Leveraging digital technology for effective decision making requires tools that can comprehend detailed complex process of healthcare organizations. Considering all dimensions, simulation is applicable in many ways th...Leveraging digital technology for effective decision making requires tools that can comprehend detailed complex process of healthcare organizations. Considering all dimensions, simulation is applicable in many ways throughout the healthcare system due to its ability to capture and mimic detail complexity in clinical operations decisions. Healthcare simulation not only helps ensure that providing services of the highest quality, but simulation ultimately increases the ability of following best practices, quality improvement, and risk management activities. Moreover, this representation of healthcare system has become a primary tool by which increased patient safety can be integrated and facilitated into clinical practices. This article presents a simulation model for healthcare outpatient clinics. This model aims to aid in setting up management guidelines and propose procedure to improve the operation of the clinics and to optimize the performance of such dynamic healthcare clinic. Model optimization is used to find out the optimal staff as resources, which includes physician, nurses, and clinics minimize patient length of stay and smooth patient flow.展开更多
Retroviruses have been proven to cause infections and diseases in a series of mammalian hosts but not in dogs.Then,this letter discussed the dog susceptibility to retrovirus infection,encompassing arguments to underst...Retroviruses have been proven to cause infections and diseases in a series of mammalian hosts but not in dogs.Then,this letter discussed the dog susceptibility to retrovirus infection,encompassing arguments to understand why dogs may have not been infected by retroviruses thus far.The potential resistance of retrovirus in dogs enables this provocative short communication to discuss this question,looking at some evolutive aspects.The lineage of canids has shown,throughout its evolutionary history,a smaller accumulation of retroviruses in canid genomes,classifed as endogenous retroviruses.In this context,the genomes of canids seem to ofer obstacles,which have been evolutionarily conserved,in the face of retroviral infection.展开更多
Background:Genotyping by sequencing(GBS)is a robust method to genotype markers.Many factors can influence the genotyping quality.One is that heterozygous genotypes could be wrongly genotyped as homozygotes,dependent o...Background:Genotyping by sequencing(GBS)is a robust method to genotype markers.Many factors can influence the genotyping quality.One is that heterozygous genotypes could be wrongly genotyped as homozygotes,dependent on the genotyping depths.In this study,a method correcting this type of genotyping error was demonstrated.The efficiency of this correction method and its effect on genomic prediction were assessed using simulated data of livestock populations.Results:Chip array(Chip)and four depths of GBS data was simulated.After quality control(call rate≥0.8 and MAF≥0.01),the remaining number of Chip and GBS SNPs were both approximately 7,000,averaged over 10 replicates.GBS genotypes were corrected with the proposed method.The reliability of genomic prediction was calculated using GBS,corrected GBS(GBSc),true genotypes for the GBS loci(GBSr)and Chip data.The results showed that GBSc had higher rates of correct genotype calls and higher correlations with true genotypes than GBS.For genomic prediction,using Chip data resulted in the highest reliability.As the depth increased to 10,the prediction reliabilities using GBS and GBSc data approached those using true GBS data.The reliabilities of genomic prediction using GBSc data were 0.604,0.672,0.684 and 0.704 after genomic correction,with the improved values of 0.013,0.009,0.006 and 0.001 at depth=2,4,5 and 10,respectively.Conclusions:The current study showed that a correction method for GBS data increased the genotype accuracies and,consequently,improved genomic predictions.These results suggest that a correction of GBS genotype is necessary,especially for the GBS data with low depths.展开更多
Dear Editor,Middle East respiratory syndrome coronavirus（MERS-CoV）affected 1,621 patients worldwide,with a 36%mortality rate by the end of 2015.The highest number of cases was recorded in Saudi Arabia,
In England and Wales,the Mental Health Act(MHA)1983 provides the legal framework for the detention of individuals suffering from a mental disorder if they are judged to present a risk of harm to self or others.The MHA...In England and Wales,the Mental Health Act(MHA)1983 provides the legal framework for the detention of individuals suffering from a mental disorder if they are judged to present a risk of harm to self or others.The MHA removes from certain psychiatric patients civil liberties otherwise inherent in our legal system.Through both statute and common law,it balances a patient’s right to autonomy with psychiatrists'duty of care by reference to the health and safety of the patient.It also balances the civil rights of individual patients against the right of society to protection1.展开更多
Background.There is growing evidence that social and behavioral determinants of health(SBDH)play a substantial effect in a wide range of health outcomes.Electronic health records(EHRs)have been widely employed to cond...Background.There is growing evidence that social and behavioral determinants of health(SBDH)play a substantial effect in a wide range of health outcomes.Electronic health records(EHRs)have been widely employed to conduct observational studies in the age of artificial intelligence(AI).However,there has been limited review into how to make the most of SBDH information from EHRs using AI approaches.Methods.A systematic search was conducted in six databases to find relevant peer-reviewed publications that had recently been published.Relevance was determined by screening and evaluating the articles.Based on selected relevant studies,a methodological analysis of AI algorithms leveraging SBDH information in EHR data was provided.Results.Our synthesis was driven by an analysis of SBDH categories,the relationship between SBDH and healthcare-related statuses,natural language processing(NLP)approaches for extracting SBDH from clinical notes,and predictive models using SBDH for health outcomes.Discussion.The associations between SBDH and health outcomes are complicated and diverse;several pathways may be involved.Using NLP technology to support the extraction of SBDH and other clinical ideas simplifies the identification and extraction of essential concepts from clinical data,efficiently unlocks unstructured data,and aids in the resolution of unstructured data-related issues.Conclusion.Despite known associations between SBDH and diseases,SBDH factors are rarely investigated as interventions to improve patient outcomes.Gaining knowledge about SBDH and how SBDH data can be collected from EHRs using NLP approaches and predictive models improves the chances of influencing health policy change for patient wellness,ultimately promoting health and health equity.展开更多
Background Pediatric patients with croup are frequently admitted if they require two doses of racemic epinephrine(RE)in the emergency department(ED).We aimed to identify factors associated with the need for additional...Background Pediatric patients with croup are frequently admitted if they require two doses of racemic epinephrine(RE)in the emergency department(ED).We aimed to identify factors associated with the need for additional therapy(>2 RE doses)among pediatric patients with croup.Methods We performed a single-center retrospective study of consecutive patients admitted from the ED with a diagnosis of croup between January 1,2011 and December 31,2015.Primary outcome was need for>2 doses of RE.Secondary out-comes included time to third RE and 72-hour return visits.We performed logistic regression to identify factors associated with use of>2 RE doses during hospitalization,and survival analysis to identify time to dosing of 3rd RE from 2nd RE.Results Of 353 included admissions[250(70.8%)males,median age 1.48,interquartile range 0.97-2.51 years],106/353(30.0%)required>2 RE.In univariate logistic regression,only recent use of steroids within 1 day prior to presentation(4.18,1.48-11.83;P=0.007)was associated with need for>2 RE.Survival from third RE was 0.74(95%CI 0.69-0.78),which was similar to the survival at 12 hours(0.70,95%CI 0.65-0.75).Return visits occurred in 19(5.4%)patients,of whom 12/19(63.2%)were given RE.Conclusions Patients hospitalized for croup with recent use of steroids prior to ED presentation have a greater need for>2 RE during hospitalization.The majority who require inpatient RE will do so within 8-12 hours.These data provide informa-tion for risk stratification and duration of monitoring for patients hospitalized with croup.展开更多
文摘Leveraging digital technology for effective decision making requires tools that can comprehend detailed complex process of healthcare organizations. Considering all dimensions, simulation is applicable in many ways throughout the healthcare system due to its ability to capture and mimic detail complexity in clinical operations decisions. Healthcare simulation not only helps ensure that providing services of the highest quality, but simulation ultimately increases the ability of following best practices, quality improvement, and risk management activities. Moreover, this representation of healthcare system has become a primary tool by which increased patient safety can be integrated and facilitated into clinical practices. This article presents a simulation model for healthcare outpatient clinics. This model aims to aid in setting up management guidelines and propose procedure to improve the operation of the clinics and to optimize the performance of such dynamic healthcare clinic. Model optimization is used to find out the optimal staff as resources, which includes physician, nurses, and clinics minimize patient length of stay and smooth patient flow.
基金Fapesp 2014/22827–7Ministério da Saúde do BrasilFundação Faculdade de Medicina and CNPq Grant to JC:301275/2019–0.
文摘Retroviruses have been proven to cause infections and diseases in a series of mammalian hosts but not in dogs.Then,this letter discussed the dog susceptibility to retrovirus infection,encompassing arguments to understand why dogs may have not been infected by retroviruses thus far.The potential resistance of retrovirus in dogs enables this provocative short communication to discuss this question,looking at some evolutive aspects.The lineage of canids has shown,throughout its evolutionary history,a smaller accumulation of retroviruses in canid genomes,classifed as endogenous retroviruses.In this context,the genomes of canids seem to ofer obstacles,which have been evolutionarily conserved,in the face of retroviral infection.
基金supported by the Genomic Selection in PlantsAnimals(GenSAP)research project financed by the Danish Council of Strategic Research(Aarhus,Denmark)the scholarship provided by the China Scholarship Council(CSC)
文摘Background:Genotyping by sequencing(GBS)is a robust method to genotype markers.Many factors can influence the genotyping quality.One is that heterozygous genotypes could be wrongly genotyped as homozygotes,dependent on the genotyping depths.In this study,a method correcting this type of genotyping error was demonstrated.The efficiency of this correction method and its effect on genomic prediction were assessed using simulated data of livestock populations.Results:Chip array(Chip)and four depths of GBS data was simulated.After quality control(call rate≥0.8 and MAF≥0.01),the remaining number of Chip and GBS SNPs were both approximately 7,000,averaged over 10 replicates.GBS genotypes were corrected with the proposed method.The reliability of genomic prediction was calculated using GBS,corrected GBS(GBSc),true genotypes for the GBS loci(GBSr)and Chip data.The results showed that GBSc had higher rates of correct genotype calls and higher correlations with true genotypes than GBS.For genomic prediction,using Chip data resulted in the highest reliability.As the depth increased to 10,the prediction reliabilities using GBS and GBSc data approached those using true GBS data.The reliabilities of genomic prediction using GBSc data were 0.604,0.672,0.684 and 0.704 after genomic correction,with the improved values of 0.013,0.009,0.006 and 0.001 at depth=2,4,5 and 10,respectively.Conclusions:The current study showed that a correction method for GBS data increased the genotype accuracies and,consequently,improved genomic predictions.These results suggest that a correction of GBS genotype is necessary,especially for the GBS data with low depths.
文摘Dear Editor,Middle East respiratory syndrome coronavirus（MERS-CoV）affected 1,621 patients worldwide,with a 36%mortality rate by the end of 2015.The highest number of cases was recorded in Saudi Arabia,
文摘In England and Wales,the Mental Health Act(MHA)1983 provides the legal framework for the detention of individuals suffering from a mental disorder if they are judged to present a risk of harm to self or others.The MHA removes from certain psychiatric patients civil liberties otherwise inherent in our legal system.Through both statute and common law,it balances a patient’s right to autonomy with psychiatrists'duty of care by reference to the health and safety of the patient.It also balances the civil rights of individual patients against the right of society to protection1.
基金RZ was partially supported by the National Institutions of Health’s National Center for Complementary&Integrative Health(NCCIH)the Office of Dietary Supplements(ODS)and National Institute on Aging(NIA)grant number R01AT009457(PI:Zhang).
文摘Background.There is growing evidence that social and behavioral determinants of health(SBDH)play a substantial effect in a wide range of health outcomes.Electronic health records(EHRs)have been widely employed to conduct observational studies in the age of artificial intelligence(AI).However,there has been limited review into how to make the most of SBDH information from EHRs using AI approaches.Methods.A systematic search was conducted in six databases to find relevant peer-reviewed publications that had recently been published.Relevance was determined by screening and evaluating the articles.Based on selected relevant studies,a methodological analysis of AI algorithms leveraging SBDH information in EHR data was provided.Results.Our synthesis was driven by an analysis of SBDH categories,the relationship between SBDH and healthcare-related statuses,natural language processing(NLP)approaches for extracting SBDH from clinical notes,and predictive models using SBDH for health outcomes.Discussion.The associations between SBDH and health outcomes are complicated and diverse;several pathways may be involved.Using NLP technology to support the extraction of SBDH and other clinical ideas simplifies the identification and extraction of essential concepts from clinical data,efficiently unlocks unstructured data,and aids in the resolution of unstructured data-related issues.Conclusion.Despite known associations between SBDH and diseases,SBDH factors are rarely investigated as interventions to improve patient outcomes.Gaining knowledge about SBDH and how SBDH data can be collected from EHRs using NLP approaches and predictive models improves the chances of influencing health policy change for patient wellness,ultimately promoting health and health equity.
文摘Background Pediatric patients with croup are frequently admitted if they require two doses of racemic epinephrine(RE)in the emergency department(ED).We aimed to identify factors associated with the need for additional therapy(>2 RE doses)among pediatric patients with croup.Methods We performed a single-center retrospective study of consecutive patients admitted from the ED with a diagnosis of croup between January 1,2011 and December 31,2015.Primary outcome was need for>2 doses of RE.Secondary out-comes included time to third RE and 72-hour return visits.We performed logistic regression to identify factors associated with use of>2 RE doses during hospitalization,and survival analysis to identify time to dosing of 3rd RE from 2nd RE.Results Of 353 included admissions[250(70.8%)males,median age 1.48,interquartile range 0.97-2.51 years],106/353(30.0%)required>2 RE.In univariate logistic regression,only recent use of steroids within 1 day prior to presentation(4.18,1.48-11.83;P=0.007)was associated with need for>2 RE.Survival from third RE was 0.74(95%CI 0.69-0.78),which was similar to the survival at 12 hours(0.70,95%CI 0.65-0.75).Return visits occurred in 19(5.4%)patients,of whom 12/19(63.2%)were given RE.Conclusions Patients hospitalized for croup with recent use of steroids prior to ED presentation have a greater need for>2 RE during hospitalization.The majority who require inpatient RE will do so within 8-12 hours.These data provide informa-tion for risk stratification and duration of monitoring for patients hospitalized with croup.
