Impact of Pandemic SARS COVID-19 on Different Construction Project Management: Problems and Solutions.

This study discusses risk management strategies caused by pandemic-related (Covid-19) suspensions in thirty-six engineering projects of different types and sizes selected from countries in the middle east and especially Iraq. The primary data collection method was a survey and questionnaire completed by selected project crew and laborers. Data were processed using Microsoft Excel to construct models to help decision-makers find solutions to the scheduling problems that may be expected to occur during a pandemic. A theoretical and practical concept for project risk management that addresses a range of global and local issues that affect schedule and cost is presented and results indicate that the most significant delays are due to a lack of good project risk management skills and remote project management capability which is exacerbated by shortfalls in technical development and information technology.

Service-Oriented Medical Device Connectivity: Particular Standards for Endoscopic Surgery.

To translate recent advances in medical device interoperability research into clinical practice, standards are being developed that specify precise requirements towards the network representation of particular medical devices connecting through ISO/IEEE 11073 SDC. The present contribution supplements this protocol standard with specific models for endoscopic camera systems, light sources, insufflators, and pumps. Through industry consensus, these new standards provide modular means to describe the devices' capabilities and modes of interaction in a service-oriented medical device communication architecture. This enables seamless data exchange and the potential for new assistive systems to support the caregiver.

Chemical herding of weathered crude oils for in-situ burning.

Mid-scale ISB experiments were conducted in a large water-basin (20 m2 × 1 m) in order to assess the applicability of chemical herding of weathered crude oil spills on water in association with in-situ burning (ISB). A silicone-based chemical herding agent, OP-40, was used to confine, or herd, three different crude oils (Siri, Grane and Oseberg blend) at various weathering degrees. The herding agent was capable of obtaining the minimum required oil slick thickness for ignition and subsequent flame spread in most of the experiments, but not for the strongly weathered oils. Also, the herding agent was capable of re-thickening the oil slick after flame extinction. The burning efficiency results indicate that the method can be viable for ISB with herders at a larger scale, and suggest that the burning efficiency scales with the amount of crude oil. Sinking behaviour of residues was also observed and quantified, as such a behaviour can pose a serious environmental threat in real scenarios.

Service-Oriented Device Connectivity: Device Specialisations for Interoperability.

There are IEEE 11073 standards for foundational, structural, and semantic point-of-care medical device interoperability, but the first devices with this interface have yet to enter the market. One of the missing pieces for implementation and approval are Device Specialisations that specify how to use information and service models to represent a specific type of device on the network. Required and optional metrics need to be standardised as well as nomenclature terms, units of measure, and extension points. Finally, device-to-device interaction at runtime has to be defined for automatic verification during testing and approval. Applications include C-arm fluoroscopes used in different clinical settings.

Enabling artificial intelligence in high acuity medical environments.

Acute patient treatment can heavily profit from AI-based assistive and decision support systems, in terms of improved patient outcome as well as increased efficiency. Yet, only very few applications have been reported because of the limited accessibility of device data due to the lack of adoption of open standards, and the complexity of regulatory/approval requirements for AI-based systems. The fragmentation of data, still being stored in isolated silos, results in limited accessibility for AI in healthcare and machine learning is complicated by the loss of semantics in data conversions. We outline a reference model that addresses the requirements of innovative AI-based research systems as well as the clinical reality. The integration of networked medical devices and Clinical Repositories based on open standards, such as IEEE 11073 SDC and HL7 FHIR, will foster novel assistance and decision support. The reference model will make point-of-care device data available for AI-based approaches. Semantic interoperability between Clinical and Research Repositories will allow correlating patient data, device data, and the patient outcome. Thus, complete workflows in high acuity environments can be analysed. Open semantic interoperability will enable the improvement of patient outcome and the increase of efficiency on a large scale and across clinical applications.

From SOMDA to application - integration strategies in the OR.NET demonstration sites.

The effective development and dissemination of the open integration for the next generation of operating rooms require a comprehensive testing environment. In this paper, we present the various challenges to be addressed in demonstration applications, and we discuss the implementation approach, the foci of the demonstration sites and the evaluation efforts. Overall, the demonstrator setups have proven the feasibility of the service-oriented medical device architecture (SOMDA) and real-time approaches with a large variety of example applications. The applications demonstrate the potentials of open device interoperability. The demonstrator implementations were technically evaluated as well as discussed with many clinicians from various disciplines. However, the evaluation is still an ongoing research at the demonstration sites. Technical evaluation focused on the properties of a network of medical devices, latencies in data transmission and stability. A careful evaluation of the SOMDA design decisions and implementations are essential to a safe and reliable interoperability of integrated medical devices and information technology (IT) system in the especially critical working environment. The clinical evaluation addressed the demands of future users and stakeholders, especially surgeons, anesthesiologists, scrub nurses and hospital operators. The opinions were carefully collected to gain further insights into the potential benefits of the technology and pitfalls in future work.

OR.NET: a service-oriented architecture for safe and dynamic medical device interoperability.

Modern surgical departments are characterized by a high degree of automation supporting complex procedures. It recently became apparent that integrated operating rooms can improve the quality of care, simplify clinical workflows, and mitigate equipment-related incidents and human errors. Particularly using computer assistance based on data from integrated surgical devices is a promising opportunity. However, the lack of manufacturer-independent interoperability often prevents the deployment of collaborative assistive systems. The German flagship project OR.NET has therefore developed, implemented, validated, and standardized concepts for open medical device interoperability. This paper describes the universal OR.NET interoperability concept enabling a safe and dynamic manufacturer-independent interconnection of point-of-care (PoC) medical devices in the operating room and the whole clinic. It is based on a protocol specifically addressing the requirements of device-to-device communication, yet also provides solutions for connecting the clinical information technology (IT) infrastructure. We present the concept of a service-oriented medical device architecture (SOMDA) as well as an introduction to the technical specification implementing the SOMDA paradigm, currently being standardized within the IEEE 11073 service-oriented device connectivity (SDC) series. In addition, the Session concept is introduced as a key enabler for safe device interconnection in highly dynamic ensembles of networked medical devices; and finally, some security aspects of a SOMDA are discussed.

Connecting the clinical IT infrastructure to a service-oriented architecture of medical devices.

The new medical device communication protocol known as IEEE 11073 SDC is well-suited for the integration of (surgical) point-of-care devices, so are the established Health Level Seven (HL7) V2 and Digital Imaging and Communications in Medicine (DICOM) standards for the communication of systems in the clinical IT infrastructure (CITI). An integrated operating room (OR) and other integrated clinical environments, however, need interoperability between both domains to fully unfold their potential for improving the quality of care as well as clinical workflows. This work thus presents concepts for the propagation of clinical and administrative data to medical devices, physiologic measurements and device parameters to clinical IT systems, as well as image and multimedia content in both directions. Prototypical implementations of the derived components have proven to integrate well with systems of networked medical devices and with the CITI, effectively connecting these heterogeneous domains. Our qualitative evaluation indicates that the interoperability concepts are suitable to be integrated into clinical workflows and are expected to benefit patients and clinicians alike. The upcoming HL7 Fast Healthcare Interoperability Resources (FHIR) communication standard will likely change the domain of clinical IT significantly. A straightforward mapping to its resource model thus ensures the tenability of these concepts despite a foreseeable change in demand and requirements.

Analysis of Annotated Data Models for Improving Data Quality.

The public Medical Data Models (MDM) portal with more than 9.000 annotated forms from clinical trials and other sources provides many research opportunities for the medical informatics community. It is mainly used to address the problem of heterogeneity by searching, mediating, reusing, and assessing data models, e. g. the semi-interactive curation of core data records in a special domain. Furthermore, it can be used as a benchmark for evaluating algorithms that create, transform, annotate, and analyse structured patient data. Using CDISC ODM for syntactically representing all data models in the MDM portal, there are semi-automatically added UMLS CUIs at several ODM levels like ItemGroupDef, ItemDef, or CodeList item. This can improve the interpretability and processability of the received information, but only if the coded information is correct and reliable. This raises the question how to assure that semantically similar datasets are also processed and classified similarly. In this work, a (semi-)automatic approach to analyse and assess items, questions, and data elements in clinical studies is described. The approach uses a hybrid evaluation process to rate and propose semantic annotations for under-specified trial items. The evaluation algorithm operates with the commonly used NLM MetaMap to provide UMLS support and corpus-based proposal algorithms to link datasets from the provided CDISC ODM item pool.

A mobile application to manage and minimise the risk of late effects caused by childhood cancer.

In their first 15 years of life, about 1 800 children are diagnosed with cancer each year in Germany. Their chances of survival, however, have improved significantly over the last 40 years. In Germany alone, over 30 000 survivors of childhood cancer are presently living. Therefore, the late effects caused by the therapy occur ever more frequently as chemotherapy and radiotherapy may leave traces even years later. In order to recognize and treat these late effects in survivors, structured and regular follow-up examinations are necessary from an early stage on. However, the compliance of former patients to participate in the recommended check-ups is not satisfying for multiple reasons. To enhance this compliance, an application for smartphones and tablets has been developed. The Aftercare App supplies a wide range of information regarding the aftercare and supports a reminder functionality to attend medical visits.

Reporting Device Observations for semantic interoperability of surgical devices and clinical information systems.

Service-oriented medical device architectures make the progress from interdisciplinary research projects to international standardisation: A new set of IEEE 11073 proposals shall pave the way to industry acceptance. This expected availability of device observations in a standardised representation enables secondary usage if interoperability with clinical information systems can be achieved. The Device Observation Reporter (DOR) described in this work is a gateway that connects these realms. After a user chooses a selection of signals from different devices in the digital operating room, the DOR records these semantically described values for a specified duration. Upon completion, the signals descriptions and values are transformed to Health Level Seven version 2 messages and sent to a hospital information system/electronic health record system within the clinical IT network. The successful integration of device data for documentation and usage in clinical information systems can further leverage the novel device communication standard proposals. Complementing these, an Integrating the Healthcare Enterprise profile will aid commercial implementers in achieving interoperability. Their solutions could incorporate clinical knowledge to autonomously select signal combinations and generate reports of diagnostic and interventional procedures, thus saving time and effort for surgical documentation.

Rule-based interface generation on mobile devices for structured documentation.

In many software systems to date, interactive graphical user interfaces (GUIs) are represented implicitly in the source code, together with the application logic. Hence, the re-use, development, and modification of these interfaces is often very laborious. Flexible adjustments of GUIs for various platforms and devices as well as individual user preferences are furthermore difficult to realize. These problems motivate a software-based separation of content and GUI models on the one hand, and application logic on the other. In this project, a software solution for structured reporting on mobile devices is developed. Clinical content archetypes developed in a previous project serve as the content model while the Android SDK provides the GUI model. The necessary bindings between the models are specified using the Jess Rule Language.

Glacier retreat in New Zealand during the Younger Dryas stadial.

Millennial-scale cold reversals in the high latitudes of both hemispheres interrupted the last transition from full glacial to interglacial climate conditions. The presence of the Younger Dryas stadial (approximately 12.9 to approximately 11.7 kyr ago) is established throughout much of the Northern Hemisphere, but the global timing, nature and extent of the event are not well established. Evidence in mid to low latitudes of the Southern Hemisphere, in particular, has remained perplexing. The debate has in part focused on the behaviour of mountain glaciers in New Zealand, where previous research has found equivocal evidence for the precise timing of increased or reduced ice extent. The interhemispheric behaviour of the climate system during the Younger Dryas thus remains an open question, fundamentally limiting our ability to formulate realistic models of global climate dynamics for this time period. Here we show that New Zealand's glaciers retreated after approximately 13 kyr bp, at the onset of the Younger Dryas, and in general over the subsequent approximately 1.5-kyr period. Our evidence is based on detailed landform mapping, a high-precision (10)Be chronology and reconstruction of former ice extents and snow lines from well-preserved cirque moraines. Our late-glacial glacier chronology matches climatic trends in Antarctica, Southern Ocean behaviour and variations in atmospheric CO(2). The evidence points to a distinct warming of the southern mid-latitude atmosphere during the Younger Dryas and a close coupling between New Zealand's cryosphere and southern high-latitude climate. These findings support the hypothesis that extensive winter sea ice and curtailed meridional ocean overturning in the North Atlantic led to a strong interhemispheric thermal gradient during late-glacial times, in turn leading to increased upwelling and CO(2) release from the Southern Ocean, thereby triggering Southern Hemisphere warming during the northern Younger Dryas.

High-frequency Holocene glacier fluctuations in New Zealand differ from the northern signature.

Understanding the timings of interhemispheric climate changes during the Holocene, along with their causes, remains a major problem of climate science. Here, we present a high-resolution 10Be chronology of glacier fluctuations in New Zealand's Southern Alps over the past 7000 years, including at least five events during the last millennium. The extents of glacier advances decreased from the middle to the late Holocene, in contrast with the Northern Hemisphere pattern. Several glacier advances occurred in New Zealand during classic northern warm periods. These findings point to the importance of regional driving and/or amplifying mechanisms. We suggest that atmospheric circulation changes in the southwest Pacific were one important factor in forcing high-frequency Holocene glacier fluctuations in New Zealand.

Statistical process control as a tool for monitoring nonoperative time.

BACKGROUND: Administrators need simple tools to quickly identify even small changes in the performance of perioperative systems. This applies both to established systems and to impact assessments of deliberate perioperative system design changes. METHODS: Statistical process control was originally developed to detect nonrandom variation in manufacturing processes by continuous comparison to previous performance. The authors applied the technique to assess the nonoperative time performance between successive cases for same surgeon following themselves in a redesigned operating room. This operating room specifically implemented a new patient care pathway that improves throughput by reducing the nonoperative time. The authors tested how quickly statistical process control detected reductions in nonoperative time. They also tested the ability of statistical process control to detect successively smaller performance changes and investigated its utility for longitudinal process monitoring. RESULTS: Statistical process control detected a clear reduction in nonoperative time after the new operating room had been used for only 2 days. The method could detect nonoperative time changes of between 5 and 10 min per case for a single operating room within one fiscal quarter. Nonoperative time for the new process was globally stable over the 31 months analyzed, but late in the analysis period, the authors detected small performance decrements, mostly attributable to factors external to the new operating room. CONCLUSIONS: Statistical process control is useful for detecting changes in perioperative system performance, represented in this study by nonoperative time. The technique is able to detect changes quickly and to detect small changes over time.

Near-synchronous interhemispheric termination of the last glacial maximum in mid-latitudes.

Isotopic records from polar ice cores imply globally asynchronous warming at the end of the last glaciation. However, 10Be exposure dates show that large-scale retreat of mid-latitude Last Glacial Maximum glaciers commenced at about the same time in both hemispheres. The timing of retreat is consistent with the onset of temperature and atmospheric CO2 increases in Antarctic ice cores. We suggest that a global trend of rising summer temperatures at the end of the Last Glacial Maximum was obscured in North Atlantic regions by hypercold winters associated with unusually extensive winter sea ice.

The effect of direct-from-recovery room discharge of laparoscopic cholecystectomy patients on recovery room workload.

Ambulatory laparoscopic cholecystectomy pathways move patients through the hospital without encountering delays caused by congested inpatient bed units. However, redirecting patients to a direct discharge pathway might not be beneficial if recovery capacity is further taxed by additional workload. In this study, we attempt to assess the operational impact on recovery room workload of directly discharging laparoscopic cholecystectomy patients to home. We conducted a retrospective case-control review of recovery room flow sheets to determine recovery room time and effort required for laparoscopic cholecystectomy patients. The study was restricted to patients of a single surgeon to minimize confounds from surgical technique. Fifty-seven case patients (May 1, 2004, through November 30, 2004), all managed with intent to directly discharge from the recovery room, were compared with control patients (n = 81) from the corresponding 6 months in the year before the direct-discharge plan. The times (mean; 95% confidence interval) to meet objective criteria for adequate pain control (3.5 minutes [2.1 to 5.9] versus 4.0 minutes [2.6 to 6.1]) and readiness for discharge from phase 1 recovery (8.1 minutes [4.8 to 13.6] versus 6.1 minutes [4.0 to 9.5]) were not different between the groups. The number and distribution of interventions documented in the recovery process were not different between groups, nor was there a difference in recovery room length of stay (158 minutes [138 to 182] versus 149 minutes [132 to 167]). In our study, recovery room records reveal little if any increased workload associated with the direct-to-home discharge of laparoscopic cholecystectomy patients.

Depression and anxiety before and after temporal lobe epilepsy surgery.

PURPOSE: To examine the course of depression and anxiety in patients with temporal lobe epilepsy (TLE) treated with epilepsy surgery (and anticonvulsant drugs) or medical means alone. METHODS: Of 94 TLE patients evaluated for epilepsy surgery, 76 underwent a resective procedure, 18 continued on medical treatment alone. Depression (Beck Depression Inventory (BDI)) and anxiety scores (Self-Rating Anxiety Scale (SRAS)) were examined during presurgical evaluation (T1) and after a mean of 16 months (T2), or 12 months after surgery. Depression and anxiety scores were related to type of intervention, underlying epileptogenic lesion, change of seizure control and anticonvulsant therapy. RESULTS: At T1, depression and anxiety scores were higher in patients with TLE than scores in published normal populations. At T2, depression but not anxiety scores were significantly lower than at T1. Change of depression scores interacted with improvements of seizure control. CONCLUSIONS: Evidence of depression and anxiety is commonly found in patients with TLE. Depression improves not because of epilepsy surgery per se, but because of improved seizure control. This is more commonly achieved by surgery than medical treatment. The results are consistent with the hypothesis that depression in TLE is caused by pathological epileptic activity rather than a fixed structural defect.