Utilizing Agent-Based Modeling for Optimization of Wayfinding in Hospital: A Case Study.

OBJECTIVES: This research aims to propose a novel methodology for analyzing and optimizing wayfinding in complex environments by examining their spatial configurations. BACKGROUND: Wayfinding difficulties often lead to disorientation and hinder users' ability to locate destinations. Although architectural design can aid in simplifying user access, existing approaches lack a specific focus on wayfinding optimization despite its significant impact on users' navigational abilities. METHODS: In this study, an agent-based model was employed to assess the efficacy of wayfinding in a multistory hospital. Subsequently, the layouts were optimized, leading to the creation of a new space distribution diagram. The simulation was then repeated to examine the potential improvement in wayfinding. Data collection encompassed user types, workflow scenarios, population distribution, and user speed. RESULTS: Comparative analysis of the agent-based simulation findings before and after layout optimization revealed a decrease in total distance and time spent on the modified floor plans for all users when compared to the existing layout. This suggests that the optimized layout holds significant potential for enhancing wayfinding performance. Given the positive outcomes observed for users, this approach is particularly well suited for preliminary design stages of complex environments, where designations among user groups are less crucial or flexibility is desired. Additional advantages include the ability to generate a comprehensive simulation of users' daily workflow, which is integrated into the optimization process and considers specific requirements regarding spatial adjacency.

Automated Detection and Scoring of Tumor-Infiltrating Lymphocytes in Breast Cancer Histopathology Slides.

Detection of tumor-infiltrating lymphocytes (TILs) in cancer images has gained significant importance as these lymphocytes can be used as a biomarker in cancer detection and treatment procedures. Our goal was to develop and apply a TILs detection tool that utilizes deep learning models, following two sequential steps. First, based on the guidelines from the International Immuno-Oncology Biomarker Working Group (IIOBWG) on Breast Cancer, we labeled 63 large pathology imaging slides and annotated the TILs in the stroma area to create the dataset required for model development. In the second step, various machine learning models were employed and trained to detect the stroma where U-Net deep learning structure was able to achieve 98% accuracy. After detecting the stroma area, a Mask R-CNN model was employed for the TILs detection task. The R-CNN model detected the TILs in various images and was used as the backbone analysis network for the GUI development of the TILs detection tool. This is the first study to combine two deep learning models for TILs detection at the cellular level in breast tumor histopathology slides. Our novel approach can be applied to scoring TILs in large cancer slides. Statistical analysis showed that the output of the implemented approach had 95% concordance with the scores assigned by the pathologists, with a p-value of 0.045 (n = 63). This demonstrated that the results from the developed software were statistically meaningful and highly accurate. The implemented approach in analyzing whole tumor histology slides and the newly developed TILs detection tool can be used for research purposes in biomedical and pathology applications and it can provide researchers and clinicians with the TIL score for various input images. Future research using additional breast cancer slides from various sources for further training and validation of the developed models is necessary for more inclusive, rigorous, and robust clinical applications.

A review of resilience variables in the context of disasters.

The increasing impacts of disasters, caused by more frequent extreme events coupled with the growth of adverse anthropogenic activities, has raised the importance of fostering more resilient communities. Measuring resilience is a vital step in the process of building and strengthening a community's resilience as it helps with identifying the priorities and monitoring the progress. The objective of the current research is to catalog variables proposed in the literature as measures of households' resilience to disasters. Searching the literature through content analysis and applying three selection criteria resulted in a list of 149 variables. These criteria required the variables to be influential on disaster resilience of households, to be quantitatively measurable, and to be obtainable from publicly available data sources. Additionally, a selection of resilience and vulnerability assessment models suggested in the literature were reviewed to highlight the importance of resilience variables in addressing their planned objectives. The variables were classified into five categories titled demographic, socioeconomic, infrastructural, environmental, and institutional. Further analysis of the variables led to identification of the most prevalent variables and commonalities among the categories, aimed to provide a more integrated approach toward resilience planning. This research can serve as an initial yet relatively extensive inventory for selecting variables that are deemed to be influential on households' resilience to extreme events. Further, quantifying a community's resilience using resilience variables can help with identifying and prioritizing the resilience needs, monitoring the progress, and justifying the costs of resilience programs.

Post-disaster place attachment: A qualitative study of place attachment in the wake of the 2013 Moore tornado.

Place attachment is the social, emotional, and functional bond people experience with a specific geographic area. The formation of this bond is based on several different characteristics of the place, such as property values, local relationships, and employment opportunities as well as the internal attributes of a person, such as age, gender, and income. While gaining an understanding of place attachment through these characteristics and attributes is indispensable to our understanding of disaster recovery, few studies have explored this relationship using qualitative methods. Here, the authors address two main questions: how does place attachment vary among different groups of individuals, and what factors contribute to place attachment in a disaster context? This study included a survey of 772 citizens of Moore, Oklahoma, who lived in the path of the May 20, 2013, tornado and decided to rebuild in situ after disaster. The authors explored place attachment using open-response questions probing residents' perceptions of their place of living. The authors found 18 common codes within their descriptions, in which community (social network), infrastructure, and commercial were the three most commonly cited parameters. Also, comparisons of participants' groups such as age and income showed that distinguishable parameters have formed post-disaster place attachment within different groups of participants.

Individual relocation decisions after tornadoes: a multi-level analysis.

This study examines how multi-level factors affected individuals' relocation decisions after EF4 and EF5 (Enhanced Fujita Tornado Intensity Scale) tornadoes struck the United States in 2013. A telephone survey was conducted with 536 respondents, including oversampled older adults, one year after these two disaster events. Respondents' addresses were used to associate individual information with block group-level variables recorded by the American Community Survey. Logistic regression revealed that residential damage and homeownership are important predictors of relocation. There was also significant interaction between these two variables, indicating less difference between homeowners and renters at higher damage levels. Homeownership diminished the likelihood of relocation among younger respondents. Random effects logistic regression found that the percentage of homeownership and of higher income households in the community buffered the effect of damage on relocation; the percentage of older adults reduced the likelihood of this group relocating. The findings are assessed from the standpoint of age difference, policy implications, and social capital and vulnerability.

Predictors for the Number of Warning Information Sources During Tornadoes.

People may receive tornado warnings from multiple information sources, but little is known about factors that affect the number of warning information sources (WISs). This study examined predictors for the number of WISs with a telephone survey on randomly sampled residents in Tuscaloosa, Alabama, and Joplin, Missouri, approximately 1 year after both cities were struck by violent tornadoes (EF4 and EF5) in 2011. The survey included 1006 finished interviews and the working sample included 903 respondents. Poisson regression and Zero-Inflated Poisson regression showed that older age and having an emergency plan predicted more WISs in both cities. Education, marital status, and gender affected the possibilities of receiving warnings and the number of WISs either in Joplin or in Tuscaloosa. The findings suggest that social disparity affects the access to warnings not only with respect to the likelihood of receiving any warnings but also with respect to the number of WISs. In addition, historical and social contexts are important for examining predictors for the number of WISs. We recommend that the number of WISs should be regarded as an important measure to evaluate access to warnings in addition to the likelihood of receiving warnings. (Disaster Med Public Health Preparedness. 2017;11:168-172).

Place attachment and disasters: Knowns and unknowns.

When considering the factors important for disaster recovery, one must consider the attachment individuals have toward their living area. This article reviews and synthesizes the current literature on the determinants of place attachment in the context of postdisaster recovery. Although the majority of the reviewed articles focused on disaster recovery, there were some which had a broader scope and were included due to their importance. This research categorizes the determinants of place attachment into four categories: demographic, socioeconomic, spatial, and psychosocial. Age, ethnicity, and religion were grouped under the category of demographics. Job status, education, and property ownership were categorized under the socioeconomic category. Attachment to home, neighborhood, and city, together with attachment to rural and urban areas, were grouped under the spatial category. Finally, mental health status and community attachment were classified under the psychosocial heading. Based on the outcome of the aforementioned synthesis, this article develops a conceptual framework to guide future research.

The Effect of Emotional Closeness and Exchanges of Support Among Family Members on Residents' Positive and Negative Psychological Responses After Hurricane Sandy.

INTRODUCTION: This study examines how changes in emotional closeness and exchanges of support among family members after Hurricane Sandy affected residents' psychological outcomes both positively and negatively. METHODS: The working sample included 130 family ties reported by 85 respondents recruited from community and shelter residents on Staten Island after it was seriously damaged by the 2012 Hurricane Sandy. Regression with robust standard errors was used to examine how changes in emotional closeness and exchanges of support with adult family members affected respondents' posttraumatic psychological distress and posttraumatic growth. RESULTS: Results showed psychological distress was significantly increased with higher levels of instrumental support received from family members; whereas posttraumatic growth was significantly increased with greater improved emotional closeness with family members. In addition, having higher levels of education was associated with lower levels of psychological distress and respondents from shelters showed higher levels of posttraumatic growth than those who were from the community. DISCUSSION: It is suggested that after a significant disaster, although a family may be the best to take care of its members' emotional needs, it should not be expected to satisfy the instrumental needs of its members. In addition, posttraumatic psychological distress and growth are not necessarily opposite to each other; the psychological well- being of residents after a disaster needs to be carefully examined from both perspectives.

Gemella morbillorum Endocarditis.

Infective endocarditis caused by Gemella morbillorum is a rare disease. In this report 67-year-old male patient with G. morbillorum endocarditis was presented. The patient was hospitalized as he had a fever of unknown origin and in the two of the three sets of blood cultures taken at the first day of hospitalization G. morbillorum was identified. The transthoracic echogram revealed 14 × 10 mm vegetation on the aortic noncoronary cuspis. After 4 weeks of antibiotic therapy, the case was referred to the clinic of cardiovascular surgery for valve surgery.

Brucellar spondylodiscitis: comparison of patients with and without abscesses.

Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

[Attitudes and side effects related to pandemic influenza A (H1N1) vaccination in healthcare personnel]. / Hastane Personeline Pandemik Influenza A (H1N1) Asi Uygulamasinin Ardindan Asilama Hakkindaki Görüsler ve Gözlenen Yan Etkiler.

The aims of this study were to evaluate the attitudes towards H1N1 vaccination and to determine the safety and side effects following 2009 pandemic influenza A (H1N1) vaccination. Pandemic influenza vaccine had been administered to the healthcare personnel in our research and training hospital in December 2009. The rate being vaccinated was established as 40% (800/2000). Four months following vaccination, the opinions about vaccination were asked to the healthcare workers, and also side effects were questioned to the vaccinated group. Two different questionnaires (for vaccinated and unvaccinated subjects) were delivered to the volunteers who agreed to participate in the study. Demographic features, reasons related to being vaccinated or not, were questioned. The vaccinated group was also questioned for the presence of chronic diseases, previous vaccinations (pandemic/seasonal influenza), local or systemic reactions that develop after vaccination. A total of 332 volunteers participated in the questionnaire. Of them 247 (74.4%) were vaccinated and 85 (25.6%) were unvaccinated. Male/female ratio of the participants was 1.2, and 55.7% of them were older than 30-year-old. Most of the participants (82.8%) were highly educated (high school and faculty-graduated). Vaccination rates were found statistically significant in advanced age group compared to young adults (p= 0.042); in male gender compared to females (p= 0.001) and in parents compared to subjects who didn't have children (p= 0.021). Vaccination rates were observed to be higher (57.5%) in non-medical staff (cleaning employers, administrative personnel, etc.) than the physicians (29.1%) and nurses (13.4%), and the rate was also high (54.7%) in personnel who worked in intensive care units, emergency department and administrative units than the personnel who worked in the clinics of internal medicine (22.3%) and surgery (23.1%) (p= 0.001). The most important causes of rejecting vaccination were being afraid of the side effects (69.4%) and not believing the effectiveness of the vaccine (56.4%). The leading causes of accepting vaccination were worries about infecting their family (60.3%) and being in a risk group (54.3%). After vaccination, local reactions (pain, swelling and redness at the vaccination site) were described in 43.3% and systemic reactions (weakness, fatigue, muscle aches, influenza-like symptoms, etc.) were described in 43.7% of the subjects. Severe side effects such as vasculitis, neuritis, encephalomyelitis, Guillian-Barre syndrome and anaphylactic reaction were not observed in any of the vaccinated cases. It was detected that worries about the safety of vaccine had negative impact for vaccination. Since no serious side effects were detected related to vaccination, it was concluded that the vaccine was safe. In spite of the scientific proofs, negative concerns about the safety of the vaccines can unfavorably affect the vaccination campaigns and can jeopardize efforts of influenza control. As a result, data collection systems about the safety and side effects of the vaccine all over the country and regular reports about these data may more efficiently guide vaccination programs in the future.