Integration of decision support systems to improve decision support performance

Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

A basis set for exploration of sensitivity to prescribed ocean conditions for estimating human contributions to extreme weather in CAM5.1-1degree

This paper presents two contributions for research into better understanding the role of anthropogenic warming in extreme weather. The first contribution is the generation of a large number of multi-decadal simulations using a medium-resolution atmospheric climate model, CAM5.1-1degree, under two scenarios of historical climate following the protocols of the C20C+ Detection and Attribution project: the one we have experienced (All-Hist), and one that might have been experienced in the absence of human interference with the climate system (Nat-Hist). These simulations are specifically designed for understanding extreme weather and atmospheric variability in the context of anthropogenic climate change. The second contribution takes advantage of the duration and size of these simulations in order to identify features of variability in the prescribed ocean conditions that may strongly influence calculated estimates of the role of anthropogenic emissions on extreme weather frequency (event attribution). There is a large amount of uncertainty in how much anthropogenic emissions should warm regional ocean surface temperatures, yet contributions to the C20C+ Detection and Attribution project and similar efforts so far use only one or a limited number of possible estimates of the ocean warming attributable to anthropogenic emissions when generating their Nat-Hist simulations. Thus, the importance of the uncertainty in regional attributable warming estimates to the results of event attribution studies is poorly understood. The identification of features of the anomalous ocean state that seem to strongly influence event attribution estimates should therefore be able to serve as a basis set for effective sampling of other plausible attributable warming patterns. The identification performed in this paper examines monthly temperature and precipitation output from the CAM5.1-1degree simulations averaged over 237 land regions, and compares interannual anomalous variations in the ratio between the frequencies of extremes in the All-Hist and Nat-Hist simulations against variations in ocean temperatures

A basis set for exploration of sensitivity to prescribed ocean conditions for estimating human contributions to extreme weather in CAM5.1-1degree

This paper presents two contributions for research into better understanding the role of anthropogenic warming in extreme weather. The first contribution is the generation of a large number of multi-decadal simulations using a medium-resolution atmospheric climate model, CAM5.1-1degree, under two scenarios of historical climate following the protocols of the C20C+ Detection and Attribution project: the one we have experienced (All-Hist), and one that might have been experienced in the absence of human interference with the climate system (Nat-Hist). These simulations are specifically designed for understanding extreme weather and atmospheric variability in the context of anthropogenic climate change. The second contribution takes advantage of the duration and size of these simulations in order to identify features of variability in the prescribed ocean conditions that may strongly influence calculated estimates of the role of anthropogenic emissions on extreme weather frequency (event attribution). There is a large amount of uncertainty in how much anthropogenic emissions should warm regional ocean surface temperatures, yet contributions to the C20C+ Detection and Attribution project and similar efforts so far use only one or a limited number of possible estimates of the ocean warming attributable to anthropogenic emissions when generating their Nat-Hist simulations. Thus, the importance of the uncertainty in regional attributable warming estimates to the results of event attribution studies is poorly understood. The identification of features of the anomalous ocean state that seem to strongly influence event attribution estimates should therefore be able to serve as a basis set for effective sampling of other plausible attributable warming patterns. The identification performed in this paper examines monthly temperature and precipitation output from the CAM5.1-1degree simulations averaged over 237 land regions, and compares interannual anomalous variations in the ratio between the frequencies of extremes in the All-Hist and Nat-Hist simulations against variations in ocean temperatures