Diagnosing cardiac disease states using a minimal cardiovascular model

Cardiovascular disease states are difficult to diagnose due to a variety of underlying dysfunctions combined with reflex mechanisms. To provide more consistent care a cardiovascular system model is combined with an efficient patient-specific parameter identification method. The goal is to identify the patient’s condition and to predict the future patient-specific reaction, making this approach a potential means for model-based guided therapy. The model and parameter-identification method are validated using clinical haemodynamic data measured during drug induced porcine pulmonary embolism experiments (N=6) and PEEP titration experiments (N=6). Identified model parameters are correlated to create predictive measures of haemodynamic changes to clinical therapy or patient condition. Prediction is tested for observed changes in arterial pressure (AP), pulmonary arterial pressure (PAP) and stroke volume (SV) as caused by a clinical change in PEEP. The parameter-identification method tracked pulmonary embolism in porcine data from an initial healthy to the disease state. The full range of haemodynamic responses was captured with mean errors of 4.1% in the pressures and 3.1% in the volumes. Pulmonary resistance increased significantly with the onset of embolism, as expected, with the percentage increase ranging from 89.98% to 261.44% of the initial state. Changes in AP, PAP and SV due to an increase in PEEP were predicted with a mean absolute percentage error less than 10% for 6 data sets. These results provide a first clinical validation of this model-based diagnostic therapeutic decision support approach to haemodynamic management

Model-based diagnosis of acute pulmonary embolism - results from a porcine model

peer reviewe

Future quality improvements in critical care in sedation management and cardiovascular modeling

The overall approach of combining computational models and methods with fundamental physiology offers significant potential for improving patient management in critical care. In particular, they offer the opportunity to create more consistent methods that increase survival and reduce iatrogenic harm, while also reducing costs through improved productivity, reduced length of stay and reduced number of interventions. Many of these methods may eventually be adopted in any intensive care unit to improve the overall quality of healthcare provided

Physiological modeling, tight glycemic control, and the ICU clinician: what are models and how can they affect practice?

Critically ill patients are highly variable in their response to care and treatment. This variability and the search for improved outcomes have led to a significant increase in the use of protocolized care to reduce variability in care. However, protocolized care does not address the variability of outcome due to inter- and intra-patient variability, both in physiological state, and the response to disease and treatment. This lack of patient-specificity defines the opportunity for patient-specific approaches to diagnosis, care, and patient management, which are complementary to, and fit within, protocolized approaches

Using structured eradication feasibility assessment to prioritize the management of new and emerging invasive alien species in Europe

Prioritizing the management of invasive alien species (IAS) is of global importance and within Europe integral to the EU IAS regulation. To prioritize management effectively, the risks posed by IAS need to be assessed, but so too does the feasibility of their management. While the risk of IAS to the EU has been assessed, the feasibility of management has not. We assessed the feasibility of eradicating 60 new (not yet established) and 35 emerging (established with limited distribution) species that pose a threat to the EU, as identified by horizon scanning. The assessment was carried out by 34 experts in invasion management from across Europe, applying the Non‐Native Risk Management scheme to defined invasion scenarios and eradication strategies for each species, assessing the feasibility of eradication using seven key risk management criteria. Management priorities were identified by combining scores for risk (derived from horizon scanning) and feasibility of eradication. The results show eradication feasibility score and risk score were not correlated, indicating that risk management criteria evaluate different information than risk assessment. In all, 17 new species were identified as particularly high priorities for eradication should they establish in the future, whereas 14 emerging species were identified as priorities for eradication now. A number of species considered highest priority for eradication were terrestrial vertebrates, a group that has been the focus of a number of eradication attempts in Europe. However, eradication priorities also included a diverse range of other taxa (plants, invertebrates and fish) suggesting there is scope to broaden the taxonomic range of attempted eradication in Europe. We demonstrate that broad scale structured assessments of management feasibility can help prioritize IAS for management. Such frameworks are needed to support evidence‐based decision‐making

Minimally invasive, patient specific, beat-by-beat estimation of left ventricular time varying elastance.

peer reviewedBACKGROUND: The aim of this paper was to establish a minimally invasive method for deriving the left ventricular time varying elastance (TVE) curve beat-by-beat, the monitoring of which's inter-beat evolution could add significant new data and insight to improve diagnosis and treatment. The method developed uses the clinically available inputs of aortic pressure, heart rate and baseline end-systolic volume (via echocardiography) to determine the outputs of left ventricular pressure, volume and dead space volume, and thus the TVE curve. This approach avoids directly assuming the shape of the TVE curve, allowing more effective capture of intra- and inter-patient variability. RESULTS: The resulting TVE curve was experimentally validated against the TVE curve as derived from experimentally measured left ventricular pressure and volume in animal models, a data set encompassing 46,318 heartbeats across 5 Pietrain pigs. This simulated TVE curve was able to effectively approximate the measured TVE curve, with an overall median absolute error of 11.4% and overall median signed error of -2.5%. CONCLUSIONS: The use of clinically available inputs means there is potential for real-time implementation of the method at the patient bedside. Thus the method could be used to provide additional, patient specific information on intra- and inter-beat variation in heart function

Non-native Species and the Aesthetics of Nature

Howhumansperceiveandjudgenatureandrelateittotheirlifeisshaped by emotional, cognitive, cultural, and social factors. Whether a species is consid- ered native, non-native, or invasive can affect such aesthetics of nature by interact- ing with our emotions, affronting or confirming our cognitive categories, or engaging in our social, economic, and cultural worlds. Consequently, how humans perceive and judge the presence of such species, or how they judge an ecosystem or land- scape change triggered by them, is not fixed or easy to define. Here, some of the psychological, cognitive, and social dimensions that influence how humans judge non-native and invasive species and their effects on ecosystems are reviewed. It is concluded, at least in the case of non-native species, that the reduction of aesthetics to a ‘service’ is problematic, for it occludes the complex psychological and social processes that shape divergent perceptions of changing species distributions

How environmental managers perceive and approach the issue of invasive species: the case of Japanese knotweed s.l. (Rhône River, France)

We would like to thank Springer for publishing our article. The final publication is available at http://link.springer.com/article/10.1007%2Fs10530-015-0969-1International audienceStudying the perceptions of stakeholders or interested parties is a good way to better understand behaviours and decisions. This is especially true for the management of invasive species such as Japanese knotweed s.l. This plant has spread widely in the Rhône basin, where significant financial resources have been devoted to its management. However, no control technique is recognized as being particularly effective. Many uncertainties remain and many documents have been produced by environmental managers to disseminate current knowledge about the plant and its management. This article aims at characterizing the perceptions that environmental managers have of Japanese knotweed s.l. A discourse analysis was conducted on the printed documentation produced about Japanese knotweed s.l. by environmental managers working along the Rhône River (France). The corpus was both qualitatively and quantitatively analysed. The results indicated a diversity of perceptions depending on the type of environmental managers involved, as well as the geographicalareas and scales on which they acted. Whereas some focused on general knowledge relating to the origins and strategies of colonization, others emphasized the diversity and efficacy of the prospective eradication techniques. There is a real interest in implementing targeted actions to meet local issues. To do so, however, these issues must be better defined. This is a challenging task, as it must involve all types of stakeholders

A scenario‐guided strategy for the future management of biological invasions

Future dynamics of biological invasions are highly uncertain because they depend on multiple social–ecological drivers. We used a scenario-based approach to explore potential management options for invasive species in Europe. During two workshops involving a multidisciplinary team of experts, we developed a management strategy arranged into 19 goals relating to policy, research, public awareness, and biosecurity. We conceived solutions for achieving these goals under different plausible future scenarios, and identified four interrelated recommendations around which any long-term strategy for managing invasive species can be structured: (1) a European biosecurity regime, (2) a dedicated communication strategy, (3) data standardization and management tools, and (4) a monitoring and assessment system. Finally, we assessed the feasibility of the management strategy and found substantial differences among scenarios. Collectively, our results indicate that it is time for a new strategy for managing biological invasions in Europe, one that is based on a more integrative approach across socioeconomic sectors and countries