A Rule-Based Decision Support System for Critical Infrastructure Management

This article presents a new rule-based decision support system for critical infrastructure management based on the interdependencies among critical infrastructures. Unlike the conventional flood front prediction model, the new failure front prediction model consists of both physical parameters and interdependencies among infrastructures, which is represented by a multi-level complex network. This study employs advanced computation methods to build tools for better understanding emergent behavior of water security infrastructure systems for use in developing superior preparedness and response strategies. This study highlights the important role played by the interdependencies among the infrastructures in failure front prediction.     

集群式院外高危心脏病患者远程实时连续监护系统

设计了一种针对院外心血管病患者的远程心电监护系统,包括便携式监护终端和医院监护中心。其特点在于可对身处院外、自由活动的心血管病患者进行远程、实时、连续的监护,同时获得被监护患者的地理位置信息。已完成的整体调试结果表明,本系统不仅能及时发现异常心电图并进行干预,而且还可根据地理位置信息对突发急病的患者进行快速救治。该系统是院内监护系统功能的延伸,有良好的临床应用前景。     

流域管理决策支持系统研究进展

流域管理决策支持系统是为帮助流域管理者实现水资源优化配置而研发的智能系统,其模拟结果直接影响流域管理的科学性和实用性.本文从水量模拟和调配系统、水质监测和评价系统、流域综合管理系统三方面总结了国内外的相关研究,并分析了现存系统的特点和存在的问题,同时简要介绍AQUA-Tool、Elbe-DSS、HD等代表性系统的模型结构和发展现状.模拟结果精确稳定、工作流程简洁、用户可视化程度高是流域管理决策支持系统的研发重点,优化方案选择模型和三维可视化工具、研发跨流域综合管理系统、提高利益相关者的参与度是未来该领域的发展方向.     

一种用于荧光显微切片断层成像系统的远程监控装置

通过对荧光显微光学切片断层成像系统实际成像过程中激光器、液位、平移台等运行状态的分析,针对性设计了对这些关键部件工作状态进行监测的方法。在此基础上,进一步研制了一套可远程监测成像系统工作状态的装置,实现了对成像系统中激光器、液位以及平移台等实时状态的监测,将成像系统从开环工作状态转变为了带实时反馈的可监控工作状态。远程监控装置的使用提高了荧光显微光学切片断层成像系统的实用性与稳定性,提高了所获取数据的完整性。     

露天煤矿废弃地生态重建智能决策支持系统的系统分析与总体设计

大型露天煤矿开采引发的土地退化问题复杂,其废弃地的生态重建更是涉及采矿学、地貌学、农学、林学、生态学、环境学、经济学和社会科学等理论。因而,很难用传统的思维方法、数量化和数学模型的应用及研究工具来解决。建立废弃地生态重建智能决策支持系统（Ｉｎｔｅｌｉ...     

Focus: Health Equity: Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review

Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I² statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.     

The Role of Decision Support System (DSS) in Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Background

The potential role of DSS in CVD prevention remains unclear as only a few studies report on patient outcomes for cardiovascular disease.

Methods and Results

A systematic review and meta-analysis of randomised controlled trials and observational studies was done using Medline, Embase, Cochrane Library, PubMed, Amed, CINAHL, Web of Science, Scopus databases; reference lists of relevant studies to 30 July 2011; and email contact with experts. The primary outcome was prevention of cardiovascular disorders (myocardial infarction, stroke, coronary heart disease, peripheral vascular disorders and heart failure) and management of hypertension owing to decision support systems, clinical decision supports systems, computerized decision support systems, clinical decision making tools and medical decision making (interventions). From 4116 references ten studies met our inclusion criteria (including 16,312 participants). Five papers reported outcomes on blood pressure management, one paper on heart failure, two papers each on stroke, and coronary heart disease. The pooled estimate for CDSS versus control group differences in SBP (mm of Hg) was - 0.99 (95% CI −3.02 to 1.04 mm of Hg; I² = 0; p = 0.851).

Conclusions

DSS show an insignificant benefit in the management and control of hypertension (insignificant reduction of SBP). The paucity of well-designed studies on patient related outcomes is a major hindrance that restricts interpretation for evaluating the role of DSS in secondary prevention. Future studies on DSS should (1) evaluate both physician performance and patient outcome measures (2) integrate into the routine clinical workflow with a provision for decision support at the point of care.     

Terrestrial Metals Bioavailability: A Comprehensive Review and Literature-Derived Decision Rule for Ecological Risk Assessment

Interstudy variation among bioavailability studies is a primary deterrent to a universal methodology to assess metals bioavailability to soil-dwelling organisms and is largely the result of specific experimental conditions unique to independent studies. Accordingly, two datasets were established from relevant literature; one includes data from studies related to bioaccumulation (total obs = 520), while the other contains data from studies related to toxicity (total obs = 1264). Experimental factors that affected toxicity and bioaccumulation independent of the effect of soil chemical/physical properties were statistically apportioned from the variation attributed to soil chemical/physical properties for both datasets using a linear mixed model. Residual bioaccumulation data were then used to develop a non-parametric regression tree whereby bootstrap and cross-validation techniques were used to internally validate the resulting decision rule. A similar approach was employed with the toxicity dataset as an independent external validation. A validated decision rule is presented as a quantitative assessment tool that characterizes typical aerobic soils in terms of their potential to sequester common divalent cationic metal contaminants and mitigate their bioavailability to soil-dwelling biota.     

Cardiac Health Risk Stratification System (CHRiSS): A Bayesian-Based Decision Support System for Left Ventricular Assist Device (LVAD) Therapy

This study investigated the use of Bayesian Networks (BNs) for left ventricular assist device (LVAD) therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE) was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (%) for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS). As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making.     

A Support Tool for Air Pollution Health Risk Management in Emerging Countries: A Case in Brazil

This study evaluated the health risk due to air pollution in São Paulo State, Brazil, comparing Brazil's standards and the World Health Organization (WHO) air quality guidelines. New methodology was applied considering, as hazard parameters, the maximum average concentrations of SO₂, NO₂, O₃, CO, and PM₁₀ from 2007 to 2011. As exposure parameters, population density and location sensitivity were considered. A health risk index based on fuzzy logic was performed to integrate the selected parameters, giving the likelihood of reaching different risk levels. Data gathering and spatial representation of parameters and risk scores were performed by means of geographic information system (GIS). Highest values of risk were observed in the Metropolitan Area of São Paulo and near the cities of Cubatão and Piracicaba, associated to vehicular and industrial emissions and sugar cane burning. Discussions about the need to revise national air quality standards have intensified over the past years. Generally, indices used for air quality do not consider the population exposed. This study showed the integration of GIS with fuzzy logic methodology to be a useful tool for health risk assessment. When evaluating the risk, exposure parameters must be intrinsically considered to enhance the importance of population vulnerability when assessing environmental problems, especially in emerging economies.     

Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.     

Lipomas as an Extremely Rare Cause for Brachial Plexus Compression: A Case Series and Systematic Review

Introduction  Brachial plexus lipomas are extremely rare benign tumors that may cause slow progression of neurological deficits leading to thoracic outlet syndrome. Up to now, surgery remains challenging. The aim of this study is to present our surgical treatment regime and long-term neurological outcome in three cases of giant brachial plexus lipomas and to show results of systematic review. Patients and Methods  Retrospective analysis of our database “peripheral nerve lesion” to identify patients suffering from brachial plexus lipomas between January 1, 2012, and December 31, 2019. Systematic review was performed for literature published until March 31, 2020, analyzing PubMed, Google Scholar, Scopus, and the Cochrane Collaboration Library independently by two authors. Results  Over the past years, three patients suffering from giant brachial plexus lipomas attended to our neurosurgical department. All patients underwent preoperative magnetic resonance imaging (MRI), ultrasound examinations, and electrophysiological testing. Tumors were removed microsurgically via anterior/posterior, supraclavicular/infraclavicular, and combined approaches. The patients were accessed postoperatively by MRI and clinical follow-up. Systematic review of the literature revealed 22 cases, which were analyzed in regard to demographics, surgical treatment, and neurological outcome. Conclusion  Brachial plexus lipomas are an extremely rare cause for brachial plexus compression. Total microsurgical removal with intraoperative electrophysiological monitoring is the treatment of choice with excellent long-term MRI and clinical outcome.     

Hazards Associated with the Consumption of Sea Turtle Meat and Eggs: A Review for Health Care Workers and the General Public

Sea turtle products (e.g., meat, adipose tissue, organs, blood, eggs) are common food items for many communities worldwide, despite national regulations in some countries prohibiting such consumption. However, there may be hazards associated with this consumption due to the presence of bacteria, parasites, biotoxins, and environmental contaminants. Reported health effects of consuming sea turtles infected with zoonotic pathogens include diarrhea, vomiting, and extreme dehydration, which occasionally have resulted in hospitalization and death. Levels of heavy metals and organochlorine compounds measured in sea turtle edible tissues exceed international food safety standards and could result in toxic effects including neurotoxicity, kidney disease, liver cancer, and developmental effects in fetuses and children. The health data presented in this review provide information to health care providers and the public concerning the potential hazards associated with sea turtle consumption. Based on past mortality statistics from turtle poisonings, nursing mothers and children should be particularly discouraged from consuming all sea turtle products. We recommend that individuals choose seafood items lower in the food chain that may have a lower contaminant load. Dissemination of this information via a public health campaign may simultaneously improve public health and enhance sea turtle conservation by reducing human consumption of these threatened and endangered species.     

Digital Health and Shared Decision-Making in Diabetes Care – A Survey Initiative in Patients and Clinicians

ObjectiveTo assess the landscape of digital health resources in the United States, better understand the impact of the digital health on shared decision-making, and identify potential barriers and opportunities for progress in the care of persons with diabetes.MethodsThe study consisted of two phases: A qualitative phase in which one-on-one interviews were conducted virtually with 34 physicians (endocrinologists {Endos}: n = 15; primary care physicians {PCPs}: n = 19) between February 11, 2021 and February 18, 2021, and a quantitative phase in which two online, email-based surveys in the English language were conducted between April 16, 2021 and May 17, 2021: one with healthcare professionals (HCP) (n = 403: n = 200 Endos and n = 203 PCPs), and one with persons with diabetes (n = 517: patients with type 1 diabetes, n = 257; patients with type 2 diabetes, n = 260).ResultsDiabetes digital health tools were found to be helpful in shared decision-making, but leading barriers include cost, coverage, and lack of time by healthcare professionals. Among diabetes digital health tools, continuous glucose monitoring (CGM) systems were used most commonly and viewed as most effective in improving quality of life and facilitating shared decision-making. Strategies for increasing use of diabetes digital health resources included lower cost, integration into electronic health records, and increased simplicity of tools.ConclusionThis study revealed that both Endos and PCPs feel that diabetes digital health tools have an overall positive impact. Integration with telemedicine and simpler, lower cost tools with increased patient access can further facilitate shared decision-making and improved diabetes care and quality of life.