Decision-Making Support in Stroke Diagnosis Process: An Approach Based on the PROMETHEE Method and Decision Model Notation.

Decision-making in the field of healthcare is a very complex activity. Several tools have been developed to support the decision-making process. DMN, a modeling technique focused on decisions, is among these and has been gaining prominence in both, literature and business, as has the multi-criteria method PROMETHEE II that helps decision-makers with multi-criteria in analyses. Thus, this research targets combining these two techniques and analyzing the decision support that these two tools afford together. The diagnostic stage of stroke patients was used to perform this work. The research demonstrated that this proposal can drive major gains in efficiency and assertiveness in decision-making in time-sensitive hospital processes. After all, there is a noticeable dearth of hospitals with specialized teams as well as a shortfall of adequate infrastructure for this treatment.

Precise multispecies agricultural gas flux determined using broadband open-path dual-comb spectroscopy.

Advances in spectroscopy have the potential to improve our understanding of agricultural processes and associated trace gas emissions. We implement field-deployed, open-path dual-comb spectroscopy (DCS) for precise multispecies emissions estimation from livestock. With broad atmospheric dual-comb spectra, we interrogate upwind and downwind paths from pens containing approximately 300 head of cattle, providing time-resolved concentration enhancements and fluxes of CH4, NH3, CO2, and H2O. The methane fluxes determined from DCS data and fluxes obtained with a colocated closed-path cavity ring-down spectroscopy gas analyzer agree to within 6%. The NH3 concentration retrievals have sensitivity of 10 parts per billion and yield corresponding NH3 fluxes with a statistical precision of 8% and low systematic uncertainty. Open-path DCS offers accurate multispecies agricultural gas flux quantification without external calibration and is easily extended to larger agricultural systems where point-sampling-based approaches are insufficient, presenting opportunities for field-scale biogeochemical studies and ecological monitoring.

Ischemic stroke: Process perspective, clinical and profile characteristics, and external factors.

OBJECTIVE: To describe a method of analysis for understanding the health care process, enriched with information on the clinical and profile characteristics of the patients. To apply the proposed technique to analyze an ischemic stroke dataset. MATERIALS AND METHODS: We analyzed 4,830 electronic health records (EHRs) from patients with ischemic stroke (2010-2017), containing information about events realized during treatment and clinical and profile information of the patients. The proposed method combined process mining techniques with data analysis, grouping the data by primary care units (PCU - units responsible for the primary care of patients residing in a geographical area). RESULTS: A novel method, named process, data, and management (PDM) analysis method was used for ischemic stroke data and it provided the following outcomes: health care process for patients with ischemic stroke with time statistics; analysis of potential factors for slow hospital admission indicating an increase in the time to hospital admission of 3.4 h (mean value) for patients with an origin at the urgent care center (UCC) - 30% of patients; analysis of PCUs with distinct secondary stroke rates indicating that the social class of patients is the main difference between them; and the visualization of risk factors (before the stroke) by the PCU to inform the health manager about the potential of prevention. DISCUSSION: PDM analysis describes a step-by-step method for combining process analysis with data analysis considering a management focus. The results obtained on the stroke context can support the definition of more refined action plans by the health manager, improving the stroke health care process and preventing new events. CONCLUSION: When a patient is diagnosed with ischemic stroke, immediate treatment is needed. Moreover, it is possible to prevent new events to some degree by monitoring and treating risk factors. PDM analysis provides an overview of the health care process with time, combining elements that affect the treatment flow and factors, which can indicate a potential for preventing new events. We also can apply PDM analysis in different scenarios, when there is information about activities from treatment flow and other characteristics related to the treatment or the prevention of the analyzed disease. The management focus of the results aids in the formulation of service policies, action plans, and resource allocation.

Estimating Herd-Scale Methane Emissions from Cattle in a Feedlot Using Eddy Covariance Measurements and the Carbon Dioxide Tracer Method.

Measurements of methane (CH) emissions from ruminants could provide invaluable data to reduce uncertainties in the global CH budget and to evaluate mitigation strategies to lower greenhouse gas emissions. The main objective of this study was to evaluate a new CO tracer (COT) approach that combined CH and CO atmospheric concentrations with eddy covariance (EC) CO flux measurements to estimate CH emissions from cattle in a feedlot. A closed-path EC system was used to measure CH and CO fluxes from a feedlot in Kansas. The EC flux measurements were scaled from landscape to animal scale using footprint analyses. Emissions of CH from the cattle were also estimated using the COT approach and measured CO and CH concentration, and scaled EC CO fluxes. The CH and CO concentration ratios showed a distinct diel trend with greater values during the daytime. Average monthly CH emission estimates using the COT approach ranged from 72 to 127 g animal d, which was consistent with the values reported in other studies that had similar animal characteristics. The COT method CH emission estimates showed good agreement with scaled CH EC fluxes (slope = 0.9 and = 0.8) for cold and dry months. However, the agreement between the two techniques was significantly reduced (slope = 1.5 and = 0.6) during wet and warm months. On average, the COT method CH emission estimates were 3% greater than the EC CH emissions. Overall, our results suggest that the COT method can be used to estimate enteric feedlot CH emissions.

Leaf wetness duration measurement: comparison of cylindrical and flat plate sensors under different field conditions.

In general, leaf wetness duration (LWD) is a key parameter influencing plant disease epidemiology, since it provides the free water required by pathogens to infect foliar tissue. LWD is used as an input in many disease warning systems, which help growers to decide the best time to spray their crops against diseases. Since there is no observation standard either for sensor or exposure, LWD measurement is often problematic. To assess the performance of electronic sensors, LWD measurements obtained with painted cylindrical and flat plate sensors were compared under different field conditions in Elora, Ontario, Canada, and in Piracicaba, São Paulo, Brazil. The sensors were tested in four different crop environments--mowed turfgrass, maize, soybean, and tomatoes--during the summer of 2003 and 2004 in Elora and during the winter of 2005 in Piracicaba. Flat plate sensors were deployed facing north and at 45 degrees to horizontal, and cylindrical sensors were deployed horizontally. At the turfgrass site, both sensors were installed 30 cm above the ground, while at the crop fields, the sensors were installed at the top and inside the canopy (except for maize, with a sensor only at the top). Considering the flat plate sensor as a reference (Sentelhas et al. Operational exposure of leaf wetness sensors. Agric For Meteorol 126:59-72, 2004a), the results in the more humid climate at Elora showed that the cylindrical sensor overestimated LWD by 1.1-4.2 h, depending on the crop and canopy position. The main cause of the overestimation was the accumulation of big water drops along the bottom of the cylindrical sensors, which required much more energy and, consequently, time to evaporate. The overall difference between sensors when evaporating wetness formed during the night was around 1.6 h. Cylindrical sensors also detected wetness earlier than did flat plates--around 0.6 h. Agreement between plate and cylinder sensors was much better in the drier climate at Piracicaba. These results allow us to caution that cylindrical sensors may overestimate wetness for operational LWD measurements in humid climates and that the effect of other protocols for angling or positioning this sensor should be investigated for different crops.

Cicatrizaçäo de anastomoses do cólon esquerdo com doença inflamatória: estudo experimental em ratos / Healing of the left colon anastomosis with inflammatory disease: experimental study in rats

Complicações relacionadas com a anastomose são descritas com freqüência nas cirurgias para o tratamento da doença inflamatória do cólon. Para conhecer a interferência da inflamação na cicatrização de anastomoses 40 ratos Wistar são utilizados e divididos em 2 grupos. Um deles serviu de controle e no outro induziu-se doença inflamatória com ácido acético 10 por cento por sondagem retal. No sétimo dia procedeu-se à laparotomia em ambos os grupos, colotomia e anastomose término-terminal com pontos separados em plano único. Avaliadas no terceiro e sétimo dias, pode-se verificar que o número de complicações no grupo de animais com doença inflamatória foi maior assim como a mortalidade. As deiscências com peritonite foi a situação mais comum (p=0,0222). A capacidade de suportar pressão, nas anastomoses que evoluíram sem complicações foi menor nestes cólons, porém a diferença quando comparada ao controle não foi significante (p=0,0836). Verificou-se que as anastomoses construídas em cólons com doença inflamatória apresentavam maior concentração de colágeno total, com predomínio de colágeno imaturo (tipo III) (p=0,0000) enquanto que nas feitas em cólons normais predominava colágeno maduro (tipo I) (p=0,0102). Observou-se ainda que a organização do colágeno era menor, no terceiro dia, nas anastomoses com doença inflamatória. Entretando a análise da reação inflamatória ao nível da anastomose foi semelhante nos dois grupos. Estes resultados permitem sugerir que a doença inflamatória leva a aumento do número de deiscências provavelmente pelo atraso da maturação e ordenação do colágeno.