Evaluación del desempeño pronóstico de dos puntajes de predicción de mortalidad a siete días en pacientes adultos oncológicos críticamente enfermos admitidos a una unidad de cuidados intensivos en Bogotá

Introducción Los sistemas de puntuación para predicción se han desarrollado para medir la severidad de la enfermedad y el pronóstico de los pacientes en la unidad de cuidados intensivos. Estas medidas son útiles para la toma de decisiones clínicas, la estandarización de la investigación, y la comparación de la calidad de la atención al paciente crítico. Materiales y métodos Estudio de tipo observacional analítico de cohorte en el que reviso las historias clínicas de 283 pacientes oncológicos admitidos a la unidad de cuidados intensivos (UCI) durante enero de 2014 a enero de 2016 y a quienes se les estimo la probabilidad de mortalidad con los puntajes pronósticos APACHE IV y MPM II, se realizó regresión logística con las variables predictoras con las que se derivaron cada uno de los modelos es sus estudios originales y se determinó la calibración, la discriminación y se calcularon los criterios de información Akaike AIC y Bayesiano BIC. Resultados En la evaluación de desempeño de los puntajes pronósticos APACHE IV mostro mayor capacidad de predicción (AUC = 0,95) en comparación con MPM II (AUC = 0,78), los dos modelos mostraron calibración adecuada con estadístico de Hosmer y Lemeshow para APACHE IV (p = 0,39) y para MPM II (p = 0,99). El ∆ BIC es de 2,9 que muestra evidencia positiva en contra de APACHE IV. Se reporta el estadístico AIC siendo menor para APACHE IV lo que indica que es el modelo con mejor ajuste a los datos. Conclusiones APACHE IV tiene un buen desempeño en la predicción de mortalidad de pacientes críticamente enfermos, incluyendo pacientes oncológicos. Por lo tanto se trata de una herramienta útil para el clínico en su labor diaria, al permitirle distinguir los pacientes con alta probabilidad de mortalidad.

Screening a Case Base for Stroke Disease Detection

Stroke stands for one of the most frequent causes of death, without distinguishing age or genders. Despite representing an expressive mortality fig-ure, the disease also causes long-term disabilities with a huge recovery time, which goes in parallel with costs. However, stroke and health diseases may also be prevented considering illness evidence. Therefore, the present work will start with the development of a decision support system to assess stroke risk, centered on a formal framework based on Logic Programming for knowledge rep-resentation and reasoning, complemented with a Case Based Reasoning (CBR) approach to computing. Indeed, and in order to target practically the CBR cycle, a normalization and an optimization phases were introduced, and clustering methods were used, then reducing the search space and enhancing the cases re-trieval one. On the other hand, and aiming at an improvement of the CBR theo-retical basis, the predicates` attributes were normalized to the interval 0…1, and the extensions of the predicates that match the universe of discourse were re-written, and set not only in terms of an evaluation of its Quality-of-Information (QoI), but also in terms of an assessment of a Degree-of-Confidence (DoC), a measure of one`s confidence that they fit into a given interval, taking into account their domains, i.e., each predicate attribute will be given in terms of a pair (QoI, DoC), a simple and elegant way to represent data or knowledge of the type incomplete, self-contradictory, or even unknown.

Prediction of Length of Hospital Stay in Preterm Infants - A Case-Based Reasoning View

The length of stay of preterm infants in a neonatology service has become an issue of a growing concern, namely considering, on the one hand, the mothers and infants health conditions and, on the other hand, the scarce healthcare facilities own resources. Thus, a pro-active strategy for problem solving has to be put in place, either to improve the quality-of-service provided or to reduce the inherent financial costs. Therefore, this work will focus on the development of a diagnosis decision support system in terms of a formal agenda built on a Logic Programming approach to knowledge representation and reasoning, complemented with a case-based problem solving methodology to computing, that caters for the handling of incomplete, unknown, or even contradictory in-formation. The proposed model has been quite accurate in predicting the length of stay (overall accuracy of 84.9%) and by reducing the computational time with values around 21.3%.

Length of Stay in Intensive Care Units - A Case Base Evaluation

As a matter of fact, an Intensive Care Unit (ICU) stands for a hospital facility where patients require close observation and monitoring. Indeed, predicting Length-of-Stay (LoS) at ICUs is essential not only to provide them with improved Quality-of-Care, but also to help the hospital management to cope with hospital resources. Therefore, in this work one`s aim is to present an Artificial Intelligence based Decision Support System to assist on the prediction of LoS at ICUs, which will be centered on a formal framework based on a Logic Programming acquaintance for knowledge representation and reasoning, complemented with a Case Based approach to computing, and able to handle unknown, incomplete, or even contradictory data, information or knowledge.

A Soft Computing Approach to Acute Coronary Syndrome

Acute Coronary Syndrome (ACS) is transversal to a broad and heterogeneous set of human beings, and assumed as a serious diagnosis and risk stratification problem. Although one may be faced with or had at his disposition different tools as biomarkers for the diagnosis and prognosis of ACS, they have to be previously evaluated and validated in different scenarios and patient cohorts. Besides ensuring that a diagnosis is correct, attention should also be directed to ensure that therapies are either correctly or safely applied. Indeed, this work will focus on the development of a diagnosis decision support system in terms of its knowledge representation and reasoning mechanisms, given here in terms of a formal framework based on Logic Programming, complemented with a problem solving methodology to computing anchored on Artificial Neural Networks. On the one hand it caters for the evaluation of ACS predisposing risk and the respective Degree-of-Confidence that one has on such a happening. On the other hand it may be seen as a major development on the Multi-Value Logics to understand things and ones behavior. Undeniably, the proposed model allows for an improvement of the diagnosis process, classifying properly the patients that presented the pathology (sensitivity ranging from 89.7% to 90.9%) as well as classifying the absence of ACS (specificity ranging from 88.4% to 90.2%).

Chest Breadths to Predict Individuals' Age - A Case Based View

It is well known that rib cage dimensions depend on the gender and vary with the age of the individual. Under this setting it is therefore possible to assume that a computational approach to the problem may be thought out and, consequently, this work will focus on the development of an Artificial Intelligence grounded decision support system to predict individual’s age, based on such measurements. On the one hand, using some basic image processing techniques it were extracted such descriptions from chest X-rays (i.e., its maximum width and height). On the other hand, the computational framework was built on top of a Logic Programming Case Base approach to knowledge representation and reasoning, which caters for the handling of incomplete, unknown, or even contradictory information. Furthermore, clustering methods based on similarity analysis among cases were used to distinguish and aggregate collections of historical data in order to reduce the search space, therefore enhancing the cases retrieval and the overall computational process. The accuracy of the proposed model is satisfactory, close to 90%.

Bidding Decision of Wind-Thermal GenCo in Day-Ahead Market

This paper deals with the self-scheduling problem of a price-taker having wind and thermal power production and assisted by a cyber-physical system for supporting management decisions in a day-ahead electric energy market. The self-scheduling is regarded as a stochastic mixed-integer linear programming problem. Uncertainties on electricity price and wind power are considered through a set of scenarios. Thermal units are modelled by start-up and variable costs, furthermore constraints are considered, such as: ramp up/down and minimum up/down time limits. The stochastic mixed-integer linear programming problem allows a decision support for strategies advantaging from an effective wind and thermal mixed bidding. A case study is presented using data from the Iberian electricity market.

Response of tropical maize to supplemental irrigation strategies.

Water is one of the most important factors influencing crop production in rainfed cropping systems. In tropical regions, supplemental irrigation reduces the risk of yield losses associated to water deficit due to insufficient rainfall. Water deficit in regions with irregularities in rainfall may be overcome with the use of supplemental irrigation, a technique based on the application of water at amounts below the crop?s evapotranspiration (ETc). We investigated the potential of supplemental irrigation as a strategy to increase yield of maize grown under tropical conditions. We used the CSM-CERES-Maize model of the Decision Support System for Agrotechnology Transfer (DSSAT) to simulate irrigation strategies of maize in six counties in the state of Minas Gerais, Brazil. Our results indicate significant differences on simulated crop yield in response to supplemental irrigation. As a consequence, water productivity was improved with reductions of 10% and 15% of full irrigation depths in one of the six counties while in two the water productivity was higher when full irrigation was applied.

EL ANÁLISIS MULTICRITERIO, UN CASO ESPECÍFICO: PROYECTO PROLAND

La técnica del análisis multicriterio se aplicó en la evaluación de técnicas de manejo alternativo para áreas de pendiente deforestadas usadas en la agricultura en Costa Rica y Guatemala. Se identificaron objetivos de evalua­ción entre los actores locales, con la ayuda de diferentes herramientas; pudién­dose identificar la pérdida de suelo, el ingreso de la finca, los insumes agrícolas, el lavado de nitrógeno, protección de la biodiversidad y necesidades nutricionales. Luego mediante algoritmos y fórmulas matemáticas, fueron caracteriza­dos todos los objetivos. Este modelo se utilizó como base para la construcción de una herramienta para apoyar la toma de decisiones que hace posible el cálculo del valor de cada objetivo bajo diferentes escenarios de producción y protección. ABSTRACT The multimedia analysis approach was applied to the evaluation of alternative management practices in deforested sloping áreas used for farming in Central American countries (Guatemala, Costa Rica). A major number of major evaluation objectives were identified, with the help of workshop ,whit local actors, including soil loss, farm income, agricultural inputs, nitrogen leaching, protection of biodiversity, and local nutrition needs. Then, appropriate algorithms and other mathematical formulas were put together for the quantitative characterization of all these objectives. This model was used as the basis for the construction of a user-friendly decision support tool, making possible the calculation of the values of the objectives for each scenario.

Simulações no CROPGRO/DSSAT do carbono no solo cultivado com soja sob plantio direto e preparo convencional, em clima subtropical do sul do Brasil.

Objetivou-se avaliar o potencial do modelo CROPGRO, inserido no DSSAT v.4,0 (Decision Support System for Agrotechnology Transfer) para simular o carbono no solo, no sistema plantio direto. Os dados foram coletados na Estação Experimental da Universidade Federal do Rio Grande do Sul (EEA/UFRGS), em Eldorado do Sul, durante o ano agrícola 2003/04, num delineamento em faixas, em Argissolo Vermelho distrófico típico. A semeadura da soja (cv. Fepagro RS10 - ciclo longo) ocorreu em 20/11/03 para uma população inicial em torno de 300 mil plantas ha-1. Foram utilizados dois sistemas de manejo do solo: preparo convencional (PC) e sistema plantio direto (PD) irrigados (I) e não irrigados (NI). Foram inseridos no DSSAT dados edáficos, meteorológicos diários e da cultura. Adotou-se o método Ceres, no CROPGROSoja para simular o teor de carbono (C) no solo. As simulações mostraram que há maior estoque de C em plantio direto irrigado em relação ao preparo convencional, demonstrando sensibilidade do CROPGRO-Soja ao manejo do solo. Os mais elevados resíduos de C em solo sob plantio direto evidenciam mitigações de emissões desse gás para a atmosfera em cultivos na região estudada.

Ri-costruire per ri-generare. Un modello per le periferie urbane

In Italia, quasi il 90% delle abitazioni esistenti sono state edificate prima degli anni Settanta del Novecento, se consideriamo la tipologia costruttiva, le normative per la sicurezza strutturale in ambito sismico e il comportamento energetico, ne deriva che la maggior parte non risponde agli standard vigenti. A questo si aggiunge la consapevolezza che il patrimonio residenziale costruito in quel periodo, e che occupa le prime periferie delle città, non si presta per sua natura costitutiva ad essere oggetto di interventi di riqualificazione che siano giustificabili in termini di costi-benefici dal punto di vista economico e per ottimizzazione ingegneristica. È opportuno ripensare piani e programmi di rinnovamento non circoscritti alle categorie di risanamento, efficientamento, manutenzione, adeguamento, ma che siano in grado di assumere in positivo il tema della sostituzione secondo il paradigma del ri-costruire per ri-generare per sviluppare strategie a medio-lungo termine per soddisfare un quadro esigenziale-prestazionale coerente con la legislazione europea, in termini di sicurezza, efficienza e impatto ambientale, e promuovere la pianificazione e lo sviluppo sostenibile delle città. L’edilizia circolare è qui intesa come un’attività finalizzata alla costruzione e gestione degli edifici all’interno di un ecosistema economico basato sulla circolarità dei processi. L’obiettivo della ricerca è duplice: (i) metodologico, rivolto alla formalizzazione di un modello innovativo d’intervento associato ai principi della circolarità e basato sulla conoscenza approfondita del patrimonio esistente; e (ii) progettuale, prevede la progettazione di un prototipo di unità abitativa e l’applicazione del modello ad un caso di studio, che viene assunto come applicazione sperimentale ad un contesto reale e momento conclusivo del processo. La definizione di una matrice valutativa consente di formulare indicazioni operative nella fase precedente l’intervento per rendere espliciti, attraverso un indice sintetico di supporto decisionale, i criteri su cui fondare le scelte tra le due macro-categorie di intervento (demolizione con ricostruzione o rinnovo).

Analytics and optimization for emergency healthcare processes

This thesis deals with the analysis and management of emergency healthcare processes through the use of advanced analytics and optimization approaches. Emergency processes are among the most complex within healthcare. This is due to their non-elective nature and their high variability. This thesis is divided into two topics. The first one concerns the core of emergency healthcare processes, the emergency department (ED). In the second chapter, we describe the ED that is the case study. This is a real case study with data derived from a large ED located in northern Italy. In the next two chapters, we introduce two tools for supporting ED activities. The first one is a new type of analytics model. Its aim is to overcome the traditional methods of analyzing the activities provided in the ED by means of an algorithm that analyses the ED pathway (organized as event log) as a whole. The second tool is a decision-support system, which integrates a deep neural network for the prediction of patient pathways, and an online simulator to evaluate the evolution of the ED over time. Its purpose is to provide a set of solutions to prevent and solve the problem of the ED overcrowding. The second part of the thesis focuses on the COVID-19 pandemic emergency. In the fifth chapter, we describe a tool that was used by the Bologna local health authority in the first part of the pandemic. Its purpose is to analyze the clinical pathway of a patient and from this automatically assign them a state. Physicians used the state for routing the patients to the correct clinical pathways. The last chapter is dedicated to the description of a MIP model, which was used for the organization of the COVID-19 vaccination campaign in the city of Bologna, Italy.

GIS applied to geotechnical and environmental risk management in a Brazilian oil pipeline

The paper presents the development of a decision support system for the management of geotechnical and environmental risks in oil pipelines using a geographical information system. The system covers a 48.5 km long section of the So Paulo to Brasilia (OSBRA) oil pipeline, which crosses three municipalities in the northeast region of the So Paulo state (Brazil) and represents an area of 205.8 km(2). The spatial database was created using geo-processing procedures, surface and intrusive investigations and geotechnical reports. The risk assessment was based mainly on qualitative models (relative numeric weights and multicriteria decision analysis) and considered pluvial erosion, slope movements, soil corrosion and third party activities. The maps were produced at a scale of 1:10,000.

PERFORMANCE OF THE MODEL CALLED ACQUANETXL IN THE ALLOCATION OF WATER IN COMPLEX WATER RESOURCE SYSTEMS

This article presents a tool for the allocation analysis of complex systems of water resources, called AcquaNetXL, developed in the form of spreadsheet in which a model of linear optimization and another nonlinear were incorporated. The AcquaNetXL keeps the concepts and attributes of a decision support system. In other words, it straightens out the communication between the user and the computer, facilitates the understanding and the formulation of the problem, the interpretation of the results and it also gives a support in the process of decision making, turning it into a clear and organized process. The performance of the algorithms used for solving the problems of water allocation was satisfactory especially for the linear model.

Planning and operation of large-scale water distribution systems with preemptive priorities

This paper describes the development of an optimization model for the management and operation of a large-scale, multireservoir water supply distribution system with preemptive priorities. The model considers multiobjectives and hedging rules. During periods of drought, when water supply is insufficient to meet the planned demand, appropriate rationing factors are applied to reduce water supply. In this paper, a water distribution system is formulated as a network and solved by the GAMS modeling system for mathematical programming and optimization. A user-friendly interface is developed to facilitate the manipulation of data and to generate graphs and tables for decision makers. The optimization model and its interface form a decision support system (DSS), which can be used to configure a water distribution system to facilitate capacity expansion and reliability studies. Several examples are presented to demonstrate the utility and versatility of the developed DSS under different supply and demand scenarios, including applications to one of the largest water supply systems in the world, the Sao Paulo Metropolitan Area Water Supply Distribution System in Brazil.