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- Abbassi, Fariba, et al.
(author)
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Novel Benchmark Values for Redo Liver Transplantation Does the Outcome Justify the Effort?
- 2022
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 276:5, s. 860-867
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Journal article (peer-reviewed)abstract
- Objective: To define benchmark cutoffs for redo liver transplantation (redo-LT). Background: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. Methods: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score <= 25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Results: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI (R) at 1-year of <= 72, and in-hospital and 1-year mortality rates of <= 13% and <= 15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redoLT benchmarks. Conclusion: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.
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| 3. |
- Abourraja, Mohamed Nezar, et al.
(author)
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A Data-Driven Discrete Event Simulation Model to Improve Emergency Department Logistics
- 2022
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In: Proceedings of the 2022 Winter Simulation Conference. - : Institute of Electrical and Electronics Engineers (IEEE).
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Conference paper (peer-reviewed)abstract
- Demands for health care are becoming overwhelming for healthcare systems around the world regarding theavailability of resources, particularly, in emergency departments (EDs) that are continuously open and mustserve immediately any patient who comes in. Efficient management of EDs and their resources is requiredmore than ever. This could be achieved either by optimizing resource utilization or by the improvement ofhospital layout. This paper investigates, through data-driven simulation alternative designs of workflowsand layouts to operate the ED of the Uppsala University Hospital in Sweden. Results are analyzed tounderstand the requirements across the hospital for reduced waiting times in the ED. The main observationrevealed that introducing a new ward dedicated to patients having complex diagnoses with a capacity ofless than 20 beds leads to lower waiting times. Furthermore, the use of data-mining was of great help inreducing the efforts of building the simulation model.
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| 4. |
- Apfalter, Petra, et al.
(author)
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Multicenter comparison trial of DNA extraction methods and PCR assays for detection of Chlamydia pneumoniae in endarterectomy specimens
- 2001
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In: Journal of Clinical Microbiology. - 1098-660X. ; 39:2, s. 519-524
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Journal article (peer-reviewed)abstract
- The reported rate of detection of Chlamydia pneumoniae DNA within atherosclerotic lesions by PCR varies between 0 and 100%. In this study, identical sets of coded experimental atheroma samples (n = 15) and spiked controls (n = 5) were analyzed by 16 test methods in nine centers by means of PCR. The positive controls were correctly identified to levels of 1, 0.1, and 0.01 inclusion bodies of C. pneumoniae/ml of tissue homogenate by 16 (100%), 11 (69%), and 3 (19%) of the test methods, respectively. Three out of 16 negative controls (19%) were rated positive. Positivity rates for atheroma samples varied between 0 and 60% for the different test methods, with the maximum concordant result for positivity being only 25% for one carotid artery sample. There was no consistent pattern of positive results among the various laboratories, and there was no correlation between the detection rates and the sensitivity of the assay used.
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| 5. |
- Boodaghian Asl, Arsineh, et al.
(author)
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A hybrid modeling approach to simulate complex systems and classify behaviors
- 2024
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In: NETWORK MODELING AND ANALYSIS IN HEALTH INFORMATICS AND BIOINFORMATICS. - : Springer Nature. - 2192-6662. ; 13:1
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Journal article (peer-reviewed)abstract
- Many important systems, both natural and artificial, are complex in nature, and models and simulations are one of the main instruments to study them. In this paper, we present an approach where a complex social system is represented at a high level of abstraction as a network, thereby addressing several challenges such as quantification, intervention, adaptation and validation. The network represents the factors that influence the mental health and wellbeing in children and young people. In this article, we present an approach that links a system dynamics simulation to simulate the network and ranking algorithms to measure the vertices' behaviors. The network is enhanced by adding edge strengths in the form of correlations between vertices (established through literature). Such an approach allows us to exploit the network structure to qualify and quantify the vertices of the network, to overlay different processes over the network topology, to add and remove new vertices, and therefore interact dynamically. This in turn allows for the qualification of vertices' importance and network resilience. System dynamics simulation allows for policy analysis, where different scenarios are analyzed by stimulating a set of vertices and the effect over the network is observed. This approach allows for an abstract, flexible, yet comprehensive way of analyzing a complex social network at any scale.
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| 6. |
- Boodaghian Asl, Arsineh, et al.
(author)
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Simulation and Model Validation for Mental Health Factors Using a Multi-Methodology Hybrid Approach
- 2021
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In: Proceedings - Winter Simulation Conference. - : Institute of Electrical and Electronics Engineers Inc..
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Conference paper (peer-reviewed)abstract
- To promote policy analysis and decision-making in mental health and well-being, simulations are used to scrutinize causal maps and provide policymakers reasonable evidence. This paper proposes and illustrates a multi-methodology hybrid approach by building a hierarchy of models, moving from a systems dynamics model to a simulation based on PageRank to quantify and assess a complex mental health map. The motives are: (1) to aid scenario analysis and comparison for possible policy interventions, (2) to quantify and validate mental health factors, and (3) to gain new insights into the core and confounding factors that affect mental health. The results indicate that the approach identifies factors that cause significant and frequent variation on mental health. Furthermore, validation confirms PageRank accuracy and detects minor fluctuations and variation in model's output behavior.
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| 7. |
- Boodaghian Asl, Arsineh, et al.
(author)
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Using pageRank and social network analysis to specify mental health factors
- 2021
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In: Proceedings of the Design Society: 23rd International Conference on Engineering Design, ICED 2021. - : Cambridge University Press (CUP). ; , s. 3379-3388
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Conference paper (peer-reviewed)abstract
- Various factors influence mental well-being, and span individual, social and familial levels. These factors are connected in many ways, forming a complex web of factors and providing pathways for developing programs to improve well-being and for further research. These factors can be studied individually using traditional methods and mapped together to be analyzed holistically from a complex system perspective. This study provides a novel approach using PageRank and social network analysis to understand such maps. The motives are: (1) to realize the most influential factors in such complex networks, (2) to understand factors that influence variations from different network aspects. A previously developed map for children's mental well-being was adopted to evaluate the approach. To achieve our motives, we have developed an approach using PageRank and Social Network Analysis. The results indicate that regardless of the network scale, two key factors called "Quantity and Quality of Relationships" and "Advocacy" can influence children's mental well-being significantly. Moreover, the divergence analysis reveals that one factor, "Recognition/Value Placed on well-being at School" causes a wide range of diffusion throughout the system.
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| 9. |
- Darwich, Adam S., et al.
(author)
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Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services : Mixed Methods Study
- 2023
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In: JMIR Human Factors. - : JMIR Publications Inc.. - 2292-9495. ; 10
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Journal article (peer-reviewed)abstract
- Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use.Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems.Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods.Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care.Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.
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