scholarly journals Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: an Asthma Use Case (Preprint)

2021 ◽  
Author(s):  
Karamarie Fecho ◽  
Stanley C Ahalt ◽  
Steven Appold ◽  
Saravanan Arunachalam ◽  
Emily Pfaff ◽  
...  
Keyword(s):  
Emergency Department ◽  
Open Source ◽  
Environmental Exposures ◽  
Application Programming Interface ◽  
Primary Outcome Measure ◽  
Environmental Data ◽  
Use Case ◽  
Chi Square ◽  
Patient Level ◽  
Asthma Exacerbations

BACKGROUND The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner. OBJECTIVE This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case. METHODS We queried the ICEES open application programming interface using a functionality that supports Chi Square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (α=.001). We focused on two primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone. RESULTS Of the N = 157,410 patients within the asthma cohort, N = 26,332 patients (16.05%) had one or more annual emergency department or inpatient visits for respiratory issues, and N = 17,056 patients (10.40%) had one or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of PM2.5 or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural vs urban residence. Moreover, the results were largely consistent across outcome measures. CONCLUSIONS Our results demonstrate that ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields.

Parquet Cube to store and process gridded data

2020 ◽  
Author(s):  
elisabeth lambert ◽  
Jean-michel Zigna ◽  
Thomas Zilio ◽  
Flavien Gouillon
Keyword(s):  
Big Data ◽  
Open Source ◽  
Value Chain ◽  
Environmental Data ◽  
Use Cases ◽  
Use Case ◽  
Gridded Data ◽  
The Earth ◽  
Oceanographic Data ◽  
Second Use

&lt;p&gt;The volume of data in the earth data observation domain grows considerably, especially with the emergence of new generations of satellites providing much more precise measures and thus voluminous data and files. The &amp;#8216;big data&amp;#8217; field provides solutions for storing and processing huge amount of data. However, there is no established consensus, neither in the industrial market nor the open source community, on big data solutions adapted to the earth data observation domain. The main difficulty is that these multi-dimensional data are not naturally scalable. CNES and CLS, driven by a CLS business needs, carried out a study to address this difficulty and try to answer it.&lt;/p&gt;&lt;p&gt;Two use cases have been identified, these two being complementary because at different points in the value chain: 1) the development of an altimetric processing chain, storing low level altimetric measurements from multiple satellite missions, and 2) the extraction of oceanographic environmental data along animal and ships tracks. The original data format of these environmental variables is netCDF. We will first show the state of the art of big data technologies that are adapted to this problematic and their limitations. Then, we will describe the prototypes behind both use cases and in particular how the data is split into independent chunks that then can be processed in parallel. The storage format chosen is the Apache parquet and in the first use case, the manipulation of the data is made with the xarray library while all the parallel processes are implemented with the Dask framework. An implementation using Zarr library instead of Parquet has also been developed and results will also be shown. In the second use case, the enrichment of the track with METOC (Meteo/Oceanographic) data is developed using the Spark framework. Finally, results of this second use case, that runs operationally today for the extraction of oceanographic data along tracks, will be shown. This second solution is an alternative to Pangeo solution in the world of industrial and Java development. It extends the traditional THREDDS subsetter, delivered by the Open source Unidata Community, to a bigdata implementation. This Parquet storage and associated service implements a smoothed transition of gridded data in Big Data infrastructures.&lt;/p&gt;

scholarly journals Hubungan Waktu Tunggu Pindah (Boarding Time) Pasien Trauma Level 1 dan 2 dengan Kejadian Kematian DI IGD RSUP SANGLAH DENPASAR

2020 ◽  
Vol 4 (1) ◽  
pp. 26
Author(s):  
Ngakan Nyoman Rai Bawa ◽  
I Dewa Agung Ketut Sudarsana ◽  
Made Duita
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
Odds Ratio ◽  
Chi Square ◽  
Cross Sectional ◽  
Probability Sampling ◽  
Consecutive Sampling ◽  
Patient Level ◽  
Mortality Event ◽  
Level 1

ABSTRAK Latar belakang: Pelayanan yang cepat dan tepat sangat dibutuhkan di dalam pelayanan Instalasi Gawat Darurat (IGD). Pelayanan di IGD dapat terhambat jika kondisi di dalam IGD penuh dengan pasien yang disebabkan oleh tidak sesuainya jumlah pasien yang berkunjung ke IGD dengan tempat tidur yang ada di IGD dan ruang rawat inap penuh. Hal tersebut dapat mengakibatkan waktu tunggu pasien yang lama untuk pindah ke ruangan yang berdampak terhadap keselamatan dan nyawa pasien itu sendiri. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan waktu tunggu pindah (boarding time) pasien trauma level 1 dan 2 dengan kejadian kematian. Metode: Penelitian ini merupakan non– eksperimen, dengan rancangan observasional analitik dengan pendekatan cross sectional. Teknik pengambilan sampel dengan cara non probability sampling yaitu consecutive sampling, sebanyak 41 orang. Instrumen yang digunakan lembar observasi dan rekam medik pasien. Analisis data dilakukan dengan menggunakan uji Chi-Square. Hasil: Hasil analisis dapat diperoleh nilai α=0,021, X2 =5,331 dan odds ratio 4,571. Ada hubungan waktu tunggu pindah (boarding time) pasien trauma level 1 dan 2 dengan kejadian kematian dengan arah korelasi positif dan memiliki risiko kematian 4,571 lipat, sekurang-kurangnya memiliki risiko kematian sebesar 1,089 kali lipat dan paling besar berisiko kematian sebesar 17,157 kali lipat. Kesimpulan: Banyak faktor yang menyebabkan kematian pasien di IGD, salah satunya adalah waktu tunggu (boarding time) pasien yang terlalu lama.Kata kunci: IGD, waktu tunggu pindah (boarding time), kejadian kematianThe Correlation of Boarding Time of Trauma Patient Level 1 and 2 with Mortality Event in Emergency Department Sanglah Hospital DenpasarABSTRACTBackground: Rapid and effective response are highly demand in the Emergency Department. Delayed emergency services may happen if the patients’ occupancy is full, it occurred due to amount of patients are higher than the beds available in the emergency room and in wards. Thus, it may lead to longer time needed for patients movement to ward (boarding time) effecting the patient’s safety nevertheless threatening the patient’s life itself. Objective: The purpose of this study was to determine the correlation between boarding time of trauma patient level 1 and 2 with mortality event. Method: This study was non–exsperimen, observasional analitik design with cross sectional approach. Sampling technique used non-probability sampling with consecutive sampling, as many as 41 people. The instrument used was an observation and the patient medical record. Data analysis was done using Chi-Square test. Results: Results of analysis can be obtained by value α=0,021 and X2 =5,331 and odds ratio 4,571. There is a correlation between Boarding time of trauma patient level 1 and 2 with mortality event with positive correlation direction with risk of mortality 4,571, odds ratio lower bound mortality risk 1,089 and upper bound 17,157. Conclusion: There was many factors that caused death in Emergency Departement one of them was too long boarding time patient.Keywords: emergency department, boarding time, mortality event

Asthma

2020 ◽  
Author(s):  
Haitham Nsour ◽  
Anne E. Dixon
Keyword(s):  
Emergency Department ◽  
Inhaled Corticosteroids ◽  
Early Recognition ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Significant Proportion ◽  
The United States ◽  
Asthma Prevalence ◽  
Public Health Burden ◽  
Asthma Exacerbations ◽  
Oral Corticosteroids

Asthma is one of the most common diseases in developed nations. A pathognomonic feature of asthma is episodic aggravations of the disease; these exacerbations can be life-threatening and contribute to a significant proportion of the public health burden of asthma. In the emergency department, successful management of asthma exacerbations requires early recognition and intervention before they become severe and potentially fatal. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for asthma. Figures show the management of asthma exacerbations in the emergency department and hospital, pooled odds ratio comparing inhaled corticosteroids and oral corticosteroids with oral corticosteroids alone following emergency department discharge, and an asthma discharge plan at the emergency department. Tables list current asthma prevalence among selected demographic groups in the United States, risk factors for fatal asthma exacerbations, differential diagnosis of asthma exacerbations, and dosages of drugs for asthma exacerbations. This review contains 3 figures, 16 tables, and 88 references. Key Words: Asthma, allergic bronchopulmonary aspergillosis, gastroesophageal reflux disease, sinus disease, breathlessness, shortness of breath  

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

CJEM ◽  
2014 ◽  
Vol 16 (06) ◽  
pp. 467-476 ◽  
Author(s):  
Pat G. Camp ◽  
Seamus P. Norton ◽  
Ran D. Goldman ◽  
Salomeh Shajari ◽  
M. Anne Smith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Family Doctor ◽  
Emergency Department Visits ◽  
Upper Respiratory Tract ◽  
Asthma Exacerbations ◽  
Initial Care ◽  
Children With Asthma ◽  
Tract Infections ◽  
The Impact

Abstract Objective: Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months. Results: A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child’s asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child’s future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child’s asthma. Conclusion: Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations.

scholarly journals Simple rules for an efficient use of Geographic Information Systems in molecular ecology

2017 ◽  
Author(s):  
Kevin Leempoel ◽  
Solange Duruz ◽  
Estelle Rochat ◽  
Ivo Widmer ◽  
Pablo Orozco-terWengel ◽  
...  
Keyword(s):  
Information Systems ◽  
Geographic Information Systems ◽  
Open Source ◽  
Spatial Data ◽  
Molecular Ecology ◽  
Relevant Information ◽  
Geographic Information ◽  
Environmental Data ◽  
Essential Information ◽  
Open Source Gis

AbstractGeographic Information Systems (GIS) are becoming increasingly popular in the context of molecular ecology and conservation biology thanks to their display options efficiency, flexibility and management of geodata. Indeed, spatial data for wildlife and livestock species is becoming a trend with many researchers publishing genomic data that is specifically suitable for landscape studies. GIS uniquely reveal the possibility to overlay genetic information with environmental data and, as such, allow us to locate and analyze genetic boundaries of various plant and animal species or to study gene-environment associations (GEA). This means that, using GIS, we can potentially identify the genetic bases of species adaptation to particular geographic conditions or to climate change. However, many biologists are not familiar with the use of GIS and underlying concepts and thus experience difficulties in finding relevant information and instructions on how to use them. In this paper, we illustrate the power of free and open source GIS approaches and provide essential information for their successful application in molecular ecology. First, we introduce key concepts related to GIS than are too often overlooked in the literature, for example coordinate systems, GPS accuracy and scale. We then provide an overview of the most employed open-source GIS-related software, file formats and refer to major environmental databases. We also reconsider sampling strategies as high costs of Next Generation Sequencing (NGS) data currently diminish the number of samples that can be sequenced per location. Thereafter, we detail methods of data exploration and spatial statistics suited for the analysis of large genetic datasets. Finally, we provide suggestions to properly edit maps and to make them as comprehensive as possible, either manually or trough programming languages.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

scholarly journals Efficient Processing of Geospatial mHealth Data Using a Scalable Crowdsensing Platform

Sensors ◽  
2020 ◽  
Vol 20 (12) ◽  
pp. 3456
Author(s):  
Robin Kraft ◽  
Ferdinand Birk ◽  
Manfred Reichert ◽  
Aniruddha Deshpande ◽  
Winfried Schlee ◽  
...  
Keyword(s):  
Architectural Design ◽  
Environmental Data ◽  
Common Interest ◽  
Sensor Data ◽  
Smart Sensors ◽  
Use Case ◽  
Sound Levels ◽  
Efficient Processing ◽  
Interactive Map ◽  
Technical Solutions

Smart sensors and smartphones are becoming increasingly prevalent. Both can be used to gather environmental data (e.g., noise). Importantly, these devices can be connected to each other as well as to the Internet to collect large amounts of sensor data, which leads to many new opportunities. In particular, mobile crowdsensing techniques can be used to capture phenomena of common interest. Especially valuable insights can be gained if the collected data are additionally related to the time and place of the measurements. However, many technical solutions still use monolithic backends that are not capable of processing crowdsensing data in a flexible, efficient, and scalable manner. In this work, an architectural design was conceived with the goal to manage geospatial data in challenging crowdsensing healthcare scenarios. It will be shown how the proposed approach can be used to provide users with an interactive map of environmental noise, allowing tinnitus patients and other health-conscious people to avoid locations with harmful sound levels. Technically, the shown approach combines cloud-native applications with Big Data and stream processing concepts. In general, the presented architectural design shall serve as a foundation to implement practical and scalable crowdsensing platforms for various healthcare scenarios beyond the addressed use case.

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