Prediction Of Heart Failure Decompensations Using Artificial Intelligence - Machine Learning Techniques

Los apartados 4.41, 4.4.2 y 4.4.3 del capítulo 4 están sujetos a confidencialidad por la autora. 203 p.Heart failure (HF) is a major concern in public health. Its total impact is increased by its high incidence and prevalence and its unfavourable medium-term prognosis. In addition, HF leads to huge health care resource consumption. Moreover, efforts to develop a deterministic understanding of rehospitalization have been difficult, as no specific patient or hospital factors have been shown to consistently predict 30-day readmission after hospitalization for HF.Taking all these facts into account, we wanted to develop a project to improve the assistance care of patients with HF. Up to know, we were using telemonitoring with a codification system that generated alarms depending on the received values. However, these simple rules generated large number of false alerts being, hence, not trustworthy. The final aims of this work are: (i) asses the benefits of remote patient telemonitoring (RPT), (ii) improve the results obtained with RPT using ML techniques, detecting which parameters measured by telemonitoring best predict HF decompensations and creating predictive models that will reduce false alerts and detect early decompensations that otherwise will lead to hospital admissions and (iii) determine the influence of environmental factors on HF decompensations.All in all, the conclusions of this study are:1. Asses the benefits of RPT: Telemonitoring has not shown a statistically significant reduction in the number of HF-related hospital admissions. Nevertheless, we have observed a statistically significant reduction in mortality in the intervention group with a considerable percentage of deaths from non-cardiovascular causes. Moreover, patients have considered the RPT programme as a tool that can help them in the control of their chronic disease and in the relationship with health professionals.2. Improve the results obtained with RPT using machine learning techniques: Significant weight increases, desaturation below 90%, perception of clinical worsening, including development of oedema, worsening of functional class and orthopnoea are good predictors of heart failure decompensation. In addition, machine learning techniques have improved the current alerts system implemented in our hospital. The system reduces the number of false alerts notably although it entails a decrement on sensitivity values. The best results are achieved with the predictive model built by applying NB with Bernoulli to the combination of telemonitoring alerts and questionnaire alerts (Weight + Ankle + well-being plus the yellow alerts of systolic blood pressure, diastolic blood pressure, O2Sat and heart rate). 3. Determine the influence of environmental factors on HF decompensations: Air temperature is the most significant environmental factor (negative correlation) in our study, although some other attributes, such as precipitation, are also relevant. This work also shows a consistent association between increasing levels SO2 and NOX air and HF hospitalizations

All Dried Out: How Responses to Drought Make Droughts Worse

Water usage is governed through a variety of mechanisms, including government administration and market tools. In 2006-2008 Barcelona’s region, a water scarce area, suffered a drought comparable to the one faced today by the US West. This article surveys a variety of techniques which were or could have been used to address these scarcity challenges. Spanish water regulations established water markets in 1999 but neither the design, nor its implementation were optimal. In addition to the design and implementation flaws, the response to the 2006-2008 drought crisis shows how emergency measures highjack water markets as a viable solution to water scarcity. Emergency responses bail out urban voters while no structural solutions to make water use in the agricultural sector more efficient are adopted. Neither the urban suppliers nor the agricultural sector has, thus, incentives to participate in a water market and droughts are to be managed using ad hoc solutions. Lessons for the US West can be drawn because that crisis’ responses are no different than the ones that could be undertaken by states west of the 100th meridian to tackle the current drought

Whose Water? Corporatization of a Common Good

This chapter encourages readers to think of agricultural communities in the era of climate change-induced droughts and population growth similar to when western Pennsylvania’s steel industry collapsed in the 1980s. If water must flow uphill to money, it should not leave a dust bowl behind. While this chapter’s proposals to address the effects on community build on examples of water reallocation where those effects have been addressed, both the just-transition literature and the experiences of some of the towns successfully adapting to abrupt changes in their economic tissue can offer lessons for areas suffering big water losses. In addition, privatization of water utilities shares with water transactions the concerns about the community voice being muffled by powerful interests and having less of a say in its future development because water is controlled elsewhere. Accordingly, the proposals put forward in this chapter may also inform regulatory responses to privatization.Section II describes the landscape of water markets today, from the traditional exchange of water rights to the investment by big companies in water-related assets as climate change makes water scarcity worse. Section III analyzes potential externalities on communities as a result of water markets, particularly in today’s markets where climate change has made water attractive for big corporations. It unpacks the critiques of community externalities by scholars who believe communities should not be compensated and it evaluates the levels of government involved in decisions concerning water markets and community externalities. Section IV offers a portfolio of measures to address community externalities and offers recommendations

Inefficient Efficiency: Crying Over Spilled Water

As the drought in Western states worsens, the agricultural sector is being criticized for failing to adopt technical responses, such as shifting to less water-demanding crops and state-of-the-art irrigation systems, in a timely manner. However, these responses can have the reverse effect: they can increase water consumption. Technological responses alone are insufficient to reduce water consumption if unaccompanied by changes in how the law defines and allocates water rights. This paper proposes a redefinition of water rights to ensure that changes in crops or irrigation techniques are socially efficient. In the West, which uses the doctrine of prior appropriation to allocate water, rights are largely measured based on how much water is diverted from streams. As a consequence, technological responses only redistribute — not reduce — the total amount of water being consumed. Such redistribution is not necessarily systemically efficient. Take, for instance, a farmer who substitutes drip irrigation for furrow irrigation. While intended to reduce water use, drip irrigation results in more water being consumed by crops than traditional furrow irrigation, which returns unused water back to the stream. Farmers are reluctant to reduce diversion, since doing so would risk partially forfeiting their water rights. As a result, drip irrigation sharply reduces the return flow available for downstream users and the environment. Downstream water users may no longer be able to produce crops and the environment may be harmed if consumption upstream increases. This rebound effect from adopting technically efficient systems has not been adequately addressed in water law while it has been accounted for in energy policies. The Supreme Court case Montana v. Wyoming is used to illustrate this point. This article advances a legal framework for ensuring that technical responses to drought accomplish the stated goal of reducing agricultural water use without harming third parties. In particular, it proposes prior consumption as an additional measure of water rights in prior appropriation regimes. Consumption more accurately reflects the true social cost of agricultural water use. This would prevent farmers from taking advantage of technical responses to increase their water use and would protect downstream users and the environment. In addition, water markets would benefit, since water rights would be better defined and the review process of water market transactions would be streamlined. The proposal is consistent with the underlying principles of prior appropriation, and the article explains why such a change would survive a potential takings challenge

The Street View of Property

Parking on public streets is scarce. The current allocation system for parking spots based on rule of capture coupled with low parking fees creates a tragedy of the commons scenario. The misallocation of parking has consequences for commerce, for access to public spaces, and for pollution and congestion. Municipalities have not widely adopted the solution that economists propose to solve this scarcity problem: increase the price. Politics aside, the reluctance of municipalities to do so may be explained by the unique nature of public property as reflected in well-rooted legal and societal constraints. This unique nature helps explain, for example, municipalities’ ban of software applications (apps) allowing occupants of curbside parking to “sell” their spots to would-be occupants in Boston or San Francisco. While the ban may be justified, the unique nature of public property is not incompatible with some well-designed, efficiency-oriented policies, as this paper will put forward. This article distills the legal constraints on curbside parking and any other public property management by drawing on case law regarding parking meters, case law on public resources managed in trust for the public, and decisions by municipalities regarding parking apps and privatization of parking meters. These constraints include, among others, that public property shall not be used to raise revenue, although placing a price on it may pursue other regulatory aims consistent with public use, or that municipalities shall not lose control of the public spaces dedicated to curbside parking. At a normative level, the above constraints provide a framework for assessing policies regarding curbside parking and, by extension the management of any other public property resources. At a positive level, the article proposes ways to make efficiency compatible with the principles guiding the management of public property. It analyzes to what extent the efficiency oriented policies that would translate into a price increase—variable pricing, tradable property rights, and privatization—clash with those principles constraining the monetization of public property. In addition, the article concludes by pointing to other situations where its analytical framework could be extended, such as other uses of public streets (for instance, use of public bus stops by shuttle-buses of private companies) or existing practices in connection to public resources of a similar nature (for instance, semi-privatization of beaches by surfers)

Prediction Of Heart Failure Decompensations Using Artificial Intelligence - Machine Learning Techniques

Los apartados 4.41, 4.4.2 y 4.4.3 del capítulo 4 están sujetos a confidencialidad por la autora. 203 p.Heart failure (HF) is a major concern in public health. Its total impact is increased by its high incidence and prevalence and its unfavourable medium-term prognosis. In addition, HF leads to huge health care resource consumption. Moreover, efforts to develop a deterministic understanding of rehospitalization have been difficult, as no specific patient or hospital factors have been shown to consistently predict 30-day readmission after hospitalization for HF.Taking all these facts into account, we wanted to develop a project to improve the assistance care of patients with HF. Up to know, we were using telemonitoring with a codification system that generated alarms depending on the received values. However, these simple rules generated large number of false alerts being, hence, not trustworthy. The final aims of this work are: (i) asses the benefits of remote patient telemonitoring (RPT), (ii) improve the results obtained with RPT using ML techniques, detecting which parameters measured by telemonitoring best predict HF decompensations and creating predictive models that will reduce false alerts and detect early decompensations that otherwise will lead to hospital admissions and (iii) determine the influence of environmental factors on HF decompensations.All in all, the conclusions of this study are:1. Asses the benefits of RPT: Telemonitoring has not shown a statistically significant reduction in the number of HF-related hospital admissions. Nevertheless, we have observed a statistically significant reduction in mortality in the intervention group with a considerable percentage of deaths from non-cardiovascular causes. Moreover, patients have considered the RPT programme as a tool that can help them in the control of their chronic disease and in the relationship with health professionals.2. Improve the results obtained with RPT using machine learning techniques: Significant weight increases, desaturation below 90%, perception of clinical worsening, including development of oedema, worsening of functional class and orthopnoea are good predictors of heart failure decompensation. In addition, machine learning techniques have improved the current alerts system implemented in our hospital. The system reduces the number of false alerts notably although it entails a decrement on sensitivity values. The best results are achieved with the predictive model built by applying NB with Bernoulli to the combination of telemonitoring alerts and questionnaire alerts (Weight + Ankle + well-being plus the yellow alerts of systolic blood pressure, diastolic blood pressure, O2Sat and heart rate). 3. Determine the influence of environmental factors on HF decompensations: Air temperature is the most significant environmental factor (negative correlation) in our study, although some other attributes, such as precipitation, are also relevant. This work also shows a consistent association between increasing levels SO2 and NOX air and HF hospitalizations

Reclaiming the Streets

Pedestrians have been getting the short end of the stick in street policies and regulations. Drivers and cars dominate our streets even though automobiles’ externalities kill thousands of people every year. Given the environmental, health, safety, and community effects of cars, municipalities should embrace a policy that puts pedestrians at the center and produces more miles of wider, well-maintained sidewalks. Sidewalks make communities greener, healthier, safer, more socially connected, and even, wealthier. COVID-19 lockdowns have shown both the relevance of sidewalks, as well as the possibility of pedestrians regaining space currently allocated to cars by widening sidewalks. This Essay identifies, first, the benefits of and potential arguments against more sidewalks. Second, it analyzes the current approach to adding sidewalks to neighborhoods without them or widening existing sidewalks. It shows the disparities created by shouldering homeowners with the responsibility of building, maintaining, and repairing sidewalks and advocates for the socialization of sidewalks’ cost. It also advocates for sidewalks reclaiming space today occupied by parked or running automobiles. Third, regarding new developments, this Essay proposes an approach mirroring technology- forcing environmental regulations that will require developers to not only not serve future road demand, but also actually reduce it by increasing the walkability score of the development and the surrounding area

Specialization Trend: Water Courts

Definition of property rights is not useful unless there is an enforcement system, either public or private, that backs it up. While the definition of property rights as a solution to the tragedy of the commons has been carefully analyzed in the literature, the enforcement piece has been somewhat overlooked. Water is becoming scarcer and conflict is rising. As a result, the need for an efficient and fair enforcement system is more necessary than ever due to climate change. Given the complexity of water law and the backlog in the judicial system, introducing specialization in the resolution of water cases may become necessary in many jurisdictions. Specialize enforcement takes different forms: from administrative agencies decisions to judicial decisions. This piece focuses on the judiciary, where specialization in the water and environmental arena has gained traction in recent decades in the United States and abroad. Specialization ensures faster resolution and better-quality decisions. To achieve those benefits, jurisdictions do not need to create a whole new system of courts necessarily. For example, in water, specialization in the judiciary can range from special masters assisting generalist judges in water cases or general judges who get assigned all water cases on the docket to full-fledged specialized courts. The article, first, covers how the literature has analyzed specialized tribunals across different legal areas, along with their advantages and disadvantages. Second, it establishes the need for specialized water courts and their procedural particularities. Factual and legal complexity of water disputes demands specialization both at the trial and at the appellate level. Third, it diagnoses the trend toward judicial specialization in water cases in the West of the United States and analyzes case studies of water courts in the United States and abroad, looking at both their institutional structure and their particular procedural rules. Based on this research, the paper offers a portfolio of institutional options for jurisdictions designing specialized courts. The proposals are particularly helpful to respond to the expected increase in conflicts over the allocation of natural resources due to climate change

Liquid Business

Water is scarcer due to climate change and in higher demand due to population growth than ever before. As if these stressors were not concerning enough, corporate investors are participating in water markets in ways that sidestep U.S. water law doctrine’s aims of preventing speculation and assuring that the holders of water rights internalize any externalities associated with changes in their rights. The operation of these new players in the shadow of traditional water law is producing elements of inefficiency and unfairness in the allocation of water rights. Resisting the polar calls for unfettered water markets, or, contrarily, the complete de-commodification of water in the face of these challenges, this Article identifies a portfolio of measures that can help get regulated water markets back on a prudent, sustainable track in our contemporary world. The portfolio includes institutional changes and measures aimed at redefining water rights. Regarding the administration and management of water rights, the Article proposes: mechanisms to address the effects on the communities where water originates, structures for joint management of surface and ground water; and tools to ensure fulfillment of all persons’ basic water needs. The changes in water rights: exclude return flows; establish character criteria for water rights holders; and define quantitative limits on the amount of water one person or entity can hold at a given time