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Modeling streamflow in non-gauged watersheds with sparse data considering physiographic, dynamic climate, and anthropogenic factors using explainable soft computing techniques
No full textStreamflow forecasting is essential for effective water resource planning and early warning systems. Streamflow and related parameters are often characterized by uncertainties and complex behaviors. Recent studies have turned to machine learning (ML) to predict streamflow. However, many of these methods have overlooked the interpretability and causality of their predictions, which undermine the confidence of end-users in the reliability of machine learning. Besides, non-gauged basins have been receiving more attention due to the inherent risks involved in streamflow prediction. This study aims to overcome these limitations by utilizing ML to model streamflow in a non-gauged basin using anthropogenic, static physiographic, and dynamic climate variables, while also providing interpretability through the use of Shapley Additive Explanations (SHAP). Four ML algorithms were employed in this study, including Histogram Gradient Boosting (HGB), Extreme Gradient Boosting (XGB), Deep Neural Network (DNN), and Convolutional Neural Network (CNN) to forecast streamflow. XGB outperformed the other models with a correlation coefficient (R) of 0.91 for training and 0.884 for testing, along with mean absolute errors (MAE) of 0.02 for training and 0.023 for testing. Significantly, the use of SHAP provided insights into the inner workings of XGB predictions, revealing how these predictions are made. SHAP provides the feature importance, interactions among features, and dependencies. This explainable model (SHAP) is an invaluable addition to ML-based streamflow predictions and early warning systems, offering human-comprehensible interpretations. The findings of this study are specially imperative to manage flood risk factors in urban areas
Extensive Metallosis in a Primary Knee Arthroplasty as a Result of Polyethylene Wear: Is It Avoidable?
Get PDFMetallosis is known to occur in metal-on-metal arthroplasty and has been of concern to orthopaedic surgeons worldwide. It is a rare, late complication of total knee arthroplasty (TKA), in which metal-on-metal contact leads to metal debris deposition in the surrounding tissue. Reasons for metal-on-metal contact could range from wear of the polyethylene insert to abnormal joint biomechanics. Many components can affect the development of metallosis, with polyethylene wear being the most common cause of metallosis. This paper discusses the case of an 85-year-old man who developed metallosis, attributed to polyethylene wear, 24 years after undergoing TKA. It also highlights the different components of knee prostheses, evaluates the efficacy of different types of polyethylene, and explores whether ceramic coating can improve TKA outcomes and reduce complications such as metallosis
Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool
Get PDFBackground:
Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need.
Objective:
This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory.
Methods:
The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool.
Results:
We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, “getting worse” or “getting better”; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code.
Conclusions:
Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively
Diagnostic Stewardship in Infectious Diseases: A Scoping Review
Get PDFIntroduction. The term ‘diagnostic stewardship’ is relatively new, with a recent surge in its use within the literature. Despite its increasing popularity, a precise definition remains elusive. Various attempts have been made to define it, with some viewing it as an integral part of antimicrobial stewardship. The World Health Organization offers a broad definition, emphasizing the importance of timely, accurate diagnostics. However, inconsistencies in the use of this term still persist, necessitating further clarification.
Gap Statement. There are currently inconsistencies in the definition of diagnostic stewardship used within the academic literature.
Aim. This scoping review aims to categorize the use of diagnostic stewardship approaches and define this approach by identifying common characteristics and factors of its use within the literature.
Methodology. This scoping review undertook a multi-database search from date of inception until October 2022. Any observational or experimental study where the authors define the intervention to be diagnostic stewardship from any clinical area was included. Screening of all papers was undertaken by a single reviewer with 10% verification by a second reviewer. Data extraction was undertaken by a single reviewer using a pre-piloted form. Given the wide variation in study design and intervention outcomes, a narrative synthesis approach was applied. Studies were clustered around common diagnostic stewardship interventions where appropriate.
Results. After duplicate removal, a total of 1310 citations were identified, of which, after full-paper screening, 105 studies were included in this scoping review. The classification of an intervention as taking a diagnostic stewardship approach is a relatively recent development, with the first publication in this field dating back to 2017. The majority of research in this area has been conducted within the USA, with very few studies undertaken outside this region. Visual inspection of the citation map reveals that the current evidence base is interconnected, with frequent references to each other’s work. The interventions commonly adopt a restrictive approach, utilizing hard and soft stops within the pre-analytical phase to restrict access to testing. Upon closer examination of the outcomes, it becomes evident that there is a predominant focus on reducing the number of tests rather than enhancing the current test protocol. This is further reflected in the limited number of studies that report on test performance (including protocol improvements, specificity and sensitivity).
Conclusion. Diagnostic stewardship seems to have deviated from its intended course, morphing into a rather rudimentary instrument wielded not to enhance but to constrict the scope of testing. Despite the World Health Organization’s advocacy for an ideology that promotes a more comprehensive approach to quality improvement, it may be more appropriate to consider alternative regional narratives when categorizing these types of quality improvement interventions
Humour in forensic services: forging connections between patients and students
Get PDFLaughter, a joke or banter can be essential to building positive relationships between patients and nurses. Students represent the present and future of mental health nursing, often having more interactions with patients than registered nurses. Despite the many benefits of humour, some considerations must be taken into account, particularly with regards to risk in forensic services. Interest in humour and related interventions in mental health settings began gaining traction over a decade ago, yet there remains limited consideration of the risks and benefits for students and patients in forensic services. This narrative review provides an analysis of the wider literature in the context of interactions shared between patients and student nurses in forensic settings to explore the benefits and risks of the use of humour
Men’s experiences of the transition to fatherhood during the first postnatal year: A qualitative systematic review
Get PDFIntroduction:
Fatherhood is a significant transition in a man’s life, introducing new challenges. Yet men’s experiences of this period remain poorly understood. Occupational therapists possess skills and knowledge to support individuals during transition. This study explored the experiences of men during the transition to fatherhood over the first postnatal year.
Method:
Underpinned by an occupational therapy theoretical perspective, a systematic review was conducted. Following searches of databases: AMED, CINAHL, Medline and PsycINFO,
qualitative studies meeting selection criteria were retrieved and quality assessed. Data was extracted and synthesised using an established meta-ethnographic approach.
Findings:
Seven articles were included in the review. Four interconnected themes: (1) A New Occupational Identity, (2) Relationship Changes, (3) Challenges and Impact, (4) Unmet
Occupational Needs, and four subthemes: Roles and Responsibilities, and Adjusting Priorities (theme 1); An Emotional Journey and Exhaustion (theme 3) were identified.
Discussion:
Fathers’ postnatal transitional experiences were reflective of a journey of adjustment and growth. Experiences indicated the requirement for greater support of fathers throughout the antenatal and postnatal transition. Occupational therapists have the skills to work with fathers to balance occupations, manage fatigue and adjust to new roles. Further research should focus on understanding experiences of men in under-represented groups
All’s eco-friendly that ends eco-friendly: Short-term memory effects in carbon footprint estimates of temporal item sequences
Get PDFWhen people estimate the summative carbon footprint of a sequence of events, how are the individual events integrated? In three experiments, we found that summative carbon footprint judgments of item sequences are disproportionately influenced by items at the end of the sequence in comparison with those at the beginning—a recency effect. When, for example, sequences ended with a low carbon footprint item, they were assigned a lower carbon footprint than corresponding sequences with an identical content but different item order. The results also revealed that a green peak (presenting many low carbon footprint items at once) had a relatively large effect on estimates when the peak was contextually distinct from other items in terms of its valence. The results are consistent with an account within which distinctiveness of representations within short-term memory differentially influences decision-making and suggest that memory processes bias the perceived environmental footprint of temporally separated instances
Use of Wearable Miniaturised Medical Devices With Artificial Intelligence (AI) in Enhancing Physical Medicine
Get PDFHigh-quality data needs to be acquired from patients at the right time not only to build effective intelligent diagnostic decision support systems (DDSSs) and medical decision-making (MDM) tools without tedious data preprocessing steps but also to trigger the most appropriate means of treatment at the proper time [1], ideally in an autonomous manner without physician intervention. Within this context, wearable miniaturised medical devices instilled with Artificial Intelligence (AI) techniques [2] equipped with geo-distributed intelligence [3] have been taking their indispensable places in the medical field with numerous sub-disciplines [4], [5], [6], [7], [8], [9], [10] to take care of patients while they are performing their daily activities. The recent advances in miniaturised mechatronics systems [11], sensor technologies, and AI expedite the development of such devices.
Miniaturised sensors are the essential components in developing miniaturised wearable devices to perceive continuous health conditions through uninterrupted tight coupling with the human body. This research analyses the non-invasive wearable miniaturised medical devices, essential sensor components to acquire high-quality health data, and AI used in these devices to build MDM and DDSSs for improving the daily routines of people with quality suggestions, alerts, and directions
Randomised pilot and feasibility trial of a group intervention for men who perpetrate intimate partner violence against women
Get PDFBackground: There is a need for robust evidence on the effectiveness and cost-effectiveness of domestic abuse perpetrator programmes in reducing abusive behaviour and improving wellbeing for victim/survivors. While any randomised controlled trial can present difficulties in terms of recruitment and retention, conducting such a trial with domestic abuse perpetrators is particularly challenging. This paper reports the pilot and feasibility trial of a voluntary domestic abuse perpetrator group programme in the United Kingdom. Methods: This was a pragmatic individually randomised pilot and feasibility trial with an integrated qualitative study in one site (covering three local-authority areas) in England. Male perpetrators were randomised to either the intervention or usual care. The intervention was a 23-week group programme for male perpetrators in heterosexual relationships, with an average of three one-to-one sessions, and one-to-one support for female current- or ex-partners delivered by third sector organisations. There was no active control treatment for men, and partners of control men were signposted towards domestic abuse support services. Data were collected at three-monthly intervals for nine months from male and female participants. The main objectives assessed were recruitment, randomisation, retention, data completeness, fidelity to the intervention model, and acceptability of the trial design. Results: This study recruited 36 men (22 randomly allocated to attend the intervention group programme, 14 to usual care), and 15 current- or ex-partners (39% of eligible partners). Retention and completeness of data were high: 67% of male (24/36), and 80% (12/15) of female participants completed the self-reported questionnaire at nine months. A framework for assessing fidelity to the intervention was developed. In interviews, men who completed all or most of the intervention gave positive feedback and reported changes in their own behaviour. Partners were also largely supportive of the trial and were positive about the intervention. Participants who were not allocated to the intervention group reported feeling disappointed but understood the rationale for the trial. Conclusions: It was feasible to recruit, randomise and retain male perpetrators and female victim/survivors of abuse and collect self-reported outcome data. Participants were engaged in the intervention and reported positive benefits. The trial design was seen as acceptable. Trial registration: ISRCTN71797549, submitted 03/08/2017, retrospectively registered 27/05/2022