Agent-based management of clinical guidelines

Les guies de pràctica clínica (GPC) contenen un conjunt d'accions i dades que ajuden a un metge a prendre decisions sobre el diagnòstic, tractament o qualsevol altre procediment a un pacient i sobre una determinada malaltia. És conegut que l'adopció d'aquestes guies en la vida diària pot millorar l'assistència mèdica als pacients, pel fet que s'estandarditzen les pràctiques. Sistemes computeritzats que utilitzen GPC poden constituir part de sistemes d'ajut a la presa de decisions més complexos amb la finalitat de proporcionar el coneixement adequat a la persona adequada, en un format correcte i en el moment precís. L'automatització de l'execució de les GPC és el primer pas per la seva implantació en els centres mèdics.Per aconseguir aquesta implantació final, hi ha diferents passos que cal solucionar com per exemple, l'adquisició i representació de les GPC, la seva verificació formal, i finalment la seva execució. Aquesta Tesi està dirigida en l'execució de GPC i proposa la implementació d'un sistema multi-agent. En aquest sistema els diferents actors dels centres mèdics coordinen les seves activitats seguint un pla global determinat per una GPC. Un dels principals problemes de qualsevol sistema que treballa en l'àmbit mèdic és el tractament del coneixement. En aquest cas s'han hagut de tractar termes mèdics i organitzatius, que s'ha resolt amb la implementació de diferents ontologies. La separació de la representació del coneixement del seu ús és intencionada i permet que el sistema d'execució de GPC sigui fàcilment adaptable a les circumstàncies concretes dels centres, on varien el personal i els recursos disponibles.En paral·lel a l'execució de GPC, el sistema proposat manega preferències del pacient per tal d'implementar serveis adaptats al pacient. En aquesta àrea concretament, a) s'han definit un conjunt de criteris, b) aquesta informació forma part del perfil de l'usuari i serveix per ordenar les propostes que el sistema li proposa, i c) un algoritme no supervisat d'aprenentatge permet adaptar les preferències del pacient segons triï.Finalment, algunes idees d'aquesta Tesi actualment s'estan aplicant en dos projectes de recerca. Per una banda, l'execució distribuïda de GPC, i per altra banda, la representació del coneixement mèdic i organitzatiu utilitzant ontologies.Clinical guidelines (CGs) contain a set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. It is widely accepted that the adoption of guideline-execution engines in daily practice would improve the patient care, by standardising the care procedures. Guideline-based systems can constitute part of a knowledge-based decision support system in order to deliver the right knowledge to the right people in the right form at the right time. The automation of the guideline execution process is a basic step towards its widespread use in medical centres.To achieve this general goal, different topics should be tackled, such as the acquisition of clinical guidelines, its formal verification, and finally its execution. This dissertation focuses on the execution of CGs and proposes the implementation of an agent-based platform in which the actors involved in health care coordinate their activities to perform the complex task of guideline enactment. The management of medical and organizational knowledge, and the formal representation of the CGs, are two knowledge-related topics addressed in this dissertation and tackled through the design of several application ontologies. The separation of the knowledge from its use is fully intentioned, and allows the CG execution engine to be easily customisable to different medical centres with varying personnel and resources.In parallel with the execution of CGs, the system handles citizen's preferences and uses them to implement patient-centred services. With respect this issue, the following tasks have been developed: a) definition of the user's criteria, b) use of the patient's profile to rank the alternatives presented to him, c) implementation of an unsupervised learning method to adapt dynamically and automatically the user's profile.Finally, several ideas of this dissertation are being directly applied in two ongoing funded research projects, including the agent-based execution of CGs and the ontological management of medical and organizational knowledge

Gravitational Settling of 22Ne in Liquid White Dwarf Interiors

The nuclear reactions that occur in the stellar progenitors of white dwarfs (WDs) lead to an internal composition of 12C, 16O, and a ``contaminant'' nucleus, 22Ne. The 22Ne is produced by helium captures on 14N left from hydrogen burning via the CNO cycle. By virtue of its two excess neutrons (relative to the predominant A=2Z nuclei), a downward force of 2m_pg is exerted on 22Ne in the WD interior. This biases its diffusive equilibrium, forcing 22Ne to settle towards the center of the WD. We discuss the physics of the gravitational settling when the WD is in the liquid state and the luminosity generated by it. This modifies the cooling of WD's with masses in excess of a solar mass. The current uncertainties in the microphysics even allow for solutions where a 1.2M_\odot WD remains mostly liquid for a few Gyrs due to the internal heating from 22Ne sedimentation. This highlights the need for an accurate calculation of the inter-diffusion coefficient, especially in the quantum liquid regime relevant for high mass WD's. There is also time in old, liquid WD's (such as those found in cataclysmic variables and possibly in accreting Type Ia progenitors) for partial settling.Comment: To Appear in Ap. J. Letters, 6 pages, 2 figure

Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study

Background: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear. Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020. Results: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation. Conclusion: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy. Keywords: Acute hypoxemic respiratory failure; COVID-19; Intensive care; Non-invasive oxygenation

Knowledge-driven delivery of home care services

The version of record is available online at: http://dx.doi.org/10.1007/s10844-010-0145-0Home Care (HC) assistance is emerging as an effective and efficient alternative to institutionalized care, especially for the case of senior patients that present multiple co-morbidities and require life long treatments under continuous supervision. The care of such patients requires the definition of specially tailored treatments and their delivery involves the coordination of a team of professionals from different institutions, requiring the management of many kinds of knowledge (medical, organizational, social and procedural). The K4Care project aims to assist the HC of elderly patients by proposing a standard HC model and implementing it in a knowledge-driven e-health platform aimed to support the provision of HC services.Peer ReviewedPostprint (author's final draft

A Cyber-Physical System for integrated remote control andprotection of smart grid critical infrastructures

This work proposes a Cyber-Physical System (CPS) for protecting Smart Electric Grid Critical Infrastructures (CI) using video surveillance while remotely monitoring them. Due to the critical nature of Smart Grid, it is necessary to guarantee an adequate level of safety, security and reliability. Thus, this CPS is back-boned by a Time-Sensitive Network solution (TSN) providing concurrent support for smart-video surveillance and Smart Grid control over a single communication infrastructure. To this end, TSN delivers high-bandwidth communication for video surveil-lance and deterministic Quality of Service (QoS), latency and bandwidth guarantees, required by the time-critical Smart Grid control. On the one hand, the CPS utilizes High-availability Seamless Redundancy (HSR) in the control subsystem via Remote Terminal Units (RTU) guaranteeing seamless failover against failures in Smart Grid. On the other hand, the smart video surveillance subsystem applies machine learning to monitor secured perimeters and detect people around the Smart Grid CI. Moreover, it is also able to directly interoperate with RTUs via MODBUS protocol to send alarms in case of e.g. intrusion. The work evaluates the accuracy and performance of the detection using common metrics in surveillance field. An integrated monitoring dashboard has also been developed in which all CPS information is available in real timeThis work was partially supported by the EU Project FitOptiVis [3] through the ECSEL Joint Undertaking under GA n. 783162, a Spanish National grant funded by MINECO through APCIN PCI2018-093184, and partially by the Research Network RED2018-102511-

Non‑invasive oxygenation support in acutely hypoxemic COVID‑19 patients admitted to the ICU: a multicenter observational retrospective study

Acute hypoxemic respiratory failure; COVID-19; Intensive careInsuficiència respiratòria hipoxèmica aguda; COVID19; Medicina intensivaInsuficiencia respiratoria hipoxémica aguda; COVID-19; Medicina intensivaBackground: Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear. Methods: In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020. Results: Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation. Conclusion: In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy

TDR pressure cell for monitoring water content retention and bulk electrical conductivity curves in undisturbed soil samples

30 Pags., 4 Tabls., 5 Figs.-- The .pdf file is the last author version.-- The definitive version is avalaible at: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1085The water retention curve (θ(ψ)), which defines the relationship between soil volumetric water content (θ) and matric potential (ψ), is of paramount importance in characterizing the hydraulic behaviour of soils. However, few methods are so far available for estimating θ(ψ) in undisturbed soil samples. We present a new design of TDR-pressure cell (TDR-Cell) for estimating θ(ψ) in undisturbed soil samples. The TDR-Cell consists of a 50-mm-long and 50-mm internal diameter stainless steel cylinder (which constitutes the outer frame of a coaxial line) attached to a porous ceramic disc and closed at the ends with two aluminium lids. A 49-mm-long and 3-mm-diameter stainless steel rod, which runs longitudinally through the centre of the cylinder, constitutes the inner rod of a coaxial TDR probe. The TDR-Cell was used to determine the θ(ψ) curves of a packed sand and seven undisturbed soil samples from three profiles of agricultural soils. These θ(ψ) curves were subsequently compared to those obtained from the corresponding 2-mm sieved soils using the pressure plate method. Measurements of bulk electrical conductivity, σa, as a function of the water content, σa(θ), of the undisturbed soil samples were also performed. An excellent correlation (R2 = 0·988) was found between the θ values measured by TDR on the different undisturbed soils and the corresponding θ obtained from the soil gravimetric water content. A typical bimodal θ(ψ) function was found for most of the undisturbed soil samples. Comparison between the θ(ψ) curves measured with the TDR-Cell and those obtained from the 2-mm sieved soils showed that the pressure plate method overestimates θ at low ψ values. The σa(θ) relationship was well described by a simple power expression (R2 > 0·95), in which the power factor, defined as tortuosity, ranged between 1·18 and 3·75.This research was supported by the Ministerio de Ciencia e Inovación (Grants: AGL2007-66320-CO2-02/AGR), CSIC (Grants: PIE-200840I214 and 2008401246) and DGA-Obra social La Caixa (Grants: GA-LC-010/2008; GA-LC-006-2008).Peer reviewe