Pedro Pereira Rodrigues

Abstract
Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation - which included the drum-buffer-rope scheduling and buffer management - and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense.

Abstract
PurposeTo develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns.MethodsParticipants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.ResultsParents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups.ConclusionsThe PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.

Abstract
Missing data is an issue that can negatively impact any task performed with the available data and it is often found in real -world domains such as healthcare. One of the most common strategies to address this issue is to perform imputation, where the missing values are replaced by estimates. Several approaches based on statistics and machine learning techniques have been proposed for this purpose, including deep learning architectures such as generative adversarial networks and autoencoders. In this work, we propose a novel siamese neural network suitable for missing data imputation, which we call Siamese Autoencoder-based Approach for Imputation (SAEI). Besides having a deep autoencoder architecture, SAEI also has a custom loss function and triplet mining strategy that are tailored for the missing data issue. The proposed SAEI approach is compared to seven state-of-the-art imputation methods in an experimental setup that comprises 14 heterogeneous datasets of the healthcare domain injected with Missing Not At Random values at a rate between 10% and 60%. The results show that SAEI significantly outperforms all the remaining imputation methods for all experimented settings, achieving an average improvement of 35%. This work is an extension of the article Siamese Autoencoder-Based Approach for Missing Data Imputation [1] presented at the International Conference on Computational Science 2023. It includes new experiments focused on runtime, generalization capabilities, and the impact of the imputation in classification tasks, where the results show that SAEI is the imputation method that induces the best classification results, improving the F1 scores for 50% of the used datasets.

Abstract
Experimental assessment of different missing data imputation methods often compute error rates between the original values and the estimated ones. This experimental setup relies on complete datasets that are injected with missing values. The injection process is straightforward for the Missing Completely At Random and Missing At Random mechanisms; however, the Missing Not At Random mechanism poses a major challenge, since the available artificial generation strategies are limited. Furthermore, the studies focused on this latter mechanism tend to disregard a comprehensive baseline of state-of-the-art imputation methods. In this work, both challenges are addressed: four new Missing Not At Random generation strategies are introduced and a benchmark study is conducted to compare six imputation methods in an experimental setup that covers 10 datasets and five missingness levels (10% to 80%). The overall findings are that, for most missing rates and datasets, the best imputation method to deal with Missing Not At Random values is the Multiple Imputation by Chained Equations, whereas for higher missingness rates autoencoders show promising results.

Abstract
Introduction and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep condition which is very heterogeneous although not formally characterized as such, resulting in missed or delayed diagnosis. Cluster analysis has been used in different clinical domains, particularly within sleep disorders. We aim to understand OSA heterogeneity and provide a variety of cluster visualizations to communicate the information clearly and efficiently.Materials and Methods: We applied an extension of k-means to be used in categorical variables: k -modes, to identify OSA patients' groups, based on demographic, physical examination, clinical his-tory, and comorbidities characterization variables (n = 40) obtained from a derivation and validation cohorts (211 and 53, respectively) from the northern region of Portugal. Missing values were imputed with k-nearest neighbours (k-NN) and a chi-square test was held for feature selection.Results: Thirteen variables were inserted in phenotypes, resulting in the following three clus-ters: Cluster 1, middle-aged males reporting witnessed apneas and high alcohol consumption before sleep; Cluster 2, middle-aged women with increased neck circumference (NC), non -repairing sleep and morning headaches; and Cluster 3, obese elderly males with increased NC, witnessed apneas and alcohol consumption. Patients from the validation cohort assigned to dif-ferent clusters showed similar proportions when compared with the derivation cohort, for mild (C1: 56 vs 75%, P = 0.230; C2: 61 vs 75%, P = 0.128; C3: 45 vs 48%, P = 0.831), moderate (C1: 24 vs 25%; C2: 20 vs 25%; C3: 25 vs 19%) and severe (C1: 20 vs 0%; C2: 18 vs 0%; C3: 29 vs 33%) levels. Therefore, the allocation supported the validation of the obtained clusters.Conclusions: Our findings suggest different OSA patients' groups, creating the need to rethink these patients' stereotypical baseline characteristics.(c) 2021 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).