NHI 2.1 Veranderingen in NHI

Dit document is een concept en uitsluitend bedoeld voor discussiedoeleinden. Een impuls is gegeven aan het verbeteren van het nationaal hydrologisch instrumentarium, NHI 2.0. NHI 2.0 voldeed in 2010 nog niet volledig aan de wensen van RWS. In 2010 hebben twee processen plaatsgevonden, die tot meer inzicht hebben geleid in de prestaties van het NHI. Ten eerste de regionale toetsing van het NHI, onder andere door STOWA, en ten tweede het gebruik van NHI in diverse regionale en landelijke studies voor Zoetwaterverkenning (ZWV). Als gevolg hiervan zijn in NHI 2.1, in opdracht van de RWS Waterdienst, veel verbeteringen doorgevoerd

Review of "Biomedical Informatics; Computer Applications in Health Care and Biomedicine" by Edward H. Shortliffe and James J. Cimino

This article is an invited review of the third edition of "Biomedical Informatics; Computer Applications in Health Care and Biomedicine", one of thirty-six volumes in Springer's 'Health Informatics Series', edited by E. Shortliffe and J. Cimino. This book spans most of the current methods and issues in health informatics, ranging through subjects as varied as data acquisition and storage, standards, natural language processing, imaging, electronic health records, decision support, teaching methods and ethics. The book is aimed at 'healthcare professionals', and is certainly appropriate for the non-technical informatics user. However, this book is also excellent background reading for the technical engineer who may be interested in the possible problems that confront the users in this field

Crop coefficients parameterization using remote sensing in basin-scale hydrological modelling

[SPA] Se utiliza un modelo hidrológico distribuido para evaluar cómo diferentes métodos influyen en la estimación de la evapotranspiración (ETc) y el balance de agua a escala de cuenca. La zona de estudio se ubica en la cuenca alta del Segura (~ 2.500 km2) en el Sureste español, zona caracterizada por una elevada heterogeneidad de condiciones del terreno y usos del suelo. El modelo hidrológico SPHY fue desarrollado y calibrado para un período de simulación de 15 años. Se emplearon cinco métodos para parametrizar el coeficiente de cultivo y se compararon los patrones espaciales y las dinámicas temporales simuladas para la evapotranspiración, la humedad del suelo y los caudales. Tres de los cinco métodos utilizan información de satélite, otro los valores del coeficiente de cultivo establecidos por FAO, y el último asume un valor constante para toda la cuenca y periodo de simulación. El análisis muestra que la generación de caudales apenas se ve afectada por la selección del método de parametrización, aunque sí es importante a la hora de calcular la evapotranspiración real, especialmente durante épocas húmedas y para los valores tabulados de FAO. [ENG] A distributed hydrologic model is used to evaluate how different methods to estimate evapotranspiration (ETc) influence the water balance and hydrologic response of basins. The study site, the upper Segura basin (~2500 km2) in Spain, is characterized by a wide range of terrain, soil, and ecosystem conditions. Input and calibration data for the hydrological model SPHY are obtained from best available data sources. The model was setup for a period of 15 year. Five crop coefficient parameterization methods are compared to explore the impact of spatial and temporal variations in these input datasets on actual evapotranspiration, streamflow and soil moisture. Methods include three that are based on remote sensing information; one based on FAO literature, and another that takes the crop coefficient equal to unity for the entire basin. The analysis shows that basin-level streamflow is hardly influenced by the choice in parameterization, but actual evapotranspiration and soil moisture are quite different, especially in the wet season and for the FAO-based method

Using decision analysis: connecting "classroom" and "field"

This paper reports on the findings of a small-scale research project investigating the views of social work students on the use of decision analysis. After giving the context of the research, the article reports on what was found when students, who had just completed a Decision Making and Risk module, were asked for their opinions on the component parts of decision analysis, its use as a practice tool and their attitudes to using it on placement. The research found that the respondents in general took a critical and supportive stance towards the use of decision analysis in social work and, with extra teaching and a positive approach from their practice assessor, would be happy to use decision analysis. When the same group of students completed a follow-up questionnaire on a placement recall day, half of them had thought about using decision analysis but only three had gone on to discuss this with their practice assessors. Some issues in relation to connecting 'classroom' and 'field' are identified and the paper concludes that a number of further steps would be necessary to realise the potential of decision analysis to help students be more systematic and analytical in their approach to decision makin

Multi-detector row computed tomography angiography of peripheral arterial disease

With the introduction of multi-detector row computed tomography (MDCT), scan speed and image quality has improved considerably. Since the longitudinal coverage is no longer a limitation, multi-detector row computed tomography angiography (MDCTA) is increasingly used to depict the peripheral arterial runoff. Hence, it is important to know the advantages and limitations of this new non-invasive alternative for the reference test, digital subtraction angiography. Optimization of the acquisition parameters and the contrast delivery is important to achieve a reliable enhancement of the entire arterial runoff in patients with peripheral arterial disease (PAD) using fast CT scanners. The purpose of this review is to discuss the different scanning and injection protocols using 4-, 16-, and 64-detector row CT scanners, to propose effective methods to evaluate and to present large data sets, to discuss its clinical value and major limitations, and to review the literature on the validity, reliability, and cost-effectiveness of multi-detector row CT in the evaluation of PAD

Comparative effectiveness of personalized lifestyle management strategies for cardiovascular disease risk reduction

Background-Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. Methods and Results-We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. Conclusions-This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures

Modeling good research practices - overview: a report of the ISPOR-SMDM modeling good research practices task force - 1.

Models—mathematical frameworks that facilitate estimation of the consequences of health care decisions—have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR modeling task force reported in 2003 has led to a new task force, jointly convened with the Society for Medical Decision Making, and this series of seven papers presents the updated recommendations for best practices in conceptualizing models; implementing state–transition approaches, discrete event simulations, or dynamic transmission models; dealing with uncertainty; and validating and reporting models transparently. This overview introduces the work of the task force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these papers includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making

Personalized Prediction of Lifetime Benefits with Statin Therapy for Asymptomatic Individuals: A Modeling Study

Background: Physicians need to inform asymptomatic individuals about personalized outcomes of statin therapy for primary prevention of cardiovascular disease (CVD). However, current prediction models focus on short-term outcomes and ignore the competing risk of death due to other causes. We aimed to predict the potential lifetime benefits with statin therapy, taking into account competing risks. Methods and Findings: A microsimulation model based on 5-y follow-up data from the Rotterdam Study, a population-based cohort of individuals aged 55 y and older living in the Ommoord district of Rotterdam, the Netherlands, was used to estimate lifetime outcomes with and without statin therapy. The model was validated in-sample using 10-y follow-up data. We used baseline variables and model output to construct (1) a web-based calculator for gains in total and CVD-free life expectancy and (2) color charts for comparing these gains to the Systematic Coronary Risk Evaluation (SCORE) charts. In 2,428 participants (mean age 67.7 y, 35.5% men), statin therapy increased total life expectancy by 0.3 y (SD 0.2) and CVD-free life expectancy by 0.7 y (SD 0.4). Age, sex, smoking, blood pressure, hypertension, lipids, diabetes, glucose, body mass index, waist-to-hip ratio, and creatinine were included in the calculator. Gains in total and CVD-free life expectancy increased with blood pressure, unfavorable lipid levels, and body mass index after multivariable adjustment. Gains decreased considerably with advancing age, while SCORE 10-y CVD mortality risk increased with age. Twenty-five percent of participants with a low SCORE risk achieved equal or larger gains in CVD-free life expectancy than the median gain in participants with a high SCORE risk. Conclusions: We developed tools to predict personalized increases in total and CVD-free life expectancy with statin therapy. The predicted gains we found are small. If the underlying model is validated in an independent cohort, the tools may be useful in discussing with patients their individual outcomes with statin therapy. Please see later in the article for the Editors' Summar

Effect of minimally invasive autopsy and ethnic background on acceptance of clinical postmortem investigation in adults

Objectives Autopsy rates worldwide have dropped significantly over the last five decades. Imaging based autopsies are increasingly used as alternatives to conventional autopsy (CA). The aim of this study was to investigate the effect of the introduction of minimally invasive autopsy, consisting of CT, MRI and tissue biopsies on the overall autopsy rate (of CA and minimally invasive autopsy) and the autopsy rate among different ethnicities. Methods We performed a prospective single center before-after study. The intervention was the introduction of m

Why increased extreme precipitation under climate change negatively affects water security

An increase in extreme precipitation is projected for many areas worldwide in the coming decades. To assess the impact of increased precipitation intensity on water security, we applied a regional-scale hydrological and soil erosion model, forced with regional climate model projections. We specifically considered the impact of climate change on the distribution of water between soil (green water) and surface water (blue water) compartments. We show that an increase in precipitation intensity leads to a redistribution of water within the catchment, where water storage in soil decreases and reservoir inflow increases. This affects plant water stress and the potential of rainfed versus irrigated agriculture, and increases dependency on reservoir storage, which is potentially threatened by increased soil erosion. This study demonstrates the crucial importance of accounting for the fact that increased precipitation intensity leads to water redistribution between green and blue water, increased soil erosion, and reduced water security. Ultimately, this has implications for design of climate change adaptation measures, which should aim to increase the water holding capacity of the soil (green water) and to maintain the storage capacity of reservoirs (blue water), benefiting rainfed and irrigated agriculture.</p