The hydrological impact assessment in the decision support of nuclear emergency response

The paper presents several aspects believed to be relevant for the integration in the decision support systems for the management of radiological emergencies, of assessment tools addressing surface water contamination. Three exemplary cases are discussed in the context-the CONVEX 2005 international alert exercise, AXIOPOLIS 09, a national drill targeting a CANDU reactor at Cernavoda nuclear power plant in Romania, and Oltenia 07-a nation-wide drill around a scenario, involving trans-border effects of a virtual accident at a VVER reactor at Kozloduy, Bulgaria. The capability of different analytic tools were tested, including public deliverables like real-time, online decision support system's HDM module and model-based computerised system for management support to identify optimal remedial strategies for restoring radionuclide-contaminated aquatic ecosystems and drainage areas, as well as research-grade, home-made facilities, in order to identify and sort out merits and issues of interest in steering their effective utilisation.

Development and validation of a mass casualty conceptual model

PURPOSE

To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events.

DESIGN

The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research.

METHODS

Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions.

FINDINGS

Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale).

CONCLUSIONS

Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care.

CLINICAL RELEVANCE

This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

The primary care physician: nephrology interface for the identification and treatment of chronic kidney disease

This article explores ways in which early identification of chronic kidney disease (CKD) and promotion of the concept of CKD as a modifiable risk can be achieved through transcending traditional primary and secondary care boundaries. National and regional strategies aimed at early identification of CKD in the community are reviewed, together with those aimed at implementation of management to reduce the risk both of progression of CKD and of complications.

Decision support system for the evaluation of urban air pollution control options: application for particulate pollution in Thessaloniki, Greece

Development of strategies to control urban air pollution is a complex and multi-disciplinary process involving a wide range of scientists with different expertise and interests. This paper presents an integrated assessment methodological scheme for the evaluation of air pollution control measures that are put forward in order to reduce sufficiently air pollution levels in urban areas. Forming long-term, efficient air pollution control strategies requires knowledge of the costs associated with their implementation, the emission inventories and emission reductions to be achieved, as well as the concentration variations that represent air quality levels in the area examined. In contrast to the majority of the currently employed assessment approaches, the presented scheme enables the evaluation of any proposed air pollution control option in terms of its combined impact on air quality and social welfare, by correlating economic and health impact assessment issues. The approach presented in this paper brings together air quality modelling and mathematical programming techniques and provides a decision support system for the determination of optimal bundles of air pollution control options according to the particular features and needs of the areas examined. Both cost-effectiveness and cost-benefit approaches are taken into account in order to put the problem on the basis of economic efficiency from a societal perspective. The methodology is implemented for the case of Thessaloniki, Greece, which is selected on the grounds that the area is considered as one of the most polluted--if not the most polluted--cities within Europe, especially with respect to airborne particles.

Chemical plant innovative safety investments decision-support methodology

INTRODUCTION

This article examines the extent to which investing in safety during the creation of a new chemical installation proves profitable.

METHOD

The authors propose a management supporting cost-benefit model that identifies and evaluates investments in safety within a chemical company. This innovative model differentiates between serious accidents and less serious accidents, thus providing an authentic image of prevention-related costs and benefits. In classic cost-benefit analyses, which do not make such differentiations, only a rudimentary image of potential profitability resulting from investments in safety is obtained.

RESULTS

The resulting management conclusions that can be drawn from such classical analyses are of a very limited nature. The proposed model, however, is applied to a real case study and the proposed investments in safety at an appointed chemical installation are weighed against the estimated hypothetical benefits resulting from the preventive measures to be installed at the installation.

CONCLUSION

In the case-study carried out in question, it would appear that the proposed prevention investments are justified.

IMPACT ON INDUSTRY

Such an economic exercise may be very important to chemical corporations trying to (further) improve their safety investments.

Applications of the three-dimensional air quality system to western U.S. air quality: IDEA, smog blog, smog stories, airquest, and the remote sensing information gateway

A system has been developed to combine remote sensing and ground-based measurements of aerosol concentration and aerosol light scattering parameters into a three-dimensional view of the atmosphere over the United States. Utilizing passive and active remote sensors from space and the ground, the system provides tools to visualize particulate air pollution in near real time and archive the results for retrospective analyses. The main components of the system (Infusing satellite Data into Environmental Applications [IDEA], the U.S. Air Quality Weblog [Smog Blog], Smog Stories, U.S. Environmental Protection Agency's AIRQuest decision support system, and the Remote Sensing Information Gateway [RSIG]) are described, and the relationship of how data move from one system to another is outlined. To provide examples of how the results can be used to analyze specific pollution episodes, three events (two fires and one wintertime low planetary boundary layer haze) are discussed. Not all tools are useful at all times, and the limitations, including the sparsity of some data, the interference caused by overlying clouds, etc., are shown. Nevertheless, multiple sources of data help a state, local, or regional air quality analyst construct a more thorough picture of a daily air pollution situation than what one would obtain with only surface-based sensors.

Analysis of acuity trends using Resource Intensity Weights via the CIHI Portal

One key to revolutionizing health care with informatics is the ability of decision-makers to access and analyze relevant data in a timely and efficient manner. Inspired by the demand for timely access to hospitalization data in Canada, CIHI Portal is an innovative web-based analytical tool which combines leading technology and data for decision support analysis. Hospitals, regional health authorities and ministries of health can use CIHI Portal to access comparable, pan-Canadian healthcare data for health data analysis, collaboration and dissemination. The goal of CIHI Portal is to support health care decision-makers in their local and regional health care planning and to answer service delivery questions.The Capital Health region in Alberta used Resource Intensity Weights (RIW) to investigate claims that patients within their region were getting sicker over the past few years and that additional resources would be required in the future. Using the CIHI Portal, Capital Health conducted an analysis on historical trends in the average RIWs Average Resource Intensity Weight is calculated as the total Resource Intensity Weight (RIW) divided by the total number of inpatient separations. and found that although typical patients were not using a greater amount of resources, there was definitely an increase in the amount of resources consumed by atypical patients. Information contained in the analysis influenced budgeting, fund reallocation and health care planning. CIHI Portal has proven to be a reliable tool for data access, information sharing and knowledge exchange. It has enhanced decision support services within the Capital Health region.

Improvement of sand filter and constructed wetland design using an environmental decision support system

With the aim of improving effluent quality of waste stabilization ponds, different designs of vertical flow constructed wetlands and intermittent sand filters were tested on an experimental full-scale plant within the framework of a European project. The information extracted from this study was completed and updated with heuristic and bibliographic knowledge. The data and knowledge acquired were difficult to integrate into mathematical models because they involve qualitative information and expert reasoning. Therefore, it was decided to develop an environmental decision support system (EDSS-Filter-Design) as a tool to integrate mathematical models and knowledge-based techniques. This paper describes the development of this support tool, emphasizing the collection of data and knowledge and representation of this information by means of mathematical equations and a rule-based system. The developed support tool provides the main design characteristics of filters: (i) required surface, (ii) media type, and (iii) media depth. These design recommendations are based on wastewater characteristics, applied load, and required treatment level data provided by the user. The results of the EDSS-Filter-Design provide appropriate and useful information and guidelines on how to design filters, according to the expert criteria. The encapsulation of the information into a decision support system reduces the design period and provides a feasible, reasoned, and positively evaluated proposal.

A combination of deterministic and stochastic approaches to optimize bed capacity in a hospital unit

Random number of arrivals and random length of stays make the number of patients in a hospital unit behave as a stochastic process. This makes the determination of the optimum size of the bed capacity more difficult. The number of admissions per day, service level and occupancy level are key control parameters that affect the optimum size of the required bed capacity. In this study a new stochastic approximation is developed and applied to a unit of a teaching hospital. Data between 2000 and 2004 was used to obtain the necessary probability distribution functions. Mathematical relationships between the control parameters and size of the bed capacity are obtained using generated data from a constructed simulation model. Nonlinear mathematical models are then used to determine the optimum size of the required bed capacity based on target levels of the control parameters, and a profit and loss analysis is performed.

Managing with maps? The development and institutionalization of a map-based health management information system in Madhya Pradesh, India

Aims: This paper presents the development of a map-based health management information system (mHMIS) in the central Indian province of Madhya Pradesh. Sample outputs and statistics from the system for one district are presented. The implementation dynamics and the preliminary performance of the system are discussed. Methods: The development of the mHMIS was a collaborative effort between the provincial Department of Health, the medical university and the Danidasupported Madhya Pradesh Basic Health Services project. One of India's most socioeconomically backward provinces, Madhya Pradesh is spread over an area of 304,000 km2, and has a population of 60.4 million distributed in its 55,392 villages and 394 towns. A primary survey of all healthcare providers (public and private) in the province was done to map these. Secondary data sources for sociodemographic information (census of India), vital statistics and health program indicators (health worker records) were used in developing the system. The process of mapping from obtaining hand-drawn maps of the villages from the commissioner, land records, to final digitizing is also described. Conclusions: Sample outputs and statistics for one district (Chindwara) from the system are presented. There were 20.35 trained doctors in rural areas and 72.78 in urban areas per 100,000 population. Preliminary experience after a year, advantages, constraints (both systemic limitations and weakness in the mHMIS) to optimal usage, and future prospects for use in this setting are discussed.

Factors associated with VHA costs of care for first 12 months after first stroke

We examined the use patterns and costs of care for a validated stroke cohort (n = 172) from 13 Department of Veterans Affairs (VA) medical centers 1 year poststroke. Decision Support System (DSS) cost and use data (inpatient and outpatient) are profiled. We provide preliminary information about the costs associated with inpatient and outpatient care and explore the relationship between the cost of stroke care, location of service (inpatient and outpatient), and patient functional outcomes. Data on both clinical and sociodemographic characteristics were abstracted from the medical record and merged with VA DSS cost data from each patient's first year poststroke. Descriptive statistics assessed patterns in treatment costs. We found that DSS costs varied as expected across key indicators, including function, health status, discharge location, and the number of comorbidities. These findings provide broad support for the use of DSS cost data in studies of VA stroke care.

Using computer simulation to reduce access time for outpatient departments

AIM

To develop general applicable models for analysing the capacity needed in appointment-based hospital facilities.

METHOD

A fairly simple analytical queuing model was used to obtain rapid global insight into the capacity needed to meet the norm of seeing 95% of all new patients within 2 weeks. For more detailed analysis, a simulation model was developed that could handle daily variations in demand and capacity schedules. The capacity needed to eliminate backlogs and the capacity needed to keep access time within 2 weeks was calculated. Both models were applied to two outpatient departments (neurology and gynaecology) at the Academic Medical Center in Amsterdam, the Netherlands. Model results for neurology were implemented.

RESULTS

For neurology, to eliminate the 6-week backlog, 26 extra consultations per week were needed over 2 months. A permanent increase of 2-weekly consultations was required to keep access time within 2 weeks. Evaluation after implementation showed the improvements the model had predicted. The gynaecology department had sufficient capacity. With the simulation, it was calculated that the same service level could be achieved with 14% less capacity. Thus the models supported decisions made for departments with shortages of capacity as well as those for departments with adequate capacity.

CONCLUSION

The analytical model provided quick insight into the extra capacity needed for the neurology department. The added value of the simulation model was the possibility of taking into account variations in demand for different weekdays and a realistic schedule for doctors' consultations. General applicability of the models was shown by applying both models to the gynaecology department.

[The conceptual framework for decision making data elements in public health]

OBJECTIVE

To develop a conceptual framework for decision-making data elements (indicator) in public health through determining its dimensions, sub-dimensions and their interrelationships.

METHODS

On the basis of literatures review, conceptual analysis and health determinant models, a conceptual framework was set up. This framework construction followed five principles: evidence-based, applicable, public health relevant, systemic and extensible. While, with the principles of conceptualization, objective-orientation, independence, and number-restriction, the domain and subdomains were also developed.

RESULTS

A conceptual framework consisting of five domains and 20 sub-domains was developed. The 5 domains were health status, non-medical health determinants, public health system performance, the resources of public health system, and characteristics of community and assurance system. The health outcome included three subdomains of health status, functional status, and death; Non-medicine health determinants domain consisted of health behavior, working and living conditions, personal resources and environmental factors; performance domain was made up of effectiveness, accessibility, efficiency, responsibility and safety; resources domain had institution resources, human resources, financial resources, equipment resources and information resources; The characteristics of community and assurance system domain was the last domain which comprises characteristics of community, public health related policy and assurance system. The complicated relationship between these domains was also described.

CONCLUSION

As the abstraction of public health system, this conceptual framework comprehensively depicts the components of public health system and complicated process of public health system. This framework conforms to the medical care quality model which is made up of structure, process, intermediate results and outcomes.

The application of seismic risk-benefit analysis to land use planning in Taipei City

In the developing countries of Asia local authorities rarely use risk analysis instruments as a decision-making support mechanism during planning and development procedures. The main purpose of this paper is to provide a methodology to enable planners to undertake such analyses. We illustrate a case study of seismic risk-benefit analysis for the city of Taipei, Taiwan, using available land use maps and surveys as well as a new tool developed by the National Science Council in Taiwan--the HAZ-Taiwan earthquake loss estimation system. We use three hypothetical earthquakes to estimate casualties and total and annualised direct economic losses, and to show their spatial distribution. We also characterise the distribution of vulnerability over the study area using cluster analysis. A risk-benefit ratio is calculated to express the levels of seismic risk attached to alternative land use plans. This paper suggests ways to perform earthquake risk evaluations and the authors intend to assist city planners to evaluate the appropriateness of their planning decisions.

The impact of integrated care on direct nursing home care

BACKGROUND/AIM

The introduction of integrated nursing home care is an important policy goal in many countries and is expected to affect the type, frequency and duration of activities delivered to nursing home residents. The exact impact however is unknown. The aim of this paper is to reduce this information gap in order to provide decision supporting information to policy makers and managers. DESIGN/METHODS/ETHICAL ISSUES: At three measurement points between 1999 and 2003, caregivers belonging to 18 functions registered activities delivered to somatic and psycho-geriatric nursing home residents in The Netherlands. Residents either received traditional care, integrated care or care that contained elements of traditional and integrated care (hybrid care). Thirty-six thousand and seventy-one registration lists were used for data analysis. Data analysis included determining, comparing and linking the (total) average frequency and duration of each activity per care type, measurement point and type of resident.

RESULTS

The (total) average frequency and total duration of most activities were higher for integrated care than for traditional and hybrid care. The average duration per activity was generally higher for traditional care. The (total) average frequency of most direct care activities at most measurement points and the total average duration per resident per day were higher for somatic care than for psycho-geriatric care.

CONCLUSIONS

The introduction of integrated nursing home care affects the total average duration and frequency of direct care activities. However, there is no noticeable impact on individual activities or on differences in activities received by somatic and psycho-geriatric residents and the degree to which the occurrence of an activity is related to the duration of that activity. This is because a large proportion of care delivery represents patterned behaviour (routines). Because existing routines are difficult to get rid of, we should not have too high expectations about the effect of integrated care on service delivery.