Analysis of Housing Policy in the Field of Social Housing

Tato práce se zabývá problematikou sociálního bydlení v ČR a obsahuje i popis systémů sociálního bydlení ve třech evropských zemích. Součástí práce je dále charakteristika uplatňované formy sociálního bydlení ve třech obcích Pardubického kraje. Zvláštní pozornost je věnována porovnání uplatňované formy sociálního bydlení ve vybraných obcích v návaznosti k navrhovaným změnám, které by měly vést k vytvoření nového systému sociálního bydlení, a to podle Koncepce sociálního bydlení pro osoby v bytové nouzi ČR 2015-2025.This thesis deals with issue of social housing in the Czech Republic and contains a description of social housing in three European countries. The work also describes applied form of social housing in three municipalities in the Pardubice Region. Special attention is dedicated to compare social housing system in selected municipalities with the proposed changes, which should lead to the creation of new social housing system according to the Concept of social housing for people in need of housing CR 2015-2025.Fakulta ekonomicko-správn

Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case-control study.

OBJECTIVE Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear. DESIGN : We performed an electronic health record-based quasi-experimental ICU study after cardiac surgery. We applied propensity score matching and compared the physiological changes after FBT episodes to matched control episodes where despite equivalent physiology no fluid bolus was given. SETTING The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital. PARTICIPANTS The study included 2,736 patients who underwent Coronary Artery Bypass Grafting and/or heart valve surgery. MAIN OUTCOME MEASURES Changes in cardiac output (CO) and mean arterial pressure (MAP) during the 60 minutes following FBT. RESULTS We analysed 3572 matched fluid bolus (FB) episodes. After FBT, but not in control episodes, CO increased within 10 min, with a maximum increase of 0.2 l/min (95%CI 0.1 to 0.2) or 4% above baseline at 40 min (p 10% from baseline in 60.6% of FBT and 49.1% of control episodes (p 10% in 51.7% of FB episodes compared to 53.4% of controls. Finally, FBT was not associated with changes in acid-base status or oxygen delivery. CONCLUSION In this quasi-experimental comparative ICU study in cardiac surgery patients, FBT was associated with statistically significant but numerically small increases in CO. Nearly half of FBT failed to induce a positive CO or MAP response

An automated retrospective VAE-surveillance tool for future quality improvement studies.

Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22'442 ventilated admissions with a total of 37'221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1-22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93-1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies

Analysis of L-leucine amino acid transporter species activity and gene expression by human blood brain barrier hCMEC/D3 model reveal potential LAT1, LAT4, B0AT2 and y+LAT1 functional cooperation

In the CNS, amino acid (AA) neurotransmitters and neurotransmitter precursors are subject to tight homeostatic control mediated by blood-brain barrier (BBB) solute carrier amino acid transporters (AATs). Since the BBB is composed of multiple closely apposed cell types and opportunities for human in vivo studies are limited, we used in vitro and computational approaches to investigate human BBB AAT activity and regulation. Quantitative real-time PCR (qPCR) of the human BBB endothelial cell model hCMEC/D3 (D3) was used to determine expression of selected AAT, tight junction (TJ), and signal transduction (ST) genes under various culture conditions. L-leucine uptake data were interrogated with a computational model developed by our group for calculating AAT activity in complex cell cultures. This approach is potentially applicable to in vitro cell culture drug studies where multiple “receptors” may mediate observed responses. Of 7 Leu AAT genes expressed by D3 only the activity of SLC7A5-SLC3A2/LAT1-4F2HC (LAT1), SLC43A2/LAT4 (LAT4) and sodium-dependent AATs, SLC6A15/B0AT2 (B0AT2), and SLC7A7/y+LAT1 (y+LAT1) were calculated to be required for Leu uptake. Therefore, D3 Leu transport may be mediated by a potentially physiologically relevant functional cooperation between the known BBB AAT, LAT1 and obligatory exchange (y+LAT1), facilitative diffusion (LAT4), and sodium symporter (B0AT2) transporters

WRSE - a non-parametric weighted-resolution ensemble for predicting individual survival distributions in the ICU

Dynamic assessment of mortality risk in the intensive care unit (ICU) can be used to stratify patients, inform about treatment effectiveness or serve as part of early-warning systems. Static risk scores, such as APACHE or SAPS, have been supplemented with data-driven approaches that track dynamic mortality risk over time. Recent works have focused on enhancing the information delivered to clinicians even further by producing full survival distributions instead of point predictions or fixed horizon risks. In this work, we propose a non-parametric ensemble model, Weighted Resolution Survival Ensemble (WRSE), tailored to estimate such dynamic individual survival distributions. Inspired by the simplicity and robustness of ensemble methods, the proposed approach combines a set of binary classifiers spaced according to a decay function reflecting the relevance of short-term predictions. Models and baselines are evaluated under weighted calibration and discrimination metrics for individual survival distributions, which closely reflect the utility of a model in ICU practice. We show competitive results with state-of-the-art probabilistic models, while greatly reducing training time by factors of 2-9x.ISSN:2640-349

WRSE -- a non-parametric weighted-resolution ensemble for predicting individual survival distributions in the ICU

Dynamic assessment of mortality risk in the intensive care unit (ICU) can be used to stratify patients, inform about treatment effectiveness or serve as part of an early-warning system. Static risk scoring systems, such as APACHE or SAPS, have recently been supplemented with data-driven approaches that track the dynamic mortality risk over time. Recent works have focused on enhancing the information delivered to clinicians even further by producing full survival distributions instead of point predictions or fixed horizon risks. In this work, we propose a non-parametric ensemble model, Weighted Resolution Survival Ensemble (WRSE), tailored to estimate such dynamic individual survival distributions. Inspired by the simplicity and robustness of ensemble methods, the proposed approach combines a set of binary classifiers spaced according to a decay function reflecting the relevance of short-term mortality predictions. Models and baselines are evaluated under weighted calibration and discrimination metrics for individual survival distributions which closely reflect the utility of a model in ICU practice. We show competitive results with state-of-the-art probabilistic models, while greatly reducing training time by factors of 2-9x