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Data	
  Detec'ves	
  
Enhancing	
  the	
  inves'ga've	
  process	
  with	
  visualiza'ons	
  
Hunter Whitney
San Francisco
November 13, 2013
Think	
  of	
  a	
  detec.ve	
  trying	
  to	
  solve	
  a	
  case	
  where	
  the	
  answer	
  
may	
  lie	
  hidden	
  within	
  stacks	
  of	
  evidence,	
  .me	
  is	
  limited,	
  
and	
  there	
  are	
  serious	
  consequences	
  for	
  any	
  errors.	
  
From	
  healthcare	
  workers	
  to	
  security	
  professionals,	
  this	
  same	
  
basic	
  scenario	
  applies	
  to	
  many	
  people	
  who	
  work	
  with	
  data.	
  
While	
  there’s	
  no	
  single	
  approach	
  to	
  finding	
  answers	
  in	
  an	
  array	
  of	
  
data,	
  UX	
  design	
  can	
  help	
  support	
  various	
  inves.ga.ve	
  processes.	
  
•  PuCng	
  the	
  pieces	
  together	
  
	
  
•  Weighing	
  the	
  evidence	
  
	
  
•  Evidence	
  handling	
  
	
  
•  Collabora.ng	
  
Data	
  as	
  evidence	
  
Pu8ng	
  the	
  Pieces	
  Together	
  
Users	
  oFen	
  have	
  to	
  work	
  with	
  evidence	
  that	
  is:	
  
	
  
•  Fragmentary,	
  mixed,	
  and	
  incomplete	
  
•  Delivered	
  in	
  an	
  asynchronous,	
  non-­‐sequen.al	
  manner	
  
Case	
  1:	
  	
  
Where	
  and	
  when	
  did	
  an	
  outbreak	
  of	
  a	
  foodborne	
  illness	
  
begin?	
  
Visual	
  Forensics	
  
Visually	
  connec'ng	
  data	
  about	
  'me,	
  place,	
  and	
  rela'onship	
  
Palan.r	
  Technologies,	
  Inc.	
  
Case	
  2:	
  	
  
Who	
  is	
  the	
  ringleader	
  of	
  a	
  recent	
  interna'onal	
  bank	
  
fraud	
  scheme?	
  
Visual	
  Forensics	
  
Visually	
  connec'ng	
  data	
  about	
  'me,	
  place,	
  and	
  rela'onship	
  
Palan.r	
  Technologies,	
  Inc.	
  
Case	
  3:	
  
Why	
  are	
  a	
  soldier’s	
  post-­‐trauma'c	
  symptoms	
  not	
  responding	
  
to	
  treatment?	
  
Visual	
  Forensics	
  
Visual	
  juxtaposi'on	
  of	
  different	
  kinds	
  of	
  data	
  
EEG	
  
MRI	
   MRI	
  (DTI)	
  
Electrical	
  ac.vity	
  data	
  
Anatomical	
  Features	
   Fiber	
  Tracts	
  (Connec.vity)	
  
Hunter	
  Whitney	
  and	
  Jeff	
  Chang,	
  MD	
   Please	
  see	
  hSp://vimeo.com/album/2489932	
  
Visual	
  juxtaposi'on	
  of	
  different	
  kinds	
  of	
  data	
  
EEG	
  
MRI	
   MRI	
  (DTI)	
  
Electrical	
  ac.vity	
  data	
  
Anatomical	
  Features	
   Fiber	
  Tracts	
  (Connec.vity)	
  
Hunter	
  Whitney	
  and	
  Jeff	
  Chang,	
  ER	
  Radiologist	
   Please	
  see	
  hSp://vimeo.com/album/2489932	
  
MRI +
DTI
DTI
Visual	
  transi'ons	
  of	
  different	
  kinds	
  of	
  data	
  
Hunter	
  Whitney	
  and	
  Jeff	
  Chang,	
  ER	
  Radiologist	
   Please	
  see	
  hSp://vimeo.com/album/2489932	
  
Weighing	
  the	
  evidence	
  
A	
  piece	
  of	
  evidence	
  does	
  not	
  exist	
  in	
  isola'on.	
  It	
  should	
  be	
  
considered	
  in	
  context	
  (but	
  the	
  context	
  can	
  rapidly	
  change):	
  
	
  
•  The	
  rela.ve	
  meaning	
  and	
  significance	
  of	
  any	
  piece	
  of	
  data	
  
may	
  change	
  as	
  other	
  available	
  informa.on	
  comes	
  in	
  
•  A	
  piece	
  of	
  evidence	
  may	
  be	
  true	
  but	
  irrelevant	
  or	
  
poten.ally	
  misleading	
  if	
  not	
  well	
  framed	
  	
  
Case	
  4:	
  	
  
What	
  is	
  causing	
  a	
  child’s	
  persistent	
  fever,	
  rash,	
  and	
  joint	
  pain?	
  
Visual	
  Forensics	
  
THE	
  CASE	
  
	
  
A	
  previously	
  healthy	
  12-­‐year-­‐old	
  boy	
  presents	
  to	
  an	
  emergency	
  department	
  in	
  southern	
  Ohio	
  in	
  October	
  with	
  a	
  chief	
  complaint	
  of	
  
fever	
  and	
  rash.	
  The	
  pa'ent	
  has	
  had	
  subjec've	
  fever	
  for	
  3	
  days	
  with	
  weakness,	
  malaise,	
  anorexia,	
  and	
  decreased	
  ac'vity.	
  He	
  had	
  
emesis	
  followed	
  by	
  diarrhea	
  on	
  the	
  second	
  day.	
  He	
  complains	
  of	
  diffuse	
  myalgias	
  and	
  migratory	
  arthralgias,	
  which	
  began	
  in	
  the	
  
right	
  shoulder	
  and	
  have	
  progressed	
  to	
  involve	
  the	
  cervical	
  spine	
  and	
  all	
  joints	
  of	
  the	
  extremi'es	
  bilaterally,	
  but	
  sparing	
  the	
  hips.	
  A	
  
rash	
  developed	
  bilaterally	
  on	
  his	
  inner	
  thighs	
  at	
  the	
  onset	
  of	
  illness,	
  then	
  spread	
  to	
  involve	
  his	
  forearms,	
  abdomen,	
  trunk,	
  and	
  
hands,	
  sequen'ally.	
  
	
  
In	
  the	
  ED,	
  his	
  temperature	
  is	
  37.3C,	
  blood	
  pressure	
  is	
  136/70	
  mmHg,	
  pulse	
  is	
  104	
  beats	
  per	
  minute,	
  and	
  respiratory	
  rate	
  is	
  24	
  breaths	
  
per	
  minute.	
  The	
  pa.ent's	
  past	
  medical	
  history	
  is	
  significant	
  only	
  for	
  aSen.on-­‐deficit	
  disorder	
  (ADD)	
  without	
  hyperac.vity,	
  and	
  his	
  
medica.ons	
  include	
  acetaminophen,	
  melatonin,	
  and	
  methylphenidate.	
  He	
  has	
  no	
  known	
  drug	
  allergies,	
  and	
  his	
  immuniza.ons	
  are	
  
current.	
  Physical	
  examina.on	
  reveals	
  erythematous	
  lesions	
  on	
  the	
  palate	
  and	
  pain	
  with	
  ac.ve	
  and	
  passive	
  range	
  of	
  mo.on	
  in	
  all	
  
extremi.es.	
  There	
  is	
  no	
  joint	
  swelling,	
  erythema,	
  or	
  warmth.	
  A	
  red	
  maculopapular	
  rash	
  with	
  scaSered	
  vesicular	
  lesions	
  is	
  present	
  on	
  
the	
  thighs,	
  forearms,	
  trunk,	
  and	
  palms.	
  A	
  rapid	
  group	
  A	
  streptococcal	
  an.gen	
  test	
  on	
  a	
  throat	
  swab	
  is	
  nega.ve.	
  The	
  pa.ent	
  is	
  Tanner	
  
stage	
  4	
  for	
  genital	
  development.	
  He	
  has	
  no	
  discharge	
  or	
  lesions.	
  The	
  pa.ent	
  is	
  prescribed	
  ibuprofen	
  and	
  discharged	
  from	
  the	
  ED	
  with	
  
a	
  diagnosis	
  of	
  hand,	
  foot,	
  and	
  mouth	
  disease.	
  
	
  
Worsening	
  symptoms	
  
The	
  pa.ent	
  returns	
  to	
  the	
  ED	
  2	
  days	
  later	
  with	
  persistent	
  fever,	
  worsening	
  arthralgia,	
  and	
  new	
  swelling	
  in	
  the	
  leF	
  knee.	
  He	
  is	
  unable	
  
to	
  ambulate	
  and	
  has	
  decreased	
  oral	
  intake.	
  Both	
  wrists	
  and	
  mul.ple	
  finger	
  joints	
  have	
  become	
  painful.	
  The	
  pain	
  is	
  greatest	
  in	
  the	
  
right	
  wrist	
  and	
  leF	
  knee.	
  Further	
  ques.oning	
  reveals	
  that	
  the	
  pa.ent	
  traveled	
  to	
  southern	
  Kentucky	
  about	
  4	
  weeks	
  ago	
  for	
  a	
  Labor	
  
Day	
  camping	
  trip	
  with	
  his	
  family.	
  He	
  recalls	
  having	
  found	
  .cks	
  on	
  his	
  clothing	
  but	
  not	
  on	
  his	
  skin.	
  He	
  denies	
  alcohol	
  or	
  drug	
  use.	
  The	
  
family	
  has	
  numerous	
  pets	
  including	
  1	
  hermit	
  crab,	
  1	
  African	
  clawed	
  frog,	
  2	
  lizards,	
  1	
  domes.c	
  white	
  rat,	
  1	
  python,	
  and	
  a	
  tank	
  of	
  
tropical	
  fish.	
  They	
  had	
  2	
  dogs,	
  but	
  both	
  recently	
  died	
  of	
  unknown	
  causes.	
  The	
  pa.ent	
  denies	
  any	
  animal	
  bites.	
  He	
  reports	
  that	
  he	
  has	
  
a	
  girlfriend,	
  but	
  he	
  denies	
  any	
  sexual	
  ac.vity.	
  His	
  temperature	
  is	
  38.9C,	
  blood	
  pressure	
  is	
  100/72	
  mmHg,	
  pulse	
  is	
  110	
  beats	
  per	
  
minute,	
  and	
  respiratory	
  rate	
  is	
  30	
  breaths	
  per	
  minute.	
  The	
  rash	
  has	
  progressed,	
  with	
  an	
  increased	
  number	
  of	
  well-­‐demarcated,	
  
macular,	
  papular,	
  and	
  vesicular	
  lesions	
  involving	
  the	
  extremi.es,	
  especially	
  the	
  palms	
  and	
  soles.	
  The	
  lesions	
  are	
  blanching	
  and	
  
nonpruri.c.	
  The	
  leF	
  knee	
  is	
  warm,	
  nonerythematous,	
  and	
  swollen	
  with	
  ballotable	
  fluid.	
  
Further	
  ques.oning	
  reveals	
  that	
  the	
  pa.ent	
  traveled	
  to	
  
southern	
  Kentucky	
  about	
  4	
  weeks	
  ago	
  for	
  a	
  Labor	
  Day	
  camping	
  
trip	
  with	
  his	
  family.	
  He	
  recalls	
  having	
  found	
  .cks	
  on	
  his	
  clothing	
  
but	
  not	
  on	
  his	
  skin.	
  	
  
	
  
He	
  denies	
  alcohol	
  or	
  drug	
  use.	
  He	
  reports	
  that	
  he	
  has	
  a	
  
girlfriend,	
  but	
  denies	
  any	
  sexual	
  ac.vity.	
  
	
  
The	
  family	
  has	
  numerous	
  pets	
  including	
  1	
  hermit	
  crab,	
  1	
  African	
  
clawed	
  frog,	
  2	
  lizards,	
  1	
  domes.c	
  white	
  rat,	
  1	
  python,	
  and	
  a	
  
tank	
  of	
  tropical	
  fish.	
  They	
  had	
  2	
  dogs,	
  but	
  both	
  recently	
  died	
  of	
  
unknown	
  causes.	
  The	
  pa.ent	
  denies	
  any	
  animal	
  bites.	
  	
  
Many	
  clues,	
  but	
  which	
  are	
  relevant?	
  
Accelera'ng	
  the	
  diagnos'c	
  process	
  with	
  visualiza'ons	
  
•  Sugges.ng	
  possibili.es	
  
	
  
•  Process	
  of	
  elimina.on	
  
	
  
•  Visual	
  emphasis	
  of	
  promising	
  direc.ons	
  
	
  	
  	
  
•  Dynamic	
  weigh.ng	
  
	
  
•  Transparency	
  of	
  the	
  process	
  
Differen'al	
  Diagnosis:	
  the	
  full	
  range	
  of	
  poten.al	
  causes,	
  
or	
  combina.ons	
  of	
  causes,	
  for	
  a	
  set	
  of	
  symptoms	
  
Reaves,	
  L;	
  Hamilton,	
  S;	
  Vossmeyer,	
  M;	
  and	
  Brady,	
  R.	
  Fever,	
  rash	
  and	
  
migratory	
  polyarthralgia.	
  Contemporary	
  Pediatrics.	
  Mar	
  2010;27(3):24-­‐38.	
  
Juvenile Idiopathic Arthritis
Postinfectious arthritis
Differen'al	
  Diagnosis	
  (Alternate	
  layout	
  1)	
  	
  
Henoch-Schönlein purpura 
Kawasaki disease
Infectious
Rheumatologic
Familial Mediterranean Fever 
Genetics
Septic arthritis
Lyme disease
Bacterial
Enteroviruses
Parvovirus
Viral
+5	
  	
  -­‐4	
  
-­‐6	
  
History and Physical
Labs
Radiology
Fever,	
  rash,	
  joint	
  pain	
  
	
  	
  
-­‐3	
  
+3	
  	
  
-­‐3	
  
more
Rock Mountain Spotted Fever
Hunter	
  Whitney	
  and	
  Veena	
  R	
  Kumar,	
  Pediatric	
  Emergency	
  physician	
  
Diagnos'c	
  Dilemma:	
  when	
  the	
  most	
  likely	
  causes	
  of	
  a	
  
pa.ent’s	
  symptoms	
  have	
  been	
  ruled	
  out	
  and	
  a	
  defini.ve	
  
diagnosis	
  has	
  not	
  been	
  established	
  
Differen'al	
  Diagnosis	
  (Alternate	
  layout	
  1)	
  	
  
Infectious
Septic arthritis
Lyme disease
Bacterial
Viral
+5	
  	
  -­‐4	
  
History and Physical
Labs
Radiology
Fever,	
  rash,	
  joint	
  pain,	
  
handles/sleeps	
  with	
  pet	
  
rat	
  oFen,	
  rat	
  bit	
  both	
  
dogs	
  
-­‐3	
  
+3	
  	
   Rock Mountain Spotted Fever
Meningococal meningitis
Gonorrhea
Secondary syphilis
Leptospirosis
Rat-bite fever
+2	
  	
  
CBC	
  normal,	
  Rapid	
  
strep	
  neg.,	
  blood	
  
culture	
  neg.,	
  joint	
  fluid	
  
culture	
  posi.ve	
  for	
  
Strep.	
  moniliformis	
  
Chest	
  X-­‐ray	
  nega.ve	
  
Hunter	
  Whitney	
  and	
  Veena	
  R	
  Kumar,	
  Pediatric	
  Emergency	
  physician	
  
Further	
  ques.oning	
  reveals	
  that	
  the	
  pa.ent	
  traveled	
  to	
  
southern	
  Kentucky	
  about	
  4	
  weeks	
  ago	
  for	
  a	
  Labor	
  Day	
  camping	
  
trip	
  with	
  his	
  family.	
  He	
  recalls	
  having	
  found	
  .cks	
  on	
  his	
  clothing	
  
but	
  not	
  on	
  his	
  skin.	
  	
  
	
  
He	
  denies	
  alcohol	
  or	
  drug	
  use.	
  He	
  reports	
  that	
  he	
  has	
  a	
  
girlfriend,	
  but	
  denies	
  any	
  sexual	
  ac.vity.	
  
	
  
The	
  family	
  has	
  numerous	
  pets	
  including	
  1	
  hermit	
  crab,	
  1	
  African	
  
clawed	
  frog,	
  2	
  lizards,	
  1	
  domes'c	
  white	
  rat,	
  1	
  python,	
  and	
  a	
  
tank	
  of	
  tropical	
  fish.	
  They	
  had	
  2	
  dogs,	
  but	
  both	
  recently	
  died	
  of	
  
unknown	
  causes.	
  The	
  pa.ent	
  denies	
  any	
  animal	
  bites.	
  	
  
Many	
  clues,	
  but	
  which	
  were	
  relevant?	
  	
  
Evidence	
  Handling	
  	
  	
  
•  Visualiza.ons	
  are	
  just	
  one	
  part	
  of	
  inves.ga.on	
  and	
  
analysis	
  	
  
•  All	
  the	
  decisions	
  star.ng	
  from	
  data	
  collec.on,	
  storage,	
  
organiza.on,	
  sta.s.cal	
  summariza.ons,	
  modeling,	
  etc.	
  
will	
  influence	
  the	
  analysis	
  and	
  interpreta.on	
  
	
  
When	
  possible:	
  
•  Enable	
  easy	
  annota.ons	
  and	
  access	
  to	
  source	
  
material	
  
•  Provide	
  mul.ple	
  views/ways	
  of	
  looking	
  at	
  the	
  data	
  
No	
  ma^er	
  how	
  good	
  the	
  visualiza'on,	
  the	
  outcome	
  of	
  the	
  
inves'ga'on	
  depends	
  on	
  the	
  integrity	
  of	
  every	
  step	
  of	
  the	
  process	
  
From	
  Data	
  Insights:	
  New	
  Ways	
  to	
  Visualize	
  and	
  Make	
  Sense	
  of	
  Data	
  by	
  Hunter	
  Whitney	
  (Morgan	
  Kaufmann	
  Publishers,	
  
November	
  2012)	
  
Collabora'ng	
  
•  Willing	
  to	
  acknowledge	
  the	
  limits	
  of	
  your	
  own	
  exper.se	
  and	
  
to	
  ask	
  for	
  help	
  when	
  necessary	
  
•  Visualiza.ons	
  can	
  enhance:	
  
•  Partnering	
  with	
  machines:	
  detec.ves	
  have	
  their	
  Watson	
  
•  Collabora.ng	
  with	
  other	
  people	
  
 
• There’s	
  a	
  lot	
  of	
  experimenta.on	
  and	
  a	
  growing	
  awareness	
  of	
  
poten.al	
  uses	
  
• Visualizing	
  data	
  is	
  nothing	
  new,	
  but	
  is	
  now	
  evolving	
  rapidly	
  
• Many	
  different	
  kinds	
  of	
  creators	
  and	
  users	
  are	
  coming	
  to	
  the	
  
table	
  with	
  varying	
  exper.se,	
  perspec.ves,	
  and	
  goals	
  	
  	
  
• Approaches	
  to	
  data	
  visualiza.ons	
  are	
  definitely	
  not	
  one	
  size	
  
fits	
  all.	
  That’s	
  why	
  the	
  UX	
  design	
  dimension	
  is	
  so	
  important!	
  	
  
Problem	
  Solving	
  with	
  Emerging	
  Tools
Thank	
  You	
  
Slide	
  1:	
  hSp://i.huffpost.com/gen/1375606/thumbs/o-­‐DETECTIVE-­‐facebook.jpg	
  
Slide	
  2:	
  
Slide	
  3:	
  hSp://www.theguardian.com/tv-­‐and-­‐radio/tvandradioblog+medical-­‐drama	
  
Slide	
  4:	
  http://images4.wikia.nocookie.net/__cb20091004222608/flashforward/images/1/1e/MI_wall.jpg
Slide 5: http://www.cafepress.com/+forensic_evidence_large_poster,698750731
Slides 6 and 14: http://www.cs.rit.edu/~rlc/Courses/IS/Projects/20131/Proj2/Clue_rules.html
Slide 26: http://www.gonemovies.com/WWW/Hoofd/A/PhotoLarge.php?Keuze=BrettJeremy, http://
www.digitaltrends.com/computing/ibm-watson-supercomputer-goes-to-college/
	
  
Supplementary Image Credits:

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Data Detectives Visualize Evidence to Solve Medical Mystery

  • 1. Data  Detec'ves   Enhancing  the  inves'ga've  process  with  visualiza'ons   Hunter Whitney San Francisco November 13, 2013
  • 2. Think  of  a  detec.ve  trying  to  solve  a  case  where  the  answer   may  lie  hidden  within  stacks  of  evidence,  .me  is  limited,   and  there  are  serious  consequences  for  any  errors.  
  • 3. From  healthcare  workers  to  security  professionals,  this  same   basic  scenario  applies  to  many  people  who  work  with  data.  
  • 4. While  there’s  no  single  approach  to  finding  answers  in  an  array  of   data,  UX  design  can  help  support  various  inves.ga.ve  processes.  
  • 5. •  PuCng  the  pieces  together     •  Weighing  the  evidence     •  Evidence  handling     •  Collabora.ng   Data  as  evidence  
  • 6. Pu8ng  the  Pieces  Together   Users  oFen  have  to  work  with  evidence  that  is:     •  Fragmentary,  mixed,  and  incomplete   •  Delivered  in  an  asynchronous,  non-­‐sequen.al  manner  
  • 7. Case  1:     Where  and  when  did  an  outbreak  of  a  foodborne  illness   begin?   Visual  Forensics  
  • 8. Visually  connec'ng  data  about  'me,  place,  and  rela'onship   Palan.r  Technologies,  Inc.  
  • 9. Case  2:     Who  is  the  ringleader  of  a  recent  interna'onal  bank   fraud  scheme?   Visual  Forensics  
  • 10. Visually  connec'ng  data  about  'me,  place,  and  rela'onship   Palan.r  Technologies,  Inc.  
  • 11. Case  3:   Why  are  a  soldier’s  post-­‐trauma'c  symptoms  not  responding   to  treatment?   Visual  Forensics  
  • 12. Visual  juxtaposi'on  of  different  kinds  of  data   EEG   MRI   MRI  (DTI)   Electrical  ac.vity  data   Anatomical  Features   Fiber  Tracts  (Connec.vity)   Hunter  Whitney  and  Jeff  Chang,  MD   Please  see  hSp://vimeo.com/album/2489932  
  • 13. Visual  juxtaposi'on  of  different  kinds  of  data   EEG   MRI   MRI  (DTI)   Electrical  ac.vity  data   Anatomical  Features   Fiber  Tracts  (Connec.vity)   Hunter  Whitney  and  Jeff  Chang,  ER  Radiologist   Please  see  hSp://vimeo.com/album/2489932  
  • 14. MRI + DTI DTI Visual  transi'ons  of  different  kinds  of  data   Hunter  Whitney  and  Jeff  Chang,  ER  Radiologist   Please  see  hSp://vimeo.com/album/2489932  
  • 15. Weighing  the  evidence   A  piece  of  evidence  does  not  exist  in  isola'on.  It  should  be   considered  in  context  (but  the  context  can  rapidly  change):     •  The  rela.ve  meaning  and  significance  of  any  piece  of  data   may  change  as  other  available  informa.on  comes  in   •  A  piece  of  evidence  may  be  true  but  irrelevant  or   poten.ally  misleading  if  not  well  framed    
  • 16. Case  4:     What  is  causing  a  child’s  persistent  fever,  rash,  and  joint  pain?   Visual  Forensics  
  • 17. THE  CASE     A  previously  healthy  12-­‐year-­‐old  boy  presents  to  an  emergency  department  in  southern  Ohio  in  October  with  a  chief  complaint  of   fever  and  rash.  The  pa'ent  has  had  subjec've  fever  for  3  days  with  weakness,  malaise,  anorexia,  and  decreased  ac'vity.  He  had   emesis  followed  by  diarrhea  on  the  second  day.  He  complains  of  diffuse  myalgias  and  migratory  arthralgias,  which  began  in  the   right  shoulder  and  have  progressed  to  involve  the  cervical  spine  and  all  joints  of  the  extremi'es  bilaterally,  but  sparing  the  hips.  A   rash  developed  bilaterally  on  his  inner  thighs  at  the  onset  of  illness,  then  spread  to  involve  his  forearms,  abdomen,  trunk,  and   hands,  sequen'ally.     In  the  ED,  his  temperature  is  37.3C,  blood  pressure  is  136/70  mmHg,  pulse  is  104  beats  per  minute,  and  respiratory  rate  is  24  breaths   per  minute.  The  pa.ent's  past  medical  history  is  significant  only  for  aSen.on-­‐deficit  disorder  (ADD)  without  hyperac.vity,  and  his   medica.ons  include  acetaminophen,  melatonin,  and  methylphenidate.  He  has  no  known  drug  allergies,  and  his  immuniza.ons  are   current.  Physical  examina.on  reveals  erythematous  lesions  on  the  palate  and  pain  with  ac.ve  and  passive  range  of  mo.on  in  all   extremi.es.  There  is  no  joint  swelling,  erythema,  or  warmth.  A  red  maculopapular  rash  with  scaSered  vesicular  lesions  is  present  on   the  thighs,  forearms,  trunk,  and  palms.  A  rapid  group  A  streptococcal  an.gen  test  on  a  throat  swab  is  nega.ve.  The  pa.ent  is  Tanner   stage  4  for  genital  development.  He  has  no  discharge  or  lesions.  The  pa.ent  is  prescribed  ibuprofen  and  discharged  from  the  ED  with   a  diagnosis  of  hand,  foot,  and  mouth  disease.     Worsening  symptoms   The  pa.ent  returns  to  the  ED  2  days  later  with  persistent  fever,  worsening  arthralgia,  and  new  swelling  in  the  leF  knee.  He  is  unable   to  ambulate  and  has  decreased  oral  intake.  Both  wrists  and  mul.ple  finger  joints  have  become  painful.  The  pain  is  greatest  in  the   right  wrist  and  leF  knee.  Further  ques.oning  reveals  that  the  pa.ent  traveled  to  southern  Kentucky  about  4  weeks  ago  for  a  Labor   Day  camping  trip  with  his  family.  He  recalls  having  found  .cks  on  his  clothing  but  not  on  his  skin.  He  denies  alcohol  or  drug  use.  The   family  has  numerous  pets  including  1  hermit  crab,  1  African  clawed  frog,  2  lizards,  1  domes.c  white  rat,  1  python,  and  a  tank  of   tropical  fish.  They  had  2  dogs,  but  both  recently  died  of  unknown  causes.  The  pa.ent  denies  any  animal  bites.  He  reports  that  he  has   a  girlfriend,  but  he  denies  any  sexual  ac.vity.  His  temperature  is  38.9C,  blood  pressure  is  100/72  mmHg,  pulse  is  110  beats  per   minute,  and  respiratory  rate  is  30  breaths  per  minute.  The  rash  has  progressed,  with  an  increased  number  of  well-­‐demarcated,   macular,  papular,  and  vesicular  lesions  involving  the  extremi.es,  especially  the  palms  and  soles.  The  lesions  are  blanching  and   nonpruri.c.  The  leF  knee  is  warm,  nonerythematous,  and  swollen  with  ballotable  fluid.  
  • 18. Further  ques.oning  reveals  that  the  pa.ent  traveled  to   southern  Kentucky  about  4  weeks  ago  for  a  Labor  Day  camping   trip  with  his  family.  He  recalls  having  found  .cks  on  his  clothing   but  not  on  his  skin.       He  denies  alcohol  or  drug  use.  He  reports  that  he  has  a   girlfriend,  but  denies  any  sexual  ac.vity.     The  family  has  numerous  pets  including  1  hermit  crab,  1  African   clawed  frog,  2  lizards,  1  domes.c  white  rat,  1  python,  and  a   tank  of  tropical  fish.  They  had  2  dogs,  but  both  recently  died  of   unknown  causes.  The  pa.ent  denies  any  animal  bites.     Many  clues,  but  which  are  relevant?  
  • 19. Accelera'ng  the  diagnos'c  process  with  visualiza'ons   •  Sugges.ng  possibili.es     •  Process  of  elimina.on     •  Visual  emphasis  of  promising  direc.ons         •  Dynamic  weigh.ng     •  Transparency  of  the  process  
  • 20. Differen'al  Diagnosis:  the  full  range  of  poten.al  causes,   or  combina.ons  of  causes,  for  a  set  of  symptoms   Reaves,  L;  Hamilton,  S;  Vossmeyer,  M;  and  Brady,  R.  Fever,  rash  and   migratory  polyarthralgia.  Contemporary  Pediatrics.  Mar  2010;27(3):24-­‐38.  
  • 21. Juvenile Idiopathic Arthritis Postinfectious arthritis Differen'al  Diagnosis  (Alternate  layout  1)     Henoch-Schönlein purpura Kawasaki disease Infectious Rheumatologic Familial Mediterranean Fever Genetics Septic arthritis Lyme disease Bacterial Enteroviruses Parvovirus Viral +5    -­‐4   -­‐6   History and Physical Labs Radiology Fever,  rash,  joint  pain       -­‐3   +3     -­‐3   more Rock Mountain Spotted Fever Hunter  Whitney  and  Veena  R  Kumar,  Pediatric  Emergency  physician  
  • 22. Diagnos'c  Dilemma:  when  the  most  likely  causes  of  a   pa.ent’s  symptoms  have  been  ruled  out  and  a  defini.ve   diagnosis  has  not  been  established  
  • 23. Differen'al  Diagnosis  (Alternate  layout  1)     Infectious Septic arthritis Lyme disease Bacterial Viral +5    -­‐4   History and Physical Labs Radiology Fever,  rash,  joint  pain,   handles/sleeps  with  pet   rat  oFen,  rat  bit  both   dogs   -­‐3   +3     Rock Mountain Spotted Fever Meningococal meningitis Gonorrhea Secondary syphilis Leptospirosis Rat-bite fever +2     CBC  normal,  Rapid   strep  neg.,  blood   culture  neg.,  joint  fluid   culture  posi.ve  for   Strep.  moniliformis   Chest  X-­‐ray  nega.ve   Hunter  Whitney  and  Veena  R  Kumar,  Pediatric  Emergency  physician  
  • 24. Further  ques.oning  reveals  that  the  pa.ent  traveled  to   southern  Kentucky  about  4  weeks  ago  for  a  Labor  Day  camping   trip  with  his  family.  He  recalls  having  found  .cks  on  his  clothing   but  not  on  his  skin.       He  denies  alcohol  or  drug  use.  He  reports  that  he  has  a   girlfriend,  but  denies  any  sexual  ac.vity.     The  family  has  numerous  pets  including  1  hermit  crab,  1  African   clawed  frog,  2  lizards,  1  domes'c  white  rat,  1  python,  and  a   tank  of  tropical  fish.  They  had  2  dogs,  but  both  recently  died  of   unknown  causes.  The  pa.ent  denies  any  animal  bites.     Many  clues,  but  which  were  relevant?    
  • 25. Evidence  Handling       •  Visualiza.ons  are  just  one  part  of  inves.ga.on  and   analysis     •  All  the  decisions  star.ng  from  data  collec.on,  storage,   organiza.on,  sta.s.cal  summariza.ons,  modeling,  etc.   will  influence  the  analysis  and  interpreta.on     When  possible:   •  Enable  easy  annota.ons  and  access  to  source   material   •  Provide  mul.ple  views/ways  of  looking  at  the  data  
  • 26. No  ma^er  how  good  the  visualiza'on,  the  outcome  of  the   inves'ga'on  depends  on  the  integrity  of  every  step  of  the  process   From  Data  Insights:  New  Ways  to  Visualize  and  Make  Sense  of  Data  by  Hunter  Whitney  (Morgan  Kaufmann  Publishers,   November  2012)  
  • 27. Collabora'ng   •  Willing  to  acknowledge  the  limits  of  your  own  exper.se  and   to  ask  for  help  when  necessary   •  Visualiza.ons  can  enhance:   •  Partnering  with  machines:  detec.ves  have  their  Watson   •  Collabora.ng  with  other  people  
  • 28.   • There’s  a  lot  of  experimenta.on  and  a  growing  awareness  of   poten.al  uses   • Visualizing  data  is  nothing  new,  but  is  now  evolving  rapidly   • Many  different  kinds  of  creators  and  users  are  coming  to  the   table  with  varying  exper.se,  perspec.ves,  and  goals       • Approaches  to  data  visualiza.ons  are  definitely  not  one  size   fits  all.  That’s  why  the  UX  design  dimension  is  so  important!     Problem  Solving  with  Emerging  Tools
  • 30. Slide  1:  hSp://i.huffpost.com/gen/1375606/thumbs/o-­‐DETECTIVE-­‐facebook.jpg   Slide  2:   Slide  3:  hSp://www.theguardian.com/tv-­‐and-­‐radio/tvandradioblog+medical-­‐drama   Slide  4:  http://images4.wikia.nocookie.net/__cb20091004222608/flashforward/images/1/1e/MI_wall.jpg Slide 5: http://www.cafepress.com/+forensic_evidence_large_poster,698750731 Slides 6 and 14: http://www.cs.rit.edu/~rlc/Courses/IS/Projects/20131/Proj2/Clue_rules.html Slide 26: http://www.gonemovies.com/WWW/Hoofd/A/PhotoLarge.php?Keuze=BrettJeremy, http:// www.digitaltrends.com/computing/ibm-watson-supercomputer-goes-to-college/   Supplementary Image Credits: