Critical events in mechanically ventilated patients

Mechanical Ventilation is an artificial way to help a Patient to breathe. This procedure is used to support patients with respiratory diseases however in many cases it can provoke lung damages, Acute Respiratory Diseases or organ failure. With the goal to early detect possible patient breath problems a set of limit values was defined to some variables monitored by the ventilator (Average Ventilation Pressure, Compliance Dynamic, Flow, Peak, Plateau and Support Pressure, Positive end-expiratory pressure, Respiratory Rate) in order to create critical events. A critical event is verified when a patient has a value higher or lower than the normal range defined for a certain period of time. The values were defined after elaborate a literature review and meeting with physicians specialized in the area. This work uses data streaming and intelligent agents to process the values collected in real-time and classify them as critical or not. Real data provided by an Intensive Care Unit were used to design and test the solution. In this study it was possible to understand the importance of introduce critical events for Mechanically Ventilated Patients. In some cases a value is considered critical (can trigger an alarm) however it is a single event (instantaneous) and it has not a clinical significance for the patient. The introduction of critical events which crosses a range of values and a pre-defined duration contributes to improve the decision-making process by decreasing the number of false positives and having a better comprehension of the patient condition.

Predicting triage waiting time in maternity emergency care by means of data mining

Healthcare organizations often benefit from information technologies as well as embedded decision support systems, which improve the quality of services and help preventing complications and adverse events. In Centro Materno Infantil do Norte (CMIN), the maternal and perinatal care unit of Centro Hospitalar of Oporto (CHP), an intelligent pre-triage system is implemented, aiming to prioritize patients in need of gynaecology and obstetrics care in two classes: urgent and consultation. The system is designed to evade emergency problems such as incorrect triage outcomes and extensive triage waiting times. The current study intends to improve the triage system, and therefore, optimize the patient workflow through the emergency room, by predicting the triage waiting time comprised between the patient triage and their medical admission. For this purpose, data mining (DM) techniques are induced in selected information provided by the information technologies implemented in CMIN. The DM models achieved accuracy values of approximately 94% with a five range target distribution, which not only allow obtaining confident prediction models, but also identify the variables that stand as direct inducers to the triage waiting times.

Predicting pre-triage waiting time in a maternity emergency room through data mining

An unsuitable patient flow as well as prolonged waiting lists in the emergency room of a maternity unit, regarding gynecology and obstetrics care, can affect the mother and child’s health, leading to adverse events and consequences regarding their safety and satisfaction. Predicting the patients’ waiting time in the emergency room is a means to avoid this problem. This study aims to predict the pre-triage waiting time in the emergency care of gynecology and obstetrics of Centro Materno Infantil do Norte (CMIN), the maternal and perinatal care unit of Centro Hospitalar of Oporto, situated in the north of Portugal. Data mining techniques were induced using information collected from the information systems and technologies available in CMIN. The models developed presented good results reaching accuracy and specificity values of approximately 74% and 94%, respectively. Additionally, the number of patients and triage professionals working in the emergency room, as well as some temporal variables were identified as direct enhancers to the pre-triage waiting time. The imp lementation of the attained knowledge in the decision support system and business intelligence platform, deployed in CMIN, leads to the optimization of the patient flow through the emergency room and improving the quality of services.

Methode und Anwendungen einer wissensorientierten Fabrikmodellierung

Factory planning, Factory modeling, Semantic Knowledge Representation, Digital Factory Planning, Digital Factory

Catalan Policies and Experiences on Cooperative Repositories

The Centre de Supercomputació de Catalunya (CESCA) together with the Consorci de Biblioteques Universitàries de Catalunya (CBUC) started in 1999 a cooperative repository, named TDR, to file in digital format the full-text of the read thesis at the universities of our country to spread them worldwide in open access preserving the intellectual copyright of the authors. This became operational in 2001 and today it is a service fully consolidated not only among the Catalan universities, but also used by other Spanish universities. Since then, there are four additional cooperative repositories which have been created: RECERCAT, for research papers; RACO, for scientific, cultural and erudite Catalan magazines; PADICAT, for archiving Catalan web sites; and MDC, for Catalan digital collections of pictures, maps, posters, old magazines... These five repositories have some common characteristics: they are open access, that is, they are accessible on the internet for free; they mostly comply with the Open Archive Initiative interoperability protocol for facilitating the efficient dissemination of content; and they have been built in a cooperative manner so that it is easy to adopt common procedures and to share the repository developing and managing costs, it permits more visibility of the indexed documents throughout the search engines, and a better provision for long-term preservation can be made. In this paper we present the common policy established for the Catalan cooperative repositories, we describe the five of them briefly, and we comment on the results obtained of our 6-year experience since the first one became operational.

Toward interoperable bioscience data.

To make full use of research data, the bioscience community needs to adopt technologies and reward mechanisms that support interoperability and promote the growth of an open 'data commoning' culture. Here we describe the prerequisites for data commoning and present an established and growing ecosystem of solutions using the shared 'Investigation-Study-Assay' framework to support that vision.

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The use of the Internet now has a specific purpose: to find information. Unfortunately, the amount of data available on the Internet is growing exponentially, creating what can be considered a nearly infinite and ever-evolving network with no discernable structure. This rapid growth has raised the question of how to find the most relevant information. Many different techniques have been introduced to address the information overload, including search engines, Semantic Web, and recommender systems, among others. Recommender systems are computer-based techniques that are used to reduce information overload and recommend products likely to interest a user when given some information about the user's profile. This technique is mainly used in e-Commerce to suggest items that fit a customer's purchasing tendencies. The use of recommender systems for e-Government is a research topic that is intended to improve the interaction among public administrations, citizens, and the private sector through reducing information overload on e-Government services. More specifically, e-Democracy aims to increase citizens' participation in democratic processes through the use of information and communication technologies. In this chapter, an architecture of a recommender system that uses fuzzy clustering methods for e-Elections is introduced. In addition, a comparison with the smartvote system, a Web-based Voting Assistance Application (VAA) used to aid voters in finding the party or candidate that is most in line with their preferences, is presented.

Inseguridad ciudadana subjetiva/miedo al delito: límites para la viabilidad de la transferencia de políticas de seguridad

Proyecto de investigación realizado a partir de una estancia en el Centre of Criminology de la University of Toronto, Canadà, entre 2006 y 2008. El miedo al delito como ámbito temático lleva 40 años de andadura y cuenta con cientos de investigaciones en su acervo. Dicha subdisciplina ha utilizado la expresión “miedo al delito” para referirse a un conjunto de conceptos académicos que ella misma va desarrollando, así como a lo que considera una experiencia subjetiva que pretende estudiar. Tanto el concepto como la experiencia han sido vagamente catalogados de respuesta emocional frente al delito o imágenes asociadas a éste. A pesar de los estudios más empíricos y de las teorías más positivistas, que tratan el miedo al delito como un fenómeno que puede ser medido y a cuyo conocimiento nos podemos ir aproximando cada vez con mayor precisión, con el trabajo de este proyecto se puede concluir que el miedo al delito constituye un elemento semántico-conceptual de las categorías académica y popular de delito. Los enfoques culturalistas o hermenéuticos han apuntado esta cuestión pero, simultáneamente, han seguido admitiendo la complementariedad entre enfoques. En principio, admitir el valor constitutivo del miedo al delito en la noción de delito parece que no excluye la necesidad de conocer si los temores a ser víctima de un delito han aumentado en nuestra ciudad, ni el saber por qué ello ha sido así. Apropiarse de tales saberes tal vez sea la única forma de aislar factores discretos que puedan ser manipulados en políticas públicas para erradicar el temor cuyo incremento se supone verificado con las mediciones. Sin embargo, puesto que lo registrado han sido actitudes cognitivas y no emociones, los eventuales programas de intervención deberían ser ideados en el mejor de los casos, con la misma complejidad que la propia formación de creencias lo que lo haría inoperativo. Acción bianual.

How collaboration could contribute to make Catalan journals visible on the Internet?

Cooperation between libraries is a universal language spoken in different dialects. In 1996 the libraries of the state-funded universities and the National Library of Catalonia (Spain) formed the Consortium of Academic Libraries of Catalonia (CBUC) to act as a channel for cooperation. The organization and activities of CBUC are an example of how this universal language has been adapted to the specific characteristics of the Libraries of Catalonia. Catalonia is an autonomous region of Spain with 7 million inhabitants with its own language, history and traditions and with a strong feeling of own identity that facilitates the cooperation. Thanks to this (and also to the hard work of the member libraries), since then, CBUC has created a union catalogue, an interlibrary lending program, the Digital Library of Catalonia, a cooperative store, different cooperatives repositories and other cooperation programs. One of these cooperatives repositories is RACO (Catalan Journals in Open Access, www.raco.cat) where can be consulted, in open access, the full-text articles of scientific, cultural and scholar Catalan journals. The main purpose of RACO is to increase the visibility and searches of the journals included and to spread the scientific and academic production published in Catalonia. This purpose makes specific in three aims: encourage the electronic edition of Catalan journals; be the interface that allows the whole search of all the journals and provide the instruments for its preservation. There are currently 244 journals in RACO, that includes more than 85.000 articles (80% in OA) from 50 publishing institutions. Since it got into operation it has had more than 4 millions of queries. These 244 journals offer the full-text of all the published issues. Nevertheless, some journal can have a delay between the introduction of the table of contents and the full-text for the recent issues. From 2005 we have a plan of retrospective digitization that has allowed to digitize more than 350.000 pages of back issues. The RACO repository works with the open source program OJS (Open Journal Systems, http://pkp.sfu.ca/ojs/) and uses Dublin Core Metadata and the interoperability protocol created by Open Archives Initiative (OAI) which allows to increase the visibility of the articles published in journals offering oneself together with other international repositories.

Anàlisi, disseny i implementació d'una eina de simulació per a l'estudi de la interoperabilitat mitjançant conversió d'atributs en entorns multi-domini

El present projecte part d’un estudi sobre el tractament de situacions d’emergència, on es considera que una infraestructura de comunicació, sobre aquest tipus d’escenaris, ha d’implementar la interoperabilitat i el control d’accés, entre els diferents elements que hi participen, utilitzant la conversió d’atributs. Per tal de materialitzar aquest estudi s’ha realitzat un anàlisi de les necessitats de l’aplicació i un disseny detallat dels mòduls que el formen. S’ha implementat d’aquesta manera una eina de simulació per entorns multi-domini. Finalment s’han realitzat un conjunt de proves per comprovar la seva fiabilitat respecte l’estudi original.

Gestió de la confiança en infraestructures de clau pública (PKI)

En aquest projecte s’ha presentat un nou model de desenvolupament de la confiança, més flexible que els anteriors, des del punt de vista de l’usuari. El model proposat es basa en llistes de confiança per tal de resoldre els problemes d’interoperabilitat entre dominis de PKI. Aquesta proposta es basa en un model jeràrquic de PKI on s’estén la confiança mitjançant uns proveïdors de confiança.

Clinicopathologic correlates in the oldest-old: Commentary on "No disease in the brain of a 115-year-old woman".

den Dunnen et al. [den Dunnen, W.F.A., Brouwer, W.H., Bijlard, E., Kamphuis, J., van Linschoten, K., Eggens-Meijer, E., Holstege, G., 2008. No disease in the brain of a 115-year-old woman. Neurobiol. Aging] had the opportunity to follow up the cognitive functioning of one of the world's oldest woman during the last 3 years of her life. They performed two neuropsychological evaluations at age 112 and 115 that revealed a striking preservation of immediate recall abilities and orientation. In contrast, working memory, retrieval from semantic memory and mental arithmetic performances declined after age 112. Overall, only a one-point decrease of MMSE score occurred (from 27 to 26) reflecting the remarkable preservation of cognitive abilities. The neuropathological assessment showed few neurofibrillary tangles (NFT) in the hippocampal formation compatible with Braak staging II, absence of amyloid deposits and other types of neurodegenerative lesions as well as preservation of neuron numbers in locus coeruleus. This finding was related to a striking paucity of Alzheimer disease (AD)-related lesions in the hippocampal formation. The present report parallels the early descriptions of rare "supernormal" centenarians supporting the dissociation between brain aging and AD processes. In conjunction with recent stereological analyses in cases aged from 90 to 102 years, it also points to the marked resistance of the hippocampal formation to the degenerative process in this age group and possible dissociation between the occurrence of slight cognitive deficits and development of AD-related pathologic changes in neocortical areas. This work is discussed in the context of current efforts to identify the biological and genetic parameters of human longevity.

Generating controlled image sets in cognitive neuroscience research.

The investigation of perceptual and cognitive functions with non-invasive brain imaging methods critically depends on the careful selection of stimuli for use in experiments. For example, it must be verified that any observed effects follow from the parameter of interest (e.g. semantic category) rather than other low-level physical features (e.g. luminance, or spectral properties). Otherwise, interpretation of results is confounded. Often, researchers circumvent this issue by including additional control conditions or tasks, both of which are flawed and also prolong experiments. Here, we present some new approaches for controlling classes of stimuli intended for use in cognitive neuroscience, however these methods can be readily extrapolated to other applications and stimulus modalities. Our approach is comprised of two levels. The first level aims at equalizing individual stimuli in terms of their mean luminance. Each data point in the stimulus is adjusted to a standardized value based on a standard value across the stimulus battery. The second level analyzes two populations of stimuli along their spectral properties (i.e. spatial frequency) using a dissimilarity metric that equals the root mean square of the distance between two populations of objects as a function of spatial frequency along x- and y-dimensions of the image. Randomized permutations are used to obtain a minimal value between the populations to minimize, in a completely data-driven manner, the spectral differences between image sets. While another paper in this issue applies these methods in the case of acoustic stimuli (Aeschlimann et al., Brain Topogr 2008), we illustrate this approach here in detail for complex visual stimuli.

The role of multisensory memories in unisensory object discrimination.

Past multisensory experiences can influence current unisensory processing and memory performance. Repeated images are better discriminated if initially presented as auditory-visual pairs, rather than only visually. An experience's context thus plays a role in how well repetitions of certain aspects are later recognized. Here, we investigated factors during the initial multisensory experience that are essential for generating improved memory performance. Subjects discriminated repeated versus initial image presentations intermixed within a continuous recognition task. Half of initial presentations were multisensory, and all repetitions were only visual. Experiment 1 examined whether purely episodic multisensory information suffices for enhancing later discrimination performance by pairing visual objects with either tones or vibrations. We could therefore also assess whether effects can be elicited with different sensory pairings. Experiment 2 examined semantic context by manipulating the congruence between auditory and visual object stimuli within blocks of trials. Relative to images only encountered visually, accuracy in discriminating image repetitions was significantly impaired by auditory-visual, yet unaffected by somatosensory-visual multisensory memory traces. By contrast, this accuracy was selectively enhanced for visual stimuli with semantically congruent multisensory pasts and unchanged for those with semantically incongruent multisensory pasts. The collective results reveal opposing effects of purely episodic versus semantic information from auditory-visual multisensory events. Nonetheless, both types of multisensory memory traces are accessible for processing incoming stimuli and indeed result in distinct visual object processing, leading to either impaired or enhanced performance relative to unisensory memory traces. We discuss these results as supporting a model of object-based multisensory interactions.

Dynamics of phonological-phonetic encoding in word production: Evidence from diverging ERPs between stroke patients and controls.

While the dynamics of lexical-semantic and lexical-phonological encoding in word production have been investigated in several event-related potential (ERP) studies, the estimated time course of phonological-phonetic encoding is the result of rather indirect evidence. We investigated the dynamics of phonological-phonetic encoding combining ERP analyses covering the entire encoding process in picture naming and word reading tasks by comparing ERP modulations in eight brain-damaged speakers presenting impaired phonological-phonetic encoding relative to 16 healthy controls. ERPs diverged between groups in terms of local waveform amplitude and global topography at ∼400ms after stimulus onset in the picture naming task and at ∼320-350ms in word reading and sustained until 100ms before articulation onset. These divergences appeared in later time windows than those found in patients with underlying lexical-semantic and lexical-phonological impairment in previous studies, providing evidence that phonological-phonetic encoding is engaged around 400ms in picture naming and around 330ms in word reading.