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Future Trends
in DSS
27/04/2015 1Dr. Bashir/CPHHI/UH/2015
Learning Objectives
• Explain Versions of DSS
• Explore Expectations from DSS
• Understand Classification of data
• Recognize Training
• Explain Interface of tools
• Understand Group DSS
• Explore Decision Support Centre
• Explain Strategic DSS
• Understand Intelligent DSS
• Explain Future of DSS
27/04/2015 2Dr. Bashir/CPHHI/UH/2014
Versions of DSS
• Many Of The Popular DSS Tools That Was The Big Hit
Around Year 2000 Has Been Transformed Into Full Business
Intelligence Tools Where You Can Get A Broad Overview
Over All Your Live Data And Easily Make Those Tough
Decisions Based On The Facts And Data Instead Of
Guesses.
• The New Versions Of Decision Support Systems Makes It
Even Easier For You To Make The Right Choices, They
Prevent The Data In A Much Better Way Than Earlier, The
Data Is More Accurate And They Are Able To Pull The Data
From Additional Sources.
27/04/2015 3Dr. Bashir/CPHHI/UH/2014
Expectation from DSS
• But What Can We Expect In 10 Or 15 Years From
These DSS Tools? In The Next 1-2 Years We Will Be
Seeing A Large Increase In Apps For Tables Like The
Apple Ipad And Similar Devices.
• There Are Already A Few Of Those On The Market
But The Quality Isn’t That Good Yet And There Are
Still A Lot Of Room For Improvements.
• We Will See DSS Tools That Can Pull Data From An
Even Wider Range Of Sources As More And More
Data Gets Stored And Filed In The Systems.
27/04/2015 4Dr. Bashir/CPHHI/UH/2014
Classification of Data
• We Integrate The Various Sources More,
There Is Much More Classification Of Data
Too. This Will Help The Decision Support
System To Make An Even Better Overview
And Help You Make Some More Accurate
Decisions And Making These Types Of
Business Intelligence Software Systems
Even More Valuable Than Today.
27/04/2015 5Dr. Bashir/CPHHI/UH/2014
Training
• Right Now Many Of The Systems Require A Lot
Of Training To Use Properly, That Part Is Also
Something We Can Expect To See Improved In
The Near Future So That Even People Will
Almost No Training Will Be Able To Get The
Right Data From The Various Systems And Be
Able To Use Types Kind Of DSS Programs
Easily.
27/04/2015 6Dr. Bashir/CPHHI/UH/2014
Interface Of Tools
• The Interface Is Like To Change Quite A Bit And
Most Of The Tools Will Very Likely Change To Be
Used Mainly On Tablets Instead Of Regular
Computers.
• This Also Means That They Will Need To Either
Pre Process The Data On A More Powerful
Computer First Or Make Optimizations To The
DSS Tools So That They Can Much Easier Process
The Data Without Having To Use Some Heavy
CPU And Ram Power In Order To Do So.
27/04/2015 7Dr. Bashir/CPHHI/UH/2014
Group DSS
• Group Decision Making Plays A Major Role
In Determining Corporate Affairs .
• How To Design The Group DSSs For
Supporting Group Meetings Is A Complex
Task Because Of The
– Complex Combination Of People, Places
– Time , Communication Networks
–Individual Preferences, And Other Technologies.
27/04/2015 8Dr. Bashir/CPHHI/UH/2014
• A Group Meeting Can Be Conducted At The
Same Place, Or At Different Places Attended By
Different Groups Of People Using
Teleconferencing Techniques.
• On The Other Hand, A Group Meeting Can Be
Conducted During A Fixed
Period Of Time, Or It Is Just An Unlimited On-
going Process.
• Group DSS Is Supposed To Support Any One Of
The Possible Combinations.
Group DSS
27/04/2015 9Dr. Bashir/CPHHI/UH/2014
Decision Support Centre
• Decision Support Centre Is An Emerging
Concept.
• A Decision Support Group Is Staffed By
Information Systems Professionals Who
Understand The Business
Environment, Form The Core Of Decision
Support Centre, With Advanced
Information Technology.
27/04/2015 10Dr. Bashir/CPHHI/UH/2014
• A Decision Support Centre Is Usually
Located In Close Proximity To Top
Management So That Instant Decision
Support Can Be Provided.
• A Decision Support Group Will Readily
Develop Or Modify DSSs To Support Top
Management In Making
Urgent And Important Decisions.
Decision Support Centre
27/04/2015 11Dr. Bashir/CPHHI/UH/2014
Strategic DSS
•DSS For Supporting Strategic
Management Is A Well Recognized Area
Of Importance And Significance .
•It Is An Area Where DSS Can Make A
Substantial
Impact On The Top Management And
Corporation.
27/04/2015 12Dr. Bashir/CPHHI/UH/2014
Intelligent DSS
•Some Authors, Notably Nolan (1986),Suggested
The Adaptation Of Artificial Intelligence (AI)
and Expert Systems Techniques To DSS.
•However, Most Authors Under-estimate The
Difficulties In Representing Commonsense
Knowledge Which Is An Unsolved Problem In
AI.
27/04/2015 13Dr. Bashir/CPHHI/UH/2014
The DSS of the Future
• Intelligent DSS Should Be More Practical.
• Future DSS Should Be Creative.
• Latest Advances In Computer Technology
Improving DSS.
27/04/2015 14Dr. Bashir/CPHHI/UH/2014
• Larger Role For
– Management Science
–Cognitive Psychology
–Behavioral Theory
–Information Economics
–Computer Science
–And Political Science
The DSS Of The Future
27/04/2015 15Dr. Bashir/CPHHI/UH/2014
• Improved DSS Apply To More
Unstructured Problems.
• Must Be Able To Create Alternatives
Independently.
• Much Longer-range Perspective Of DSS
Research.
The DSS Of The Future
27/04/2015 16Dr. Bashir/CPHHI/UH/2014
The DSS of the Future
• Research On Interactions Between Individuals
And Groups.
• More Examination Of The Human Component
Of DSS: Learning And Empowerment.
• Enhancement Of DSS Applications With Values
And Ethics.
The DSS Of The Future
27/04/2015 17Dr. Bashir/CPHHI/UH/2014
The DSS of the Future
• Major Research In Human-machine
Interfaces And Their Impacts On
Creativity And Learning.
• Organizational Impacts Of DSS.
• Decision Support System Products Are
Incorporating Artificial Intelligence:
Intelligent DSS.
The DSS Of The Future
27/04/2015 18Dr. Bashir/CPHHI/UH/2014
The DSS of the Future
• Focused Versions Of DSS Toward Specific Sets
Of Users Or Applications.
• Continued Development Of User-friendly
Capabilities.
• The DSS Software Market Continues To
Develop And Mature.
The DSS Of The Future
27/04/2015 19Dr. Bashir/CPHHI/UH/2014
20
Virtual Reality
• Virtual Reality System: Enables One Or More
Users To Move And React In A Computer-
simulated Environment
• Immersive Virtual Reality: User Becomes Fully
Immersed In An Artificial, Three-dimensional
World That Is Completely Generated By A
Computer
27/04/2015 Dr. Bashir/CPHHI/UH/2014
21
Interface Devices
• Head-Mounted Display (HMD)
• CAVE (Computer Assisted Virtual Environment )
– Projects Stereo Images On Walls And Floor Of A
Room-sized Cube
• Earphones
• Haptic (Touch) Interface
– Relays Sense Of Touch And Other Sensations In A
Virtual World
– Most Challenging To Create
27/04/2015 Dr. Bashir/CPHHI/UH/2014
The PowerWall is a virtual reality system that displays large models in
accurate dimensions.
22Dr. Bashir/CPHHI/UH/2014
Military personnel train in an immersive CAVE system.
23Dr. Bashir/CPHHI/UH/2014
Virtual Reality Applications
• Medicine
–Pain And Anxiety; Examinations And
Diagnoses; Physical Therapy
• Education And Training
–Virtual School Trips, Military Training
27/04/2015 24Dr. Bashir/CPHHI/UH/2014
What Developments
• Support for Patient Groups
• Telemedicine
– Outreach Monitoring – Lifeshirt and others
• Human Factors Design
– Alarms and Displays – Preventing Medical Error
27/04/2015 25Dr. Bashir/CPHHI/UH/2014
Telemedicine
• Synergistic On New Non-medical Technologies
– Land-based Telephone Technology
– Mobile Telephone Technology
– Blue Tooth,.........wireless...........etc.
• Takes Different Forms
– Remote ECG Analysis
– Remote Consultation
27/04/2015 26Dr. Bashir/CPHHI/UH/2014
What is Telemedicine
•Telemedicine May Be Defined As
The Use Of Computers And
Telecommunication Technologies
To Provide Medical Information
And Services From Distant Locations
27/04/2015 27Dr. Bashir/CPHHI/UH/2014
Different Types Of Services
 Telecardiology
 Teleradiology
 Telepathology
 Tele psychiatry
 Early Warning System
[ Prevention and control of endemic and infectious diseases ]
27/04/2015 28Dr. Bashir/CPHHI/UH/2014
Requirement Specification
Nodal Hospital
Referral Hospital
• A Patient Getting Treated
• A Doctor
• A Remote Telemedicine Console Having Audio Visual
And Data Conferencing Facilities
• An Expert/ Specialized Doctor
• A Central Telemedicine Server Having
Audio Visual And Data Conferencing Facility
27/04/2015 29Dr. Bashir/CPHHI/UH/2014
Sequence Of Operation
PATIENT IN
Patient visits OPD
Local Doctor checks up
Patient receives local treatment
and not referred to telemedicine
system
Patient referred to the Telemedicine system (some special
investigations may be suggested)
Patient visits Telemedicine data-entry console.
Operator entries patient record, data and images of test
results, appointment date is fixed for online telemedicine
session
OUT
OUT
Offline Data transfer
from Nodal Centre
27/04/2015 30Dr. Bashir/CPHHI/UH/2014
Sequence of Operation
Patient 1
Patient 2
Patient 3
Patient 4
.
.
.
Online conference for the patient.
Patient, local doctors at the nodal
hospital and specialist doctors at the
referral hospital
Patient Queue
IN OUT
27/04/2015 31Dr. Bashir/CPHHI/UH/2014
Hardware Configuration
Digital camera
Referral Hospital
Nodal Hospital
PSTN/ISDN/VSAT link
Scanner
PrinterModem
Modem
Microscope and other
medical instruments
Video Conference
Video Conference
Telephone
Telephone
27/04/2015 32Dr. Bashir/CPHHI/UH/2014
Software Modules
Offline Activities
Online Activities
27/04/2015 33Dr. Bashir/CPHHI/UH/2014
The Data
• Data Related To A Patient’s Personal
Information
• Data Related To A Patients Medical Information
• Data For Patient Management In Telemedicine
• Data Related To The Doctors
• Data For System Management
27/04/2015 34Dr. Bashir/CPHHI/UH/2014
Other Issues
•Incorporation of Standard.
•Health Level Seven (HL7)
•Digital Imaging Communication in Medicine
(DICOM)
•Data Security.
•Legal & Ethical Issue
27/04/2015 35Dr. Bashir/CPHHI/UH/2014
More Radical Approach
• Lifeshirt
– Set of sensors in a jacket
– Recorded on a PDA
– Analysed by software
remotely or at home
– Remote monitoring possible
– GPS
27/04/2015 47Dr. Bashir/CPHHI/UH/2014
Lifeshirt requires
• Online/automatic data interpretation
– Data-mining and machine learning
• Easy to use sensors
• Social framework of response
27/04/2015 48Dr. Bashir/CPHHI/UH/2014
Human Error
Cause of Critical Incident %
Human Factors Error 65.9
Fixation Error 20.5
Unknown Cause 10.6
Equipment Failure 3.0
Type of error %
Failure to check 43.9
Inexperience 41.0
Inattention 32.7
Fixation 20.5
Haste 25.8
Distraction 14.0
Fatigue 10.8
Not following procedure 6.1
27/04/2015 49Dr. Bashir/CPHHI/UH/2014
Lessons to be drawn
• Informatics solutions that are not ecological
will create more error
• Solutions that create more error will destroy
clinical confidence in informatics
• Solutions that destroy confidence in
informatics will not be used
27/04/2015 50Dr. Bashir/CPHHI/UH/2014
Conclusions
• Health Informatics will be very important in the
future
– Very varied
– Depend on Social underpinning
– Has to be appropriate not flash
27/04/2015 51Dr. Bashir/CPHHI/UH/2014
Conclusions
Our imagination is the only limit to what we can hope
to have in the future.
Charles F. Kettering
I have seen the future and it doesn't work.
Robert Fulford
27/04/2015 52Dr. Bashir/CPHHI/UH/2014
• Any Questions?
27/04/2015 53Dr. Bashir/CPHHI/UH/2014

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Ch.10 dss future

  • 1. Future Trends in DSS 27/04/2015 1Dr. Bashir/CPHHI/UH/2015
  • 2. Learning Objectives • Explain Versions of DSS • Explore Expectations from DSS • Understand Classification of data • Recognize Training • Explain Interface of tools • Understand Group DSS • Explore Decision Support Centre • Explain Strategic DSS • Understand Intelligent DSS • Explain Future of DSS 27/04/2015 2Dr. Bashir/CPHHI/UH/2014
  • 3. Versions of DSS • Many Of The Popular DSS Tools That Was The Big Hit Around Year 2000 Has Been Transformed Into Full Business Intelligence Tools Where You Can Get A Broad Overview Over All Your Live Data And Easily Make Those Tough Decisions Based On The Facts And Data Instead Of Guesses. • The New Versions Of Decision Support Systems Makes It Even Easier For You To Make The Right Choices, They Prevent The Data In A Much Better Way Than Earlier, The Data Is More Accurate And They Are Able To Pull The Data From Additional Sources. 27/04/2015 3Dr. Bashir/CPHHI/UH/2014
  • 4. Expectation from DSS • But What Can We Expect In 10 Or 15 Years From These DSS Tools? In The Next 1-2 Years We Will Be Seeing A Large Increase In Apps For Tables Like The Apple Ipad And Similar Devices. • There Are Already A Few Of Those On The Market But The Quality Isn’t That Good Yet And There Are Still A Lot Of Room For Improvements. • We Will See DSS Tools That Can Pull Data From An Even Wider Range Of Sources As More And More Data Gets Stored And Filed In The Systems. 27/04/2015 4Dr. Bashir/CPHHI/UH/2014
  • 5. Classification of Data • We Integrate The Various Sources More, There Is Much More Classification Of Data Too. This Will Help The Decision Support System To Make An Even Better Overview And Help You Make Some More Accurate Decisions And Making These Types Of Business Intelligence Software Systems Even More Valuable Than Today. 27/04/2015 5Dr. Bashir/CPHHI/UH/2014
  • 6. Training • Right Now Many Of The Systems Require A Lot Of Training To Use Properly, That Part Is Also Something We Can Expect To See Improved In The Near Future So That Even People Will Almost No Training Will Be Able To Get The Right Data From The Various Systems And Be Able To Use Types Kind Of DSS Programs Easily. 27/04/2015 6Dr. Bashir/CPHHI/UH/2014
  • 7. Interface Of Tools • The Interface Is Like To Change Quite A Bit And Most Of The Tools Will Very Likely Change To Be Used Mainly On Tablets Instead Of Regular Computers. • This Also Means That They Will Need To Either Pre Process The Data On A More Powerful Computer First Or Make Optimizations To The DSS Tools So That They Can Much Easier Process The Data Without Having To Use Some Heavy CPU And Ram Power In Order To Do So. 27/04/2015 7Dr. Bashir/CPHHI/UH/2014
  • 8. Group DSS • Group Decision Making Plays A Major Role In Determining Corporate Affairs . • How To Design The Group DSSs For Supporting Group Meetings Is A Complex Task Because Of The – Complex Combination Of People, Places – Time , Communication Networks –Individual Preferences, And Other Technologies. 27/04/2015 8Dr. Bashir/CPHHI/UH/2014
  • 9. • A Group Meeting Can Be Conducted At The Same Place, Or At Different Places Attended By Different Groups Of People Using Teleconferencing Techniques. • On The Other Hand, A Group Meeting Can Be Conducted During A Fixed Period Of Time, Or It Is Just An Unlimited On- going Process. • Group DSS Is Supposed To Support Any One Of The Possible Combinations. Group DSS 27/04/2015 9Dr. Bashir/CPHHI/UH/2014
  • 10. Decision Support Centre • Decision Support Centre Is An Emerging Concept. • A Decision Support Group Is Staffed By Information Systems Professionals Who Understand The Business Environment, Form The Core Of Decision Support Centre, With Advanced Information Technology. 27/04/2015 10Dr. Bashir/CPHHI/UH/2014
  • 11. • A Decision Support Centre Is Usually Located In Close Proximity To Top Management So That Instant Decision Support Can Be Provided. • A Decision Support Group Will Readily Develop Or Modify DSSs To Support Top Management In Making Urgent And Important Decisions. Decision Support Centre 27/04/2015 11Dr. Bashir/CPHHI/UH/2014
  • 12. Strategic DSS •DSS For Supporting Strategic Management Is A Well Recognized Area Of Importance And Significance . •It Is An Area Where DSS Can Make A Substantial Impact On The Top Management And Corporation. 27/04/2015 12Dr. Bashir/CPHHI/UH/2014
  • 13. Intelligent DSS •Some Authors, Notably Nolan (1986),Suggested The Adaptation Of Artificial Intelligence (AI) and Expert Systems Techniques To DSS. •However, Most Authors Under-estimate The Difficulties In Representing Commonsense Knowledge Which Is An Unsolved Problem In AI. 27/04/2015 13Dr. Bashir/CPHHI/UH/2014
  • 14. The DSS of the Future • Intelligent DSS Should Be More Practical. • Future DSS Should Be Creative. • Latest Advances In Computer Technology Improving DSS. 27/04/2015 14Dr. Bashir/CPHHI/UH/2014
  • 15. • Larger Role For – Management Science –Cognitive Psychology –Behavioral Theory –Information Economics –Computer Science –And Political Science The DSS Of The Future 27/04/2015 15Dr. Bashir/CPHHI/UH/2014
  • 16. • Improved DSS Apply To More Unstructured Problems. • Must Be Able To Create Alternatives Independently. • Much Longer-range Perspective Of DSS Research. The DSS Of The Future 27/04/2015 16Dr. Bashir/CPHHI/UH/2014
  • 17. The DSS of the Future • Research On Interactions Between Individuals And Groups. • More Examination Of The Human Component Of DSS: Learning And Empowerment. • Enhancement Of DSS Applications With Values And Ethics. The DSS Of The Future 27/04/2015 17Dr. Bashir/CPHHI/UH/2014
  • 18. The DSS of the Future • Major Research In Human-machine Interfaces And Their Impacts On Creativity And Learning. • Organizational Impacts Of DSS. • Decision Support System Products Are Incorporating Artificial Intelligence: Intelligent DSS. The DSS Of The Future 27/04/2015 18Dr. Bashir/CPHHI/UH/2014
  • 19. The DSS of the Future • Focused Versions Of DSS Toward Specific Sets Of Users Or Applications. • Continued Development Of User-friendly Capabilities. • The DSS Software Market Continues To Develop And Mature. The DSS Of The Future 27/04/2015 19Dr. Bashir/CPHHI/UH/2014
  • 20. 20 Virtual Reality • Virtual Reality System: Enables One Or More Users To Move And React In A Computer- simulated Environment • Immersive Virtual Reality: User Becomes Fully Immersed In An Artificial, Three-dimensional World That Is Completely Generated By A Computer 27/04/2015 Dr. Bashir/CPHHI/UH/2014
  • 21. 21 Interface Devices • Head-Mounted Display (HMD) • CAVE (Computer Assisted Virtual Environment ) – Projects Stereo Images On Walls And Floor Of A Room-sized Cube • Earphones • Haptic (Touch) Interface – Relays Sense Of Touch And Other Sensations In A Virtual World – Most Challenging To Create 27/04/2015 Dr. Bashir/CPHHI/UH/2014
  • 22. The PowerWall is a virtual reality system that displays large models in accurate dimensions. 22Dr. Bashir/CPHHI/UH/2014
  • 23. Military personnel train in an immersive CAVE system. 23Dr. Bashir/CPHHI/UH/2014
  • 24. Virtual Reality Applications • Medicine –Pain And Anxiety; Examinations And Diagnoses; Physical Therapy • Education And Training –Virtual School Trips, Military Training 27/04/2015 24Dr. Bashir/CPHHI/UH/2014
  • 25. What Developments • Support for Patient Groups • Telemedicine – Outreach Monitoring – Lifeshirt and others • Human Factors Design – Alarms and Displays – Preventing Medical Error 27/04/2015 25Dr. Bashir/CPHHI/UH/2014
  • 26. Telemedicine • Synergistic On New Non-medical Technologies – Land-based Telephone Technology – Mobile Telephone Technology – Blue Tooth,.........wireless...........etc. • Takes Different Forms – Remote ECG Analysis – Remote Consultation 27/04/2015 26Dr. Bashir/CPHHI/UH/2014
  • 27. What is Telemedicine •Telemedicine May Be Defined As The Use Of Computers And Telecommunication Technologies To Provide Medical Information And Services From Distant Locations 27/04/2015 27Dr. Bashir/CPHHI/UH/2014
  • 28. Different Types Of Services  Telecardiology  Teleradiology  Telepathology  Tele psychiatry  Early Warning System [ Prevention and control of endemic and infectious diseases ] 27/04/2015 28Dr. Bashir/CPHHI/UH/2014
  • 29. Requirement Specification Nodal Hospital Referral Hospital • A Patient Getting Treated • A Doctor • A Remote Telemedicine Console Having Audio Visual And Data Conferencing Facilities • An Expert/ Specialized Doctor • A Central Telemedicine Server Having Audio Visual And Data Conferencing Facility 27/04/2015 29Dr. Bashir/CPHHI/UH/2014
  • 30. Sequence Of Operation PATIENT IN Patient visits OPD Local Doctor checks up Patient receives local treatment and not referred to telemedicine system Patient referred to the Telemedicine system (some special investigations may be suggested) Patient visits Telemedicine data-entry console. Operator entries patient record, data and images of test results, appointment date is fixed for online telemedicine session OUT OUT Offline Data transfer from Nodal Centre 27/04/2015 30Dr. Bashir/CPHHI/UH/2014
  • 31. Sequence of Operation Patient 1 Patient 2 Patient 3 Patient 4 . . . Online conference for the patient. Patient, local doctors at the nodal hospital and specialist doctors at the referral hospital Patient Queue IN OUT 27/04/2015 31Dr. Bashir/CPHHI/UH/2014
  • 32. Hardware Configuration Digital camera Referral Hospital Nodal Hospital PSTN/ISDN/VSAT link Scanner PrinterModem Modem Microscope and other medical instruments Video Conference Video Conference Telephone Telephone 27/04/2015 32Dr. Bashir/CPHHI/UH/2014
  • 33. Software Modules Offline Activities Online Activities 27/04/2015 33Dr. Bashir/CPHHI/UH/2014
  • 34. The Data • Data Related To A Patient’s Personal Information • Data Related To A Patients Medical Information • Data For Patient Management In Telemedicine • Data Related To The Doctors • Data For System Management 27/04/2015 34Dr. Bashir/CPHHI/UH/2014
  • 35. Other Issues •Incorporation of Standard. •Health Level Seven (HL7) •Digital Imaging Communication in Medicine (DICOM) •Data Security. •Legal & Ethical Issue 27/04/2015 35Dr. Bashir/CPHHI/UH/2014
  • 36. More Radical Approach • Lifeshirt – Set of sensors in a jacket – Recorded on a PDA – Analysed by software remotely or at home – Remote monitoring possible – GPS 27/04/2015 47Dr. Bashir/CPHHI/UH/2014
  • 37. Lifeshirt requires • Online/automatic data interpretation – Data-mining and machine learning • Easy to use sensors • Social framework of response 27/04/2015 48Dr. Bashir/CPHHI/UH/2014
  • 38. Human Error Cause of Critical Incident % Human Factors Error 65.9 Fixation Error 20.5 Unknown Cause 10.6 Equipment Failure 3.0 Type of error % Failure to check 43.9 Inexperience 41.0 Inattention 32.7 Fixation 20.5 Haste 25.8 Distraction 14.0 Fatigue 10.8 Not following procedure 6.1 27/04/2015 49Dr. Bashir/CPHHI/UH/2014
  • 39. Lessons to be drawn • Informatics solutions that are not ecological will create more error • Solutions that create more error will destroy clinical confidence in informatics • Solutions that destroy confidence in informatics will not be used 27/04/2015 50Dr. Bashir/CPHHI/UH/2014
  • 40. Conclusions • Health Informatics will be very important in the future – Very varied – Depend on Social underpinning – Has to be appropriate not flash 27/04/2015 51Dr. Bashir/CPHHI/UH/2014
  • 41. Conclusions Our imagination is the only limit to what we can hope to have in the future. Charles F. Kettering I have seen the future and it doesn't work. Robert Fulford 27/04/2015 52Dr. Bashir/CPHHI/UH/2014
  • 42. • Any Questions? 27/04/2015 53Dr. Bashir/CPHHI/UH/2014