Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?

Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users.

Simplified Predictive Instrument to Rule Out Acute Coronary Syndromes in a High-Risk Population.

BACKGROUND: It is unclear whether diagnostic protocols based on cardiac markers to identify low-risk chest pain patients suitable for early release from the emergency department can be applied to patients older than 65 years or with traditional cardiac risk factors. METHODS AND RESULTS: In a single-center retrospective study of 231 consecutive patients with high-risk factor burden in which a first cardiac troponin (cTn) level was measured in the emergency department and a second cTn sample was drawn 4 to 14 hours later, we compared the performance of a modified 2-Hour Accelerated Diagnostic Protocol to Assess Patients with Chest Pain Using Contemporary Troponins as the Only Biomarker (ADAPT) rule to a new risk classification scheme that identifies patients as low risk if they have no known coronary artery disease, a nonischemic electrocardiogram, and 2 cTn levels below the assay's limit of detection. Demographic and outcome data were abstracted through chart review. The median age of our population was 64 years, and 75% had Thrombosis In Myocardial Infarction risk score ≥2. Using our risk classification rule, 53 (23%) patients were low risk with a negative predictive value for 30-day cardiac events of 98%. Applying a modified ADAPT rule to our cohort, 18 (8%) patients were identified as low risk with a negative predictive value of 100%. In a sensitivity analysis, the negative predictive value of our risk algorithm did not change when we relied only on undetectable baseline cTn and eliminated the second cTn assessment. CONCLUSIONS: If confirmed in prospective studies, this less-restrictive risk classification strategy could be used to safely identify chest pain patients with more traditional cardiac risk factors for early emergency department release.

Retrieval of grassland biophysical parameters using multitemporal optical and radar satellite data

The amount and quality of available biomass is a key factor for the sustainable livestock industry and agricultural management related decision making. Globally 31.5% of land cover is grassland while 80% of Ireland’s agricultural land is grassland. In Ireland, grasslands are intensively managed and provide the cheapest feed source for animals. This dissertation presents a detailed state of the art review of satellite remote sensing of grasslands, and the potential application of optical (Moderate–resolution Imaging Spectroradiometer (MODIS)) and radar (TerraSAR-X) time series imagery to estimate the grassland biomass at two study sites (Moorepark and Grange) in the Republic of Ireland using both statistical and state of the art machine learning algorithms. High quality weather data available from the on-site weather station was also used to calculate the Growing Degree Days (GDD) for Grange to determine the impact of ancillary data on biomass estimation. In situ and satellite data covering 12 years for the Moorepark and 6 years for the Grange study sites were used to predict grassland biomass using multiple linear regression, Neuro Fuzzy Inference Systems (ANFIS) models. The results demonstrate that a dense (8-day composite) MODIS image time series, along with high quality in situ data, can be used to retrieve grassland biomass with high performance (R2 = 0:86; p < 0:05, RMSE = 11.07 for Moorepark). The model for Grange was modified to evaluate the synergistic use of vegetation indices derived from remote sensing time series and accumulated GDD information. As GDD is strongly linked to the plant development, or phonological stage, an improvement in biomass estimation would be expected. It was observed that using the ANFIS model the biomass estimation accuracy increased from R2 = 0:76 (p < 0:05) to R2 = 0:81 (p < 0:05) and the root mean square error was reduced by 2.72%. The work on the application of optical remote sensing was further developed using a TerraSAR-X Staring Spotlight mode time series over the Moorepark study site to explore the extent to which very high resolution Synthetic Aperture Radar (SAR) data of interferometrically coherent paddocks can be exploited to retrieve grassland biophysical parameters. After filtering out the non-coherent plots it is demonstrated that interferometric coherence can be used to retrieve grassland biophysical parameters (i. e., height, biomass), and that it is possible to detect changes due to the grass growth, and grazing and mowing events, when the temporal baseline is short (11 days). However, it not possible to automatically uniquely identify the cause of these changes based only on the SAR backscatter and coherence, due to the ambiguity caused by tall grass laid down due to the wind. Overall, the work presented in this dissertation has demonstrated the potential of dense remote sensing and weather data time series to predict grassland biomass using machine-learning algorithms, where high quality ground data were used for training. At present a major limitation for national scale biomass retrieval is the lack of spatial and temporal ground samples, which can be partially resolved by minor modifications in the existing PastureBaseIreland database by adding the location and extent ofeach grassland paddock in the database. As far as remote sensing data requirements are concerned, MODIS is useful for large scale evaluation but due to its coarse resolution it is not possible to detect the variations within the fields and between the fields at the farm scale. However, this issue will be resolved in terms of spatial resolution by the Sentinel-2 mission, and when both satellites (Sentinel-2A and Sentinel-2B) are operational the revisit time will reduce to 5 days, which together with Landsat-8, should enable sufficient cloud-free data for operational biomass estimation at a national scale. The Synthetic Aperture Radar Interferometry (InSAR) approach is feasible if there are enough coherent interferometric pairs available, however this is difficult to achieve due to the temporal decorrelation of the signal. For repeat-pass InSAR over a vegetated area even an 11 days temporal baseline is too large. In order to achieve better coherence a very high resolution is required at the cost of spatial coverage, which limits its scope for use in an operational context at a national scale. Future InSAR missions with pair acquisition in Tandem mode will minimize the temporal decorrelation over vegetation areas for more focused studies. The proposed approach complements the current paradigm of Big Data in Earth Observation, and illustrates the feasibility of integrating data from multiple sources. In future, this framework can be used to build an operational decision support system for retrieval of grassland biophysical parameters based on data from long term planned optical missions (e. g., Landsat, Sentinel) that will ensure the continuity of data acquisition. Similarly, Spanish X-band PAZ and TerraSAR-X2 missions will ensure the continuity of TerraSAR-X and COSMO-SkyMed.

Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

Decisions, decisions everywhere (in the open data era).

Abstract: Decision support systems have been widely used for years in companies to gain insights from internal data, thus making successful decisions. Lately, thanks to the increasing availability of open data, these systems are also integrating open data to enrich decision making process with external data. On the other hand, within an open-data scenario, decision support systems can be also useful to decide which data should be opened, not only by considering technical or legal constraints, but other requirements, such as "reusing potential" of data. In this talk, we focus on both issues: (i) open data for decision making, and (ii) decision making for opening data. We will first briefly comment some research problems regarding using open data for decision making. Then, we will give an outline of a novel decision-making approach (based on how open data is being actually used in open-source projects hosted in Github) for supporting open data publication. Bio of the speaker: Jose-Norberto Mazón holds a PhD from the University of Alicante (Spain). He is head of the "Cátedra Telefónica" on Big Data and coordinator of the Computing degree at the University of Alicante. He is also member of the WaKe research group at the University of Alicante. His research work focuses on open data management, data integration and business intelligence within "big data" scenarios, and their application to the tourism domain (smart tourism destinations). He has published his research in international journals, such as Decision Support Systems, Information Sciences, Data & Knowledge Engineering or ACM Transaction on the Web. Finally, he is involved in the open data project in the University of Alicante, including its open data portal at http://datos.ua.es

A DST-based Approach for Construction Project Risk Analysis

Despite its huge potential in risk analysis, the Dempster–Shafer Theory of Evidence (DST) has not received enough attention in construction management. This paper presents a DST-based approach for structuring personal experience and professional judgment when assessing construction project risk. DST was innovatively used to tackle the problem of lacking sufficient information through enabling analysts to provide incomplete assessments. Risk cost is used as a common scale for measuring risk impact on the various project objectives, and the Evidential Reasoning algorithm is suggested as a novel alternative for aggregating individual assessments. A spreadsheet-based decision support system (DSS) was devised to facilitate the proposed approach. Four case studies were conducted to examine the approach's viability. Senior managers in four British construction companies tried the DSS and gave very promising feedback. The paper concludes that the proposed methodology may contribute to bridging the gap between theory and practice of construction risk assessment.

Probabilistic Graphical Modelling for Software Product Lines: A Frameweork for Modeling and Reasoning under Uncertainty

This work provides a holistic investigation into the realm of feature modeling within software product lines. The work presented identifies limitations and challenges within the current feature modeling approaches. Those limitations include, but not limited to, the dearth of satisfactory cognitive presentation, inconveniency in scalable systems, inflexibility in adapting changes, nonexistence of predictability of models behavior, as well as the lack of probabilistic quantification of model’s implications and decision support for reasoning under uncertainty. The work in this thesis addresses these challenges by proposing a series of solutions. The first solution is the construction of a Bayesian Belief Feature Model, which is a novel modeling approach capable of quantifying the uncertainty measures in model parameters by a means of incorporating probabilistic modeling with a conventional modeling approach. The Bayesian Belief feature model presents a new enhanced feature modeling approach in terms of truth quantification and visual expressiveness. The second solution takes into consideration the unclear support for the reasoning under the uncertainty process, and the challenging constraint satisfaction problem in software product lines. This has been done through the development of a mathematical reasoner, which was designed to satisfy the model constraints by considering probability weight for all involved parameters and quantify the actual implications of the problem constraints. The developed Uncertain Constraint Satisfaction Problem approach has been tested and validated through a set of designated experiments. Profoundly stating, the main contributions of this thesis include the following: • Develop a framework for probabilistic graphical modeling to build the purported Bayesian belief feature model. • Extend the model to enhance visual expressiveness throughout the integration of colour degree variation; in which the colour varies with respect to the predefined probabilistic weights. • Enhance the constraints satisfaction problem by the uncertainty measuring of the parameters truth assumption. • Validate the developed approach against different experimental settings to determine its functionality and performance.

Anticipating future risk in social-ecological systems using fuzzy cognitive mapping: the case of wildfire in the Chiquitania, Bolivia

Understanding complex social-ecological systems, and anticipating how they may respond to rapid change, requires an approach that incorporates environmental, social, economic, and policy factors, usually in a context of fragmented data availability. We employed fuzzy cognitive mapping (FCM) to integrate these factors in the assessment of future wildfire risk in the Chiquitania region, Bolivia. In this region, dealing with wildfires is becoming increasingly challenging because of reinforcing feedbacks between multiple drivers. We conducted semistructured interviews and constructed different FCMs in focus groups to understand the regional dynamics of wildfire from diverse perspectives. We used FCM modelling to evaluate possible adaptation scenarios in the context of future drier climatic conditions. Scenarios also considered possible failure to respond in time to the emergent risk. This approach proved of great potential to support decision making for risk management. It helped identify key forcing variables and generate insights into potential risks and trade-offs of different strategies. The “Hands-off” scenario resulted in amplified impacts driven by intensifying trends, affecting particularly the agricultural production under drought conditions. The “Fire management” scenario, which adopted a bottom-up approach to improve controlled burning, showed less trade-offs between wildfire risk reduction and production compared with the “Fire suppression” scenario. Findings highlighted the importance of considering strategies that involve all actors who use fire, and the need to nest these strategies for a more systemic approach to manage wildfire risk. The FCM model could be used as a decision-support tool and serve as a “boundary object” to facilitate collaboration and integration of different perceptions of fire in the region. This approach also has the potential to inform decisions in other dynamic frontier landscapes around the world that are facing increased risk of large wildfires.

Discrete-event Simulation and Optimization to Improve the Performance of a Healthcare System

Thesis (Ph.D.)--University of Washington, 2016-08

Modelo de decisão multicritério para seleções interciclo das universidades novas: estudo na Universidade Federal do Rio Grande do Norte

The discussions wherein develop proposals for university reform in Brazil include, among other things, the conception of the university titled "New University", whose structural origin comes from the bill of higher education reform and unification of the foundations of education European upper (Bologna process). At its core, the Bologna process has imposed a series of transformations, among which, the promotion of mobility, as a stimulus to interinstitutional cooperation to enable an better and bigger qualification of the students. Nevertheless, what we see is that this point is one of the main points made flawed by Brazilian institutions that have adopted this model of higher education. An example is the Bachelor of Science and Technology - BC&T, Federal University of Rio Grande do Norte - UFRN, where there are problems of the internal order, represented by the problem of the reusing of the disciplines, such also of external order, in cases of transfers interinstitutional. Because of this, and knowing that this is a typical problem in which multiple criteria are involved, the aim of this study is to propose a multicriteria model for selection of interciclo of the BC&T of the UFRN which addresses the issue of mobility. For this, this study was of exploratory and study case nature, use as tools of data collection, the bibliographic and documentary research, as well as semi-structured interviews. For the elaboration of the model, were used the five phases most commonly used in the modeling of problems in operational research in a sample of 91 students of BC&T. As a result, we obtained a model that addresses the issue of internal and external mobility of the school and that, moreover, was also more robust and fair than the current model of BC&T and also what is used in other courses of the UFRN, taking into consideration the expected results by the decision makers

Sistema de predição de alarmes em processos industriais por classificação não-supervisionada

Um sistema de predição de alarmes com a finalidade de auxiliar a implantação de uma política de manutenção preditiva industrial e de constituir-se em uma ferramenta gerencial de apoio à tomada de decisão é proposto neste trabalho. O sistema adquire leituras de diversos sensores instalados na planta, extrai suas características e avalia a saúde do equipamento. O diagnóstico e prognóstico implica a classificação das condições de operação da planta. Técnicas de árvores de regressão e classificação não-supervisionada são utilizadas neste artigo. Uma amostra das medições de 73 variáveis feitas por sensores instalados em uma usina hidrelétrica foi utilizada para testar e validar a proposta. As medições foram amostradas em um período de 15 meses.

An iterative analytical design framework for the optimal designing of an off-grid renewable energy based hybrid smart micro-grid

Creative ways of utilising renewable energy sources in electricity generation especially in remote areas and particularly in countries depending on imported energy, while increasing energy security and reducing cost of such isolated off-grid systems, is becoming an urgently needed necessity for the effective strategic planning of Energy Systems. The aim of this research project was to design and implement a new decision support framework for the optimal design of hybrid micro grids considering different types of different technologies, where the design objective is to minimize the total cost of the hybrid micro grid while at the same time satisfying the required electric demand. Results of a comprehensive literature review, of existing analytical, decision support tools and literature on HPS, has identified the gaps and the necessary conceptual parts of an analytical decision support framework. As a result this research proposes and reports an Iterative Analytical Design Framework (IADF) and its implementation for the optimal design of an Off-grid renewable energy based hybrid smart micro-grid (OGREH-SμG) with intra and inter-grid (μG2μG & μG2G) synchronization capabilities and a novel storage technique. The modelling design and simulations were based on simulations conducted using HOMER Energy and MatLab/SIMULINK, Energy Planning and Design software platforms. The design, experimental proof of concept, verification and simulation of a new storage concept incorporating Hydrogen Peroxide (H2O2) fuel cell is also reported. The implementation of the smart components consisting Raspberry Pi that is devised and programmed for the semi-smart energy management framework (a novel control strategy, including synchronization capabilities) of the OGREH-SμG are also detailed and reported. The hybrid μG was designed and implemented as a case study for the Bayir/Jordan area. This research has provided an alternative decision support tool to solve Renewable Energy Integration for the optimal number, type and size of components to configure the hybrid μG. In addition this research has formulated and reported a linear cost function to mathematically verify computer based simulations and fine tune the solutions in the iterative framework and concluded that such solutions converge to a correct optimal approximation when considering the properties of the problem. As a result of this investigation it has been demonstrated that, the implemented and reported OGREH-SμG design incorporates wind and sun powered generation complemented with batteries, two fuel cell units and a diesel generator is a unique approach to Utilizing indigenous renewable energy with a capability of being able to synchronize with other μ-grids is the most effective and optimal way of electrifying developing countries with fewer resources in a sustainable way, with minimum impact on the environment while also achieving reductions in GHG. The dissertation concludes with suggested extensions to this work in the future.

'Artificial Immune Systems Tutorial'

The biological immune system is a robust, complex, adaptive system that defends the body from foreign pathogens. It is able to categorize all cells (or molecules) within the body as self-cells or non-self cells. It does this with the help of a distributed task force that has the intelligence to take action from a local and also a global perspective using its network of chemical messengers for communication. There are two major branches of the immune system. The innate immune system is an unchanging mechanism that detects and destroys certain invading organisms, whilst the adaptive immune system responds to previously unknown foreign cells and builds a response to them that can remain in the body over a long period of time. This remarkable information processing biological system has caught the attention of computer science in recent years. A novel computational intelligence technique, inspired by immunology, has emerged, called Artificial Immune Systems. Several concepts from the immune have been extracted and applied for solution to real world science and engineering problems. In this tutorial, we briefly describe the immune system metaphors that are relevant to existing Artificial Immune Systems methods. We will then show illustrative real-world problems suitable for Artificial Immune Systems and give a step-by-step algorithm walkthrough for one such problem. A comparison of the Artificial Immune Systems to other well-known algorithms, areas for future work, tips & tricks and a list of resources will round this tutorial off. It should be noted that as Artificial Immune Systems is still a young and evolving field, there is not yet a fixed algorithm template and hence actual implementations might differ somewhat from time to time and from those examples given here.

A generic method of engagement to elicit regional coastal management options

Stakeholder engagement is important for successful management of natural resources, both to make effective decisions and to obtain support. However, in the context of coastal management, questions remain unanswered on how to effectively link decisions made at the catchment level with objectives for marine biodiversity and fisheries productivity. Moreover, there is much uncertainty on how to best elicit community input in a rigorous manner that supports management decisions. A decision support process is described that uses the adaptive management loop as its basis to elicit management objectives, priorities and management options using two case studies in the Great Barrier Reef, Australia. The approach described is then generalised for international interest. A hierarchical engagement model of local stakeholders, regional and senior managers is used. The result is a semi-quantitative generic elicitation framework that ultimately provides a prioritised list of management options in the context of clearly articulated management objectives that has widespread application for coastal communities worldwide. The case studies show that demand for local input and regional management is high, but local influences affect the relative success of both engagement processes and uptake by managers. Differences between case study outcomes highlight the importance of discussing objectives prior to suggesting management actions, and avoiding or minimising conflicts at the early stages of the process. Strong contributors to success are a) the provision of local information to the community group, and b) the early inclusion of senior managers and influencers in the group to ensure the intellectual and time investment is not compromised at the final stages of the process. The project has uncovered a conundrum in the significant gap between the way managers perceive their management actions and outcomes, and community's perception of the effectiveness (and wisdom) of these same management actions.

Modelo de Scoring para o Crédito à Habitação: Um estudo de caso em Portugal

Mestrado em Contabilidade e Gestão das Instituições Financeiras