Improvements in data quality for decision support in intensive care

Nowadays, there is a plethora of technology in hospitals and, in particular, in intensive care units. The clinical data produced everyday can be integrated in a decision support system in real-time to improve quality of care of the critically ill patients. However, there are many sensitive aspects that must be taken into account, mainly the data quality and the integration of heterogeneous data sources. This paper presents INTCare, an Intelligent Decision Support System for Intensive Care in real-time and addresses the previous aspects, in particular, the development of an Electronic Nursing Record and the improvements in the quality of monitored data.Fundação para a Ciência e a Tecnologia (FCT

Challenges and opportunities in mapping land use intensity globally

Future increases in land-based production will need to focus more on sustainably intensifying existing production systems. Unfortunately, our understanding of the global patterns of land use intensity is weak, partly because land use intensity is a complex, multidimensional term, and partly because we lack appropriate datasets to assess land use intensity across broad geographic extents. Here, we review the state of the art regarding approaches for mapping land use intensity and provide a comprehensive overview of available global-scale datasets on land use intensity. We also outline major challenges and opportunities for mappinglanduseintensityfor cropland, grazing, and forestry systems, and identify key issues for future research.Peer Reviewe

Transparency and sustainability in global commodity supply chains

Over the last few decades rapid advances in processes to collect, monitor, disclose, and disseminate information have contributed towards the development of entirely new modes of sustainability governance for global commodity supply chains. However, there has been very little critical appraisal of the contribution made by different transparency initiatives to sustainability and the ways in which they can (and cannot) influence new governance arrangements. Here we seek to strengthen the theoretical underpinning of research and action on supply chain transparency by addressing four questions: (1) What is meant by supply chain transparency? (2) What is the relevance of supply chain transparency to supply chain sustainability governance? (3) What is the current status of supply chain transparency, and what are the strengths and weaknesses of existing initiatives? and (4) What propositions can be advanced for how transparency can have a positive transformative effect on the governance interventions that seek to strengthen sustainability outcomes? We use examples from agricultural supply chains and the zero-deforestation agenda as a focus of our analysis but draw insights that are relevant to the transparency and sustainability of supply chains in general. We propose a typology to distinguish among types of supply chain information that are needed to support improvements in sustainability governance, and illustrate a number of major shortfalls and systematic biases in existing information systems. We also propose a set of ten propositions that, taken together, serve to expose some of the potential pitfalls and undesirable outcomes that may result from (inevitably) limited or poorly designed transparency systems, whilst offering guidance on some of the ways in which greater transparency can make a more effective, lasting and positive contribution to sustainability

Ensuring editorial continuity and quality of science during the COVID-19 storm: the ICM experience

We analyzed the manuscript submissions to ICM and the responses of the invited reviewers from January to April 2020, and compared the findings of peer-review activity with the same time span in 2019. From January 1st to April 30th 2020, there was a considerable increase in submissions (1201 total submissions, 617 of which were COVID-related) over the comparable time in 2019 (554 total submissions). In both cases, the average percentage of advanced rejections was around 60.In 2019, 180 manuscripts were sent to 1.271 reviewers. In the comparable period of 2020, 296 manuscripts were sent out to 1.741 reviewers. Despite the rapid and massive increase in workload for intensive care health professionals due to the ‘Corona crisis’ our findings suggest that, overall, the peer-review activity in high-quality intensive care journals has not suffered a crisis and does guarantee the continuity of one of the columns of quality in science

Glucose variability measures and their effect on mortality: a systematic review

Objective: To systematically review the medical literature on the association between glucose variability measures and mortality in critically ill patients. Methods: Studies assessing the association between a measure of glucose variability and mortality that reported original data from a clinical trial or observational study on critically ill adult patients were searched in Ovid MEDLINE (R) and Ovid EMBASE (R). Data on patient populations, study designs, glucose regulations, statistical approaches, outcome measures, and glucose variability indicators (their definition and applicability) were extracted. Result: Twelve studies met the inclusion criteria; 13 different indicators were used to measure glucose variability. Standard deviation and the presence of both hypo-and hyperglycemia were the most common indicators. All studies reported a statistically significant association between mortality and at least one glucose variability indicator. In four studies both blood glucose levels and severity of illness were considered as confounders, but only one of them checked model assumptions to assert inference validity. Conclusions: Glucose variability has been quantified in many different ways, and in each study at least one of them appeared to be associated with mortality. Because of methodological limitations and the possibility of reporting bias, it is still unsettled whether and in which quantification this association is independent of other confounders. Future research will benefit from using an indicator reference subset for glucose variability, metrics that are linked more directly to negative physiological effects, more methodological rigor, and/or better reportin

Multiple pathways of commodity crop expansion in tropical forest landscapes

Commodity crop expansion, for both global and domestic urban markets, follows multiple land change pathways entailing direct and indirect deforestation, and results in various social and environmental impacts. Here we compare six published case studies of rapid commodity crop expansion within forested tropical regions. Across cases, between 1.7% and 89.5% of new commodity cropland was sourced from forestlands. Four main factors controlled pathways of commodity crop expansion: (i) the availability of suitable forestland, which is determined by forest area, agroecological or accessibility constraints, and land use policies, (ii) economic and technical characteristics of agricultural systems, (iii) differences in constraints and strategies between small-scale and large-scale actors, and (iv) variable costs and benefits of forest clearing. When remaining forests were unsuitable for agriculture and/or policies restricted forest encroachment, a larger share of commodity crop expansion occurred by conversion of existing agricultural lands, and land use displacement was smaller. Expansion strategies of large-scale actors emerge from context-specific balances between the search for suitable lands; transaction costs or conflicts associated with expanding into forests or other state-owned lands versus smallholder lands; net benefits of forest clearing; and greater access to infrastructure in already-cleared lands. We propose five hypotheses to be tested in further studies: (i) land availability mediates expansion pathways and the likelihood that land use is displaced to distant, rather than to local places; (ii) use of already-cleared lands is favored when commodity crops require access to infrastructure; (iii) in proportion to total agricultural expansion, large-scale actors generate more clearing of mature forests than smallholders; (iv) property rights and land tenure security influence the actors participating in commodity crop expansion, the form of land use displacement, and livelihood outcomes; (v) intensive commodity crops may fail to spare land when inducing displacement. We conclude that understanding pathways of commodity crop expansion is essential to improve land use governance