set of operations capable of manipulating this data structure, is proposed. The characteristics that an aggregate data model has are discussed and a brief survey of the main proposals in literature is made. The operators that allow statistical entities to be manipulated both from the descriptive and from the summary data point of view are discussed, and some examples are given. Each operator can be seen as a family of operators, and each is able to automatically compute the summary values of the statistical entity obtained by its application. A brief discussion regarding the limitations of the relational model for this type of data and a comparison with other proposals are presented. The advantages of the Mefisto model over those proposals are illustrated. It is shown that it is possible to define user friendly query languages based on the Mefisto model. >

Steps towards a digital health ecosystem

In the paper an IT infrastructure for supporting the shift from organization-centric to patient-centric model of healthcare service delivery to facilitate collaborative, multidisciplinary and cross-organizational healthcare delivery processes is presented. The core of this infrastructure is an internet platform that provides e-services and promotes the interoperability by enabling not only inter-communication among authorized healthcare professionals, but also sharing the Virtual Healthcare Record, an authoritative, multi-dimensional view on the patient health state. The platform is implemented in the LuMiR project for Basilicata, an Italian region where integration of healthcare applications is required. The LUMIR approach, its origin and peculiarities are briefly presented. The projects final target is the regional health digital ecosystem that interacts with the healthcare system for better supporting it. The agent-oriented paradigm emerges as a promising approach to map the autonomic healthcare systems and their users in virtual entities, and to add values such as flexibility, adaptability, and reusability. over traditional object- or service-oriented approaches.

A functional model for macro-databases

Recently there have been numerous proposals aimed at correcting the deficiency in existing database models to manipulate macro data (such as summary tables). The authors propose a new functional model, Mefisto, based on the definition of a new data structure, the “statistical entity”, and on a set of operations capable of manipulating this data structure by operating at metadata level.

Interpretation of statistical queries to relational databases

A research in progress concerning the problem of extending the logical independence approach to statistical query answering is described. The main ideas and limitations of a system which assists a user in obtaining a statistical table from a relational database by describing only elements that compose the table are discussed. The proposed system assists the user in formulating statistical queries by means of a universal relation interface, i.e., independently from the underlying database structure. To generate the result, an extended relational algebra is needed to process aggregations in queries function; heuristics for the interpretation of queries and their translation in terms of database primitives are the basis of the proposed approach.

On the Assessment of Medical Expert Systems

In this report we examine some paradigms for a comprehensive evaluation of an Expert System in the health field. This methodology is considered here as an intellectual tool to improve the performance of health professionals in tackling defined health problems. In this respect, the known experiences about the assessment of the performance of Medical Expert Systems’ seem rather narrow in their aims. Therefore, different contexts for the evaluation are proposed, in respect to a range of criteria that show growing width and subjectivity. Four levels are described: i) raw efficiency of the system in itself; ii) effectiveness in the user’s environment; iii) long term effects on the user’s behaviour; iv) effectiveness on the health problem. We propose a cooperative effort to drive and support the evaluations: to establish detailed guidelines, to give rise to a collection of reviews about each system and to mantain a register of applications.

Toward a Model of Clinical Trials

In the paper some results of the modelling of the clinical trial (CT) process are presented. CT research is a complex process which includes the protocol editing, its use and implementation in the CT experimentation, and the evaluation of the results. To improve the medical research, it is necessary to consider the CT research process as a whole. We structured the CT research process in three subprocesses: a) clinical trial management; b) management of statistical units; and c) patient health care delivery process. Each process has different objectives and is enacted in different environments, carried out by its own agents and resources, and influenced by specific rules characterising each process. The model is supported by three perspectives on the CT process: functional, structural, and behavioural views.

An object-oriented model for a multimedia patient folder management system

The management of information related to clinical activities is a complex task. In fact, patient related information reported in patient folders comes from heterogeneous sources and may be rendered by means of different modalities. Data can originate from direct observations made by physicians like in the case of objective examination. In other cases physiologic phenomena are captured by means of the involved electrical activity (like in the case of heart or brain activity), whereas anatomical structure details are obtained by means of radiologic techniques. In this paper we propose an object-oriented model of a multimedia patient folder. This model has an adequate flexibility for adapting the most different clinical environment. It allows the physician to structure the information needed for his/her patient folder without employing a programming language. Finally we show some features of the CADMIO system, a tool for designing patient folder management systems, based on this model.

An Interface for the Direct Manipulation of Statistical Data

Abstract The aim of this paper is to propose the Vista visual language, which can be easily used by statistical users when they interact with a statistical database in order directly to manipulate data. This language uses a direct acyclic graph as an internal model (Grass) for the database scheme representation. The operators on the statistical data manipulate their descriptive elements, while the statistical processing is performed through statistical packages. This visual language permits querying in the database scheme and the selection of subschemas. Vista is integrated in the statistical database management system Adams (Aggregate Data Management System). This systems allows also an interaction through a keywords-based language. The main tasks performed by the Adams system are the graphical visualization of the database scheme, the direct manipulation and the expression of query commands.

A survey of telemedicine in Italy.

Italy has a tradition of experimental telemedicine which dates back to the early 1970s. However, despite promising experience, widespread diffusion of telemedicine services has not occurred. The Ministry of Research recognized the potential of telemedicine for improving the quality of health care and reducing costs, and has launched a national plan for financing research and training. The plan is expected to have a major impact on the organization of telemedicine research in Italy. In this paper we describe the current situation, outline the structure of the national plan, and survey various applications in different fields, such as teleconsulting, teleradiology and telemonitoring.

ADAMS: Aggregate data management system for epidemiologists and health-care managers

An effective health-care policy is supported by the availability of data in the form of statistical tables for epidemiologists and health-care managers. Creation, analysis and exploitation of these data strongly support the monitoring of trends in mortality and morbidity phenomena and the evaluation of offered health services. This might imply the transformation of statistical tables to more suitable formats. A successful management, manipulation and querying of a statistical table is a complex activity requiring a considerable knowledge of statistical problems. Computerised support can be precious in this task and this led to the development of several data management systems. In this paper we sketch out the features of ADAMS (Aggregate Data Management System), a system conceived to allow an easy interaction with statistical tables, reshaping and browsing of their descriptive part. ADAMS aims at simplifying the problem of extracting information from a statistical database and performing statistical table manipulation. The following functionalities are provided: definition of a statistical database at descriptive level; storage of data in the database; manipulation of data according to the summarisation and reclassification operators; browsing between data and their descriptive part. It also supports different manipulation styles according to different user profiles.