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1.
JAMA ; 323(10): 1000, 2020 03 10.
Artículo en Inglés | MEDLINE | ID: mdl-32154854
4.
Euro Surveill ; 25(9)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32156332

RESUMEN

Two months after the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the possibility of established and widespread community transmission in the European Union and European Economic Area (EU/EEA) is becoming more likely. We provide scenarios for use in preparedness for a possible widespread epidemic. The EU/EEA is moving towards the 'limited sustained transmission' phase. We propose actions to prepare for potential mitigation phases and coordinate efforts to protect the health of citizens.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Planificación en Desastres , Epidemias , Planificación en Salud , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Betacoronavirus/patogenicidad , Comorbilidad , Infecciones por Coronavirus/transmisión , Europa (Continente)/epidemiología , Unión Europea , Predicción , Humanos , Internacionalidad , Persona de Mediana Edad , Modelos Teóricos , Neumonía Viral/transmisión , Salud Pública , Factores de Riesgo , Incertidumbre
5.
Artículo en Inglés | MEDLINE | ID: mdl-32182811

RESUMEN

The outbreak of an epidemic disease may pose significant treats to human beings and may further lead to a global crisis. In order to control the spread of an epidemic, the effective management of rapidly increased medical waste through establishing a temporary reverse logistics system is of vital importance. However, no research has been conducted with the focus on the design of an epidemic reverse logistics network for dealing with medical waste during epidemic outbreaks, which, if improperly treated, may accelerate disease spread and pose a significant risk for both medical staffs and patients. Therefore, this paper proposes a novel multi-objective multi-period mixed integer program for reverse logistics network design in epidemic outbreaks, which aims at determining the best locations of temporary facilities and the transportation strategies for effective management of the exponentially increased medical waste within a very short period. The application of the model is illustrated with a case study based on the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China. Even though the uncertainty of the future COVID-19 spread tendency is very high at the time of this research, several general policy recommendations can still be obtained based on computational experiments and quantitative analyses. Among other insights, the results suggest installing temporary incinerators may be an effective solution for managing the tremendous increase of medical waste during the COVID-19 outbreak in Wuhan, but the location selection of these temporary incinerators is of significant importance. Due to the limitation on available data and knowledge at present stage, more real-world information are needed to assess the effectiveness of the current solution.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Eliminación de Residuos Sanitarios , Residuos Sanitarios , Neumonía Viral/epidemiología , Administración de Residuos/métodos , Betacoronavirus , China/epidemiología , Epidemias , Humanos , Investigación Operativa , Solución de Problemas , Incertidumbre
6.
Behav Brain Sci ; 43: e2, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32159476

RESUMEN

When constrained by limited resources, how do we choose axioms of rationality? The target article relies on Bayesian reasoning that encounter serious tractability problems. We propose another axiomatic foundation: quantum probability theory, which provides for less complex and more comprehensive descriptions. More generally, defining rationality in terms of axiomatic systems misses a key issue: rationality must be defined by humans facing vague information.


Asunto(s)
Cognición , Solución de Problemas , Teorema de Bayes , Humanos , Probabilidad , Incertidumbre
7.
Br J Radiol ; 93(1107): 20190919, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32003576

RESUMEN

OBJECTIVE: Monte Carlo (MC) simulations substantially improve the accuracy of predicted doses. This study aims to determine and quantify the uncertainties of setting up such a MC system. METHODS: Doses simulated with two Geant4-based MC calculation codes, but independently tuned to the same beam data, have been compared. Different methods of MC modelling of a pre-absorber have been employed, either modifying the beam source parameters (descriptive) or adding the pre-absorber as a physical component (physical). RESULTS: After the independent beam modelling of both systems in water (resulting in excellent range agreement) range differences of up to 3.6/4.8 mm (1.5% of total range) in bone/brain-like tissues were found, which resulted from the use of different mean water ionisation potentials during the energy tuning process. When repeating using a common definition of water, ranges in bone/brain agreed within 0.1 mm and gamma-analysis (global 1%,1mm) showed excellent agreement (>93%) for all patient fields. However, due to a lack of modelling of proton fluence loss in the descriptive pre-absorber, differences of 7% in absolute dose between the pre-absorber definitions were found. CONCLUSION: This study quantifies the influence of using different water ionisation potentials during the MC beam modelling process. Furthermore, when using a descriptive pre-absorber model, additional Faraday cup or ionisation chamber measurements with pre-absorber are necessary. ADVANCES IN KNOWLEDGE: This is the first study quantifying the uncertainties caused by the MC beam modelling process for proton pencil beam scanning, and a more detailed beam modelling process for MC simulations is proposed to minimise the influence of critical parameters.


Asunto(s)
Método de Montecarlo , Terapia de Protones/métodos , Incertidumbre , Absorción de Radiación , Aire , Huesos/efectos de la radiación , Encéfalo/efectos de la radiación , Humanos , Hipofraccionamiento de la Dosis de Radiación , Dosificación Radioterapéutica , Reproducibilidad de los Resultados , Agua
8.
Biochem Med (Zagreb) ; 30(1): 010101, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-32063728

RESUMEN

Uncertainty is an inseparable part of all types of measurement. Recently, the International Organization for Standardization (ISO) released a new standard (ISO 20914) on how to calculate measurement uncertainty (MU) in laboratory medicine. This standard can be regarded as the beginning of a new era in laboratory medicine. Measurement uncertainty comprises various components and is used to calculate the total uncertainty. All components must be expressed in standard deviation (SD) and then combined. However, the characteristics of these components are not the same; some are expressed as SD, while others are expressed as a ± b, such as the purity of the reagents. All non-SD variables must be transformed into SD, which requires a detailed knowledge of common statistical distributions used in the calculation of MU. Here, the main statistical distributions used in MU calculation are briefly summarized.


Asunto(s)
Ciencia del Laboratorio Clínico , Distribuciones Estadísticas , Incertidumbre , Humanos , Ciencia del Laboratorio Clínico/normas
9.
Br J Anaesth ; 124(3): e148-e154, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32000976

RESUMEN

Modern healthcare is delivered by interprofessional teams, and good leadership of these teams is integral to safe patient care. Good leadership in the operating theatre has traditionally been considered as authoritative, confident and directive, and stereotypically associated with men. We argue that this may not be the best model for team-based patient care and promote the concept of inclusive leadership as a valid alternative. Inclusive leadership encourages all team members to contribute to decision-making, thus engendering more team cohesion, information sharing and speaking up, and ultimately enhancing team effectiveness. However, the relational behaviours associated with inclusive leadership are stereotypically associated with women and may not in fact be recognised as leadership. In this article we provide evidence on the advantages of inclusive leadership over authoritative leadership and explore gender stereotypes and obstacles that limit the recognition of inclusive leadership. We propose that operating teams rise above gender stereotypes of leadership. Inclusive leadership can elicit maximum performance of every team member, thus realising the full potential of interprofessional healthcare teams to provide the best care for patients.


Asunto(s)
Liderazgo , Quirófanos , Grupo de Atención al Paciente , Estereotipo , Humanos , Incertidumbre
11.
Waste Manag ; 105: 73-83, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-32032854

RESUMEN

A well-designed collection system plays a critical role in establishing a financially sustainable construction and demolition (C&D) management system. In order to achieve the best performance of the collection system, the development of an advanced decision-making tool with trade-off among multiple criteria is significant. The main objective of this research is to select economically best locations of transfer stations (TSs) to improve the effectiveness and efficiency of the collection system for C&D waste. This paper develops a scenario-based multi-period robust facility location model to minimize the total cost of the collection system for C&D waste. The novelty of the proposed model is the consideration of the uncertainty of C&D waste generation source locations in the construction industry. Also, besides the traditional economic criteria, the risk of decision-making or the reliability of the optimal solution obtained is taken into account for the best overall performance solution. A comparative analysis is performed to demonstrate the superiority of the proposed model. The trade-offs between decision-making risk and economic criteria are performed with a sensitivity analysis. By applying the proposed robust facility location model for TSs for a case study in Chongqing, China, this paper verify the effectiveness and usefulness of the model. The results of this study indicate that the dynamic location strategy made by the proposed robust model can remain the optimal layout of the TSs under uncertainty to improve facility efficiency. Moreover, focusing on risk criteria in decision-making can achieve the best performance solution with reliability.


Asunto(s)
Industria de la Construcción , Administración de Residuos , China , Materiales de Construcción , Modelos Teóricos , Reproducibilidad de los Resultados , Incertidumbre
12.
Water Res ; 174: 115614, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32087414

RESUMEN

In the more than 15 years since its introduction, quantitative microbial risk assessment (QMRA) has become a widely used technique for assessing population health risk posed by waterborne pathogens. However, the variation in approaches taken for QMRA in relation to drinking water supply is not well understood. This systematic review identifies, categorises, and critically synthesises peer-reviewed and academic case studies of QMRA implementation for existing distributed public drinking water supplies. Thirty-nine English-language, peer-reviewed and academic studies published from 2003 to 2019 were identified. Key findings were synthesised in narrative form. The overall designs of the included studies varied widely, as did the assumptions used in risk calculation, especially in relation to pathogen dose. There was also substantial variation in the degree to which the use of location-specific data weighed with the use of assumptions when performing risk calculation. In general, the included studies' complexity did not appear to be associated with greater result certainty. Factors relating to pathogen dose were commonly influential on risk estimates whereas dose-response parameters tended to be of low relative influence. In two of the included studies, use of the 'susceptible fraction' factor was inconsistent with recognised guidance and potentially led to the underestimation of risk. While approaches and assumptions used in QMRA need not be standardised, improvement in the reporting of QMRA results and uncertainties would be beneficial. It is recommended that future authors consider the water supply QMRA reporting checklist developed for the current review. Consideration of the broad types of uncertainty relevant to QMRA is also recommended. Policy-makers should consider emergent discussion on acute microbial health-based targets when setting normative guidelines. The continued representation of QMRA case studies within peer-reviewed and academic literature would also enhance future implementation. Further research is needed on the optimisation of QMRA resourcing given the application context.


Asunto(s)
Agua Potable , Medición de Riesgo , Microbiología del Agua , Incertidumbre , Abastecimiento de Agua
13.
J Emerg Manag ; 18(1): 75-79, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32031673

RESUMEN

This study aimed to identify issues that arose during the early response stage of the Bam earthquake as perceived by the aid workers. Eleven people who had been involved in the Bam earthquake response, and who were working for the Red Crescent in Iran or the Kerman University of Medical Science teams, were interviewed. These groups were two of the main organizations providing assistance to victims of the Bam earthquake. The authors used two nonrandom sampling methods, namely, purposive and snowball sampling. The interviewees identified two main barriers for achieving an effective response at the early stage aftermath of the earthquake, as follows: first, the lack of accurate information on the location and extent of the earthquake due to shortage in communication tools and, second, inadequate training on different challenges posed in relation to the disaster, before the earthquake occurred.


Asunto(s)
Planificación en Desastres , Desastres , Terremotos , Incertidumbre , Humanos , Irán
15.
Environ Monit Assess ; 192(2): 100, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31912242

RESUMEN

Water temperature is a key characteristic defining chemical, physical, and biologic conditions in riverine systems. Models of riverine water quality require many inputs, which are commonly beset by uncertainty. This study presents an uncertainty analysis of inputs to the stream-temperature simulation model HFLUX. This paper's assessment relies on a Markov chain Monte Carlo (MCMC) analysis with the DREAM algorithm, which has fast convergence rate and good accuracy. The inputs herein considered are the river width and depth, percent shade, view to sky, streamflow, and the minimum and maximum values of inputs required for uncertainty analysis. The results are presented as histograms for each input specifying the input's uncertainty. A comparison of the observational data with the DREAM algorithm estimates yielded a maximum error equal to 7.5%, which indicates excellent performance of the DREAM algorithm in ascertaining the effect of uncertainty in riverine water quality assessment.


Asunto(s)
Monitoreo del Ambiente/métodos , Hidrodinámica , Ríos , Algoritmos , Teorema de Bayes , Cadenas de Markov , Método de Montecarlo , Temperatura Ambiental , Incertidumbre , Agua/química , Calidad del Agua
16.
Mar Pollut Bull ; 150: 110746, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31910518

RESUMEN

Limited models are available to estimate human physical health risks (e.g., probability of outcomes such as lung disease, cancer, skin disease) from exposure to chemicals resulting from oil spills that may occur offshore and later impact coastline spills. An approach is presented to assess physical health risks from oil spills that involves establishing a platform capable of assessing aggregate health risk (via inhalation, ingestion, and dermal exposure routes). Gaps include the need to develop models reflecting oil spill concentration distributions given the influence from environmental, physical, biological and chemical factors. Human activities need to be quantified for different populations including emergency response workers, fishermen, shellfish consumers, and children who play at beaches that may be impacted by oil spills. Work is also needed in developing comprehensive toxicological profiles for the majority of chemicals - including dispersants found in oil spills - and to estimate toxicity from mixtures.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminación por Petróleo , Contaminantes Químicos del Agua/análisis , Humanos , Conocimiento , Medición de Riesgo , Alimentos Marinos , Incertidumbre
17.
Br J Radiol ; 93(1107): 20190584, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31977241

RESUMEN

OBJECTIVE: We compared the sensitivity of intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) plans to setup uncertainties in locally advanced non-small cell lung cancer (NSCLC) using probabilistic scenarios. METHODS: Minimax robust (MM) and planning target volume (PTV) optimised IMPT and VMAT nominal plans were created with physical dose of 70 Gy in 35 fractions in 10 representative patients. Using population data of setup errors, a fractionated treatment course was simulated, summed (Dsum) and compared to the nominal plan. Three treatment-course simulations were done for each plan. Target robustness criteria were: dose deviation of ≤5% to clinical target volume (CTV) D98% and CTV V95% ≥ 99.9%. Voxelwise simulation repeatability was analysed using Bland-Altman plots. Acceptable limits of agreement were 2% of the prescription dose. RESULTS: All Dsum met target robustness criteria. While fraction VMAT and MM-IMPT doses were excellent, simulated fraction doses in PTV-IMPT were suboptimal. Almost all (>99%) of VMAT and MM-IMPT fraction doses met both target robustness criteria. For PTV-IMPT, only 96.9 and 80.3% of fractions met CTVD98% and V95% criteria respectively. Simulation repeatability was excellent (limits of agreement range: 0.41-1.1 Gy) with strong positive correlations. CONCLUSION: When considering the whole treatment course, setup errors do not influence robustness irrespective of planning techniques used. However, on a fraction level, VMAT and MM-IMPT plans are superior compared to PTV-IMPT plans. ADVANCES IN KNOWLEDGE: Probabilistic analysis provides a fast and practical method for evaluating VMAT and IMPT plan sensitivity against setup uncertainty. VMAT and robust-optimised IMPT plans have comparable sensitivity to setup uncertainties in conventionally fractionated treatment for NSCLC.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Fotones/uso terapéutico , Terapia de Protones/métodos , Errores de Configuración en Radioterapia , Radioterapia de Intensidad Modulada/métodos , Incertidumbre , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Fraccionamiento de la Dosis de Radiación , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
18.
Water Res ; 171: 115403, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31901508

RESUMEN

Remote sensing reflectance (Rrs) values measured by satellite sensors involve large amounts of uncertainty leading to non-negligible noise in remote Chlorophyll-a (Chl-a) concentration estimation. This work distinguished between two main stages in the case of estimating distributions of Chl-a within the Gulf of St. Lawrence (Canada). At the model building stage, the retrieval algorithm used both in-situ Chl-a measurements and the corresponding Moderate Resolution Imaging Spectroradiometer (MODIS) L2-level data estimated Rrs at 412, 443, 469, 488, 531, 547, 555, 645, 667, 678 nm at a 1 km spatial resolution during 2004-2013. Through the training and validation of various models and Rrs combinations of the considered eight techniques (including support vector regression, artificial neural networks, gradient boosting machine, random forests, standard CI-OC3M, multiple linear regression, generalized addictive regression, principal component regression), the support vector regression (SVR) technique was shown to have the best performance in Chl-a concentration estimation using Rrs at 412, 443, 488, 531 and 678 nm. The accuracy indicators for both the training (850) and the validation (213) datasets were found to be very good to excellent (e.g., the R2 value varied between 0.7058 and 0.9068). At the space-time estimation stage, this work took a step forward by using the Bayesian maximum entropy (BME) theory to further process the SVR estimated Chl-a concentrations by incorporating the inherent spatiotemporal dependency of physical Chl-a distribution. A 56% improvement was achieved in the reduction of the mean uncertainty of the validation data decreased considerably (from 1.2222 to 0.5322 mg/m3). Then, this novel BME/SVR framework was employed to estimate the daily Chl-a concentrations in the Gulf of St. Lawrence during Jan 1-Dec 31 of 2017 (1 km spatial resolution). The results showed that the daily mean Chl-a concentration varied from 1.6630 to 3.3431 mg/m3, and that the daily mean Chl-a uncertainty reduction of the composite BME/SVR vs. the SVR estimation had a maximum reduction value of 1.0082 and an average reduction value of 0.6173 mg/m3. The monthly spatial Chl-a distribution covariances showed that the highest Chl-a concentration variability occurred during November and that the spatiotemporal Chl-a concentration pattern changed a lot during the period August to November. In conclusion, the proposed BME/SVR was shown to be a promising remote Chl-a retrieval approach that exhibited a significant ability in reducing the non-negligible uncertainty and improving the accuracy of remote sensing Chl-a concentration estimates.


Asunto(s)
Clorofila A , Tecnología de Sensores Remotos , Teorema de Bayes , Canadá , Clorofila , Monitoreo del Ambiente , Incertidumbre
19.
Waste Manag ; 104: 262-269, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31991267

RESUMEN

Anaerobic digestion (AD) reduces GHG emission and facilitates renewable energy generation. The slow rate of adoption of this technology is often attributed to economic and technical considerations. Collaboration of two or more dairy farms into a centralized AD system can improve the process economics through economies of scale. However, uncertainties related to the process parameters and the scope/scale of the collaborative implementation impede its adoption. This study presents techno-economic optimization model as a design aid to determine ideal location, capacity, and participation level (cluster size) that maximize economic return on a cooperative digester. This study employs a probabilistic approach to overcome uncertainty regarding project parameters such as manure biomethane potential (BMP), project capital, and electricity sale price. Two case studies based on dairy production regions in Wisconsin were developed to test the model and demonstrate its capabilities. Herd sizes and spatial distribution in a given region were found to be critical factors in determining the viability of digestion projects in general, and collaborative digestion systems in particular. The number of simulation runs needed to capture the probability of profitable AD facility establishment was less than 1000 for both case studies assessed. Electricity sale price and biomethane potential of feedstock utilized were found to be the most restrictive to the feasibility of AD adoption. Changing the optimization objective function, to adopting maximization, favored the formation of collaborative AD facilities for both case studies evaluated.


Asunto(s)
Biocombustibles , Estiércol , Anaerobiosis , Animales , Metano , Técnicas de Planificación , Incertidumbre , Wisconsin
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