175 research outputs found
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
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
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Predictive Value of Updating Framingham Risk Scores with Novel Risk Markers in the U.S. General Population
Background: According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population. Methods and Findings: Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003–2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male), 70% (80%) were at low (<10%), 19% (14%) at intermediate (≥10–<20%), and 11% (6%) at high (≥20%) 10-year CVD (CHD) risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02–0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01–0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited. Conclusions: Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies
Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders
Background: A substantial proportion of patients with whiplash injuries develop chronic
symptoms. However, the best treatment of acute injuries to prevent long-term problems is
uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice
and education at their initial visit to the emergency department (ED), followed by review at three
weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised
controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus
usual advice when patients first attend the emergency department; 2. referral to physiotherapy
versus reinforcement of advice for patients with continuing symptoms at three weeks.
Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design
in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in
participating emergency departments and are sent a study questionnaire within a week of their ED
attendance. Three thousand participants will be included. Patients with persisting symptoms three
weeks after their ED attendance are eligible to join an individually randomised study of
physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be
randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the
Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to
work and normal activities. An economic evaluation is being carried out.
Conclusion: This paper describes the protocol and operational aspects of a complex intervention
trial based in NHS emergency and physiotherapy departments, evaluating two components of a
stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations,
with the first stage being cluster randomised and the second individually randomised
Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care : Back Skills Training Trial
Background
Low back pain (LBP) is a major public health problem. Risk factors for the development and persistence of LBP include physical and psychological factors. However, most research activity has focused on physical solutions including manipulation, exercise training and activity promotion.
Methods/Design
This randomised controlled trial will establish the clinical and cost-effectiveness of a group programme, based on cognitive behavioural principles, for the management of sub-acute and chronic LBP in primary care. Our primary outcomes are disease specific measures of pain and function. Secondary outcomes include back beliefs, generic health related quality of life and resource use. All outcomes are measured over 12 months. Participants randomised to the intervention arm are invited to attend up to six weekly sessions each of 90 minutes; each group has 6–8 participants. A parallel qualitative study will aid the evaluation of the intervention.
Discussion
In this paper we describe the rationale and design of a randomised evaluation of a group based cognitive behavioural intervention for low back pain
A preliminary prediction model for potentially guiding patient choices between breast conserving surgery and mastectomy in early breast cancer patients; a Dutch experience
Costs and effectiveness of a brief MRI examination of patients with acute knee injury
The aim of this study was to assess the costs and effectiveness of selective short magnetic resonance imaging (MRI) in patients with acute knee injury. A model was developed to evaluate the selective use of MRI in patients with acute knee injury and no fracture on radiography based on the results of a trial in which 208 patients were randomized between radiography only and radiography plus MRI. We analyzed medical (diagnostic and therapeutic) costs, quality of life, duration of diagnostic workup, number of additional diagnostic examinations, time absent from work, and time to convalescence during a 6-month follow-up period. Quality of life was lowest (EuroQol at 6 weeks 0.61 (95% CI 0.54–0.67)); duration of diagnostic workup, absence from work, and time to convalescence were longest; and the number of diagnostic examinations was largest with radiography only. These outcomes were more favorable for both MRI strategies (EuroQol at 6 weeks 0.72 (95% CI 0.67–0.77) for both). Mean total costs were 2,593 euros (95% CI 1,815–3,372) with radiography only, 2,116 euros (95% CI 1,488–2,743) with radiography plus MRI, and 1,973 euros (95% CI 1,401–2,543) with selective MRI. The results suggest that selective use of a short MRI examination saves costs and potentially increases effectiveness in patients with acute knee injury without a fracture on radiography
Risk of Intracranial Complications in Minor Head Injury:The Role of Loss of Consciousness and Post-Traumatic Amnesia in a Multi-Center Observational Study
Various guidelines for minor head injury focus on patients with a Glasgow Coma Scale (GCS) score of 13-15 and loss of consciousness (LOC) or post-traumatic amnesia (PTA), while clinical management for patients without LOC or PTA is often unclear. We aimed to investigate the effect of presence and absence of LOC or PTA on intracranial complications in minor head injury. A prospective multi-center cohort study of all patients with blunt head injury and GCS score of 15 was conducted at six Dutch centers between 2015 and 2017. Five centers used the national guideline and one center used a local guideline-both based on the CT in Head Injury Patients (CHIP) prediction model-to identify patients in need of a computed tomography (CT) scan. We studied the presence of traumatic findings and neurosurgical interventions in patients with and without LOC or PTA. In addition, we assessed the association of LOC and PTA with traumatic findings with logistic regression analysis and the additional predictive value of LOC and PTA compared with other risk factors in the CHIP model. Of 3914 patients, 2249 (58%) experienced neither LOC nor PTA and in 305 (8%) LOC and PTA was unknown. Traumatic findings were present in 153 of 1360 patients (11%) with LOC or PTA and in 67 of 2249 patients (3%) without LOC and PTA. Five patients without LOC and PTA had potential neurosurgical lesions and one patient underwent a neurosurgical intervention. LOC and PTA were strongly associated with traumatic findings on CT, with adjusted odds ratios of 2.9 (95% confidence interval [CI] 2.2-3.8) and 3.5 (95% CI 2.7-4.6), respectively. To conclude, patients who had minor head injury with neither LOC nor PTA are at risk of intracranial complications. Clinical guidelines should include clinical management for patients without LOC and PTA, and they should include LOC and PTA as separate risk factors rather than as diagnostic selection criteria
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