Poincaré plots to analyze photoplethysmography signal between non-smokers and smokers

<span>An analysis of blood circulation was used to identify variations of heart rate and to create an early warning system of autonomic dysfunction. The Poincaré plot analyzed blood circulation using photoplethysmography (PPG) signals between non-smokers and smokers in three different indices: SD1, SD2, and SD1 SD2 ratio (SSR). There were twenty subjects separated into non-smoker and smoker groups with sample sizes of 10, respectively. An independent sample t-test to compare the continuous variables. Whereas, the comparison between two groups employed Fisher’s exact test for categorical variables. The result showed that SD1 was found to be considerably lower in the group of smokers (0.03±0.01) than that of the non-smokers (0.06±0.03). Similarly, SSR was recorded at 0.0012±0.0005 and 0.0023±0.0012 for smoking and non-smoking subjects, respectively. As a comparison, SD2 for non-smokers (25.7±0.5) was lower than smokers (27.3±0.4). In conclusion, we revealed that the parameters of Poincaré plots (SD1, SD2, and SSR) exert good performances to significantly differentiate the PPG signals of the group of non-smokers from those of smokers. We also supposed that the method promises to be a suitable method to distinguish the cardiovascular disease group. Therefore, this method can be applied as a part of early detection system of cardiovascular diseases.</span>

Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study

Background Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. Methods An evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken. Results All sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: − 0.15, − 0.05); p = < 0.001). Changes in trends coincided with implementation of site-specific changes. Conclusions System level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations.

Torrent Monitoring and Early Warning Systems Development

The level of sustainability of a modern society is associated with the ability to manage unwanted stressors from the environment, regardless of origin. Torrential floods represent a hydrological hazard whose frequency and intensity have increased in recent years, mainly due to climate changes. In order to effectively manage the risks of torrents, it is necessary to apply early warning systems, since torrential floods are formed very quickly, especially on the watercourses of a small catchment area. The early warning system is part of a comprehensive torrential flood risk management system, seen as a technical entity for the collection, transformation, and rapid distribution of data. Modern early warning systems are the successors of rudimentary methods used in the past, and they are based on ICT and mobile applications developed in relation to the requirements of end users. The chapter presents an analysis of characteristic examples of the use. The main conclusion of the chapter indicates the need to implement early warning systems in national emergency management structures.

Developing Strategies in the Sharing Economy

The sharing economy is challenging the traditional business models and strategies by encouraging collaboration, non-ownership, temporal access, and redistribution of goods and/or services. Within this framework, the current chapter aims to examine how managers influence, voluntarily or involuntarily, the reliability of a managerial early warning system, based on an artificial neural network. The analysis focuses on seven Romanian sustainable knowledge-based organizations and brings forward that managers tend to influence the results provided by a managerial early warning system based on artificial neural network, voluntarily and involuntarily. On the one hand, they are the ones who consciously decide which departments and persons are involved in establishing the structure of the managerial early warning system. On the other hand, they unconsciously influence the structure of the managerial early warning system through the authority they exercise during the managerial debate.