BACKGROUND: Hemodynamic assessment of critically ill patients is a challenging endeavor, and advanced monitoring techniques are often required to guide treatment choices. Given the technical complexity and occasional unavailability of these techniques, estimation of cardiac function based on clinical examination is valuable for critical care physicians to diagnose circulatory shock. Yet, the lack of knowledge on how to best conduct and teach the clinical examination to estimate cardiac function has reduced its accuracy to almost that of "flipping a coin."OBJECTIVE: The aim of this study was to investigate the decision-making process underlying estimates of cardiac function of patients acutely admitted to the intensive care unit (ICU) based on current standardized clinical examination using Bayesian methods.METHODS: Patient data were collected as part of the Simple Intensive Care Studies-I (SICS-I) prospective cohort study. All adult patients consecutively admitted to the ICU with an expected stay longer than 24 hours were included, for whom clinical examination was conducted and cardiac function was estimated. Using these data, first, the probabilistic dependencies between the examiners' estimates and the set of clinically measured variables upon which these rely were analyzed using a Bayesian network. Second, the accuracy of cardiac function estimates was assessed by comparison to the cardiac index values measured by critical care ultrasonography.RESULTS: A total of 1075 patients were included, of which 783 patients had validated cardiac index measurements. A Bayesian network analysis identified two clinical variables upon which cardiac function estimate is conditionally dependent, namely, noradrenaline administration and presence of delayed capillary refill time or mottling. When the patient received noradrenaline, the probability of cardiac function being estimated as reasonable or good P(ER,G) was lower, irrespective of whether the patient was mechanically ventilated (P[ER,G|ventilation, noradrenaline]=0.63, P[ER,G|ventilation, no noradrenaline]=0.91, P[ER,G|no ventilation, noradrenaline]=0.67, P[ER,G|no ventilation, no noradrenaline]=0.93). The same trend was found for capillary refill time or mottling. Sensitivity of estimating a low cardiac index was 26% and 39% and specificity was 83% and 74% for students and physicians, respectively. Positive and negative likelihood ratios were 1.53 (95% CI 1.19-1.97) and 0.87 (95% CI 0.80-0.95), respectively, overall.CONCLUSIONS: The conditional dependencies between clinical variables and the cardiac function estimates resulted in a network consistent with known physiological relations. Conditional probability queries allow for multiple clinical scenarios to be recreated, which provide insight into the possible thought process underlying the examiners' cardiac function estimates. This information can help develop interactive digital training tools for students and physicians and contribute toward the goal of further improving the diagnostic accuracy of clinical examination in ICU patients.TRIAL REGISTRATION: ClinicalTrials.gov NCT02912624; https://clinicaltrials.gov/ct2/show/NCT02912624.
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Current methods for energy diagnosis in heating, ventilation and air conditioning (HVAC) systems are not consistent with process and instrumentation diagrams (P&IDs) as used by engineers to design and operate these systems, leading to very limited application of energy performance diagnosis in practice. In a previous paper, a generic reference architecture – hereafter referred to as the 4S3F (four symptoms and three faults) framework – was developed. Because it is closely related to the way HVAC experts diagnose problems in HVAC installations, 4S3F largely overcomes the problem of limited application. The present article addresses the fault diagnosis process using automated fault identification (AFI) based on symptoms detected with a diagnostic Bayesian network (DBN). It demonstrates that possible faults can be extracted from P&IDs at different levels and that P&IDs form the basis for setting up effective DBNs. The process was applied to real sensor data for a whole year. In a case study for a thermal energy plant, control faults were successfully isolated using balance, energy performance and operational state symptoms. Correction of the isolated faults led to annual primary energy savings of 25%. An analysis showed that the values of set probabilities in the DBN model are not outcome-sensitive. Link to the formal publication via its DOI https://doi.org/10.1016/j.enbuild.2020.110289
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In practice, faults in building installations are seldom noticed because automated systems to diagnose such faults are not common use, despite many proposed methods: they are cumbersome to apply and not matching the way of thinking of HVAC engineers. Additionally, fault diagnosis and energy performance diagnosis are seldom combined, while energy wastage is mostly a consequence of component, sensors or control faults. In this paper new advances on the 4S3F diagnose framework for automated diagnostic of energy waste in HVAC systems are presented. The architecture of HVAC systems can be derived from a process and instrumentation diagram (P&ID) usually set up by HVAC designers. The paper demonstrates how all possible faults and symptoms can be extracted on a very structured way from the P&ID, and classified in 4 types of symptoms (deviations from balance equations, operational states, energy performances or additional information) and 3 types of faults (component, control and model faults). Symptoms and faults are related to each other through Diagnostic Bayesian Networks (DBNs) which work as an expert system. During operation of the HVAC system the data from the BMS is converted to symptoms, which are fed to the DBN. The DBN analyses the symptoms and determines the probability of faults. Generic indicators are proposed for the 4 types of symptoms. Standard DBN models for common components, controls and models are developed and it is demonstrated how to combine them in order to represent the complete HVAC system. Both the symptom and the fault identification parts are tested on historical BMS data of an ATES system including heat pump, boiler, solar panels, and hydronic systems. The energy savings resulting from fault corrections are estimated and amount 25%. Finally, the 4S3F method is extended to hard and soft sensor faults. Sensors are the core of any FDD system and any control system. Automated diagnostic of sensor faults is therefore essential. By considering hard sensors as components and soft sensors as models, they can be integrated into the 4S3F method.
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The Heating Ventilation and Air Conditioning (HVAC) sector is responsible for a large part of the total worldwide energy consumption, a significant part of which is caused by incorrect operation of controls and maintenance. HVAC systems are becoming increasingly complex, especially due to multi-commodity energy sources, and as a result, the chance of failures in systems and controls will increase. Therefore, systems that diagnose energy performance are of paramount importance. However, despite much research on Fault Detection and Diagnosis (FDD) methods for HVAC systems, they are rarely applied. One major reason is that proposed methods are different from the approaches taken by HVAC designers who employ process and instrumentation diagrams (P&IDs). This led to the following main research question: Which FDD architecture is suitable for HVAC systems in general to support the set up and implementation of FDD methods, including energy performance diagnosis? First, an energy performance FDD architecture based on information embedded in P&IDs was elaborated. The new FDD method, called the 4S3F method, combines systems theory with data analysis. In the 4S3F method, the detection and diagnosis phases are separated. The symptoms and faults are classified into 4 types of symptoms (deviations from balance equations, operating states (OS) and energy performance (EP), and additional information) and 3 types of faults (component, control and model faults). Second, the 4S3F method has been tested in four case studies. In the first case study, the symptom detection part was tested using historical Building Management System (BMS) data for a whole year: the combined heat and power plant of the THUAS (The Hague University of Applied Sciences) building in Delft, including an aquifer thermal energy storage (ATES) system, a heat pump, a gas boiler and hot and cold water hydronic systems. This case study showed that balance, EP and OS symptoms can be extracted from the P&ID and the presence of symptoms detected. In the second case study, a proof of principle of the fault diagnosis part of the 4S3F method was successfully performed on the same HVAC system extracting possible component and control faults from the P&ID. A Bayesian Network diagnostic, which mimics the way of diagnosis by HVAC engineers, was applied to identify the probability of all possible faults by interpreting the symptoms. The diagnostic Bayesian network (DBN) was set up in accordance with the P&ID, i.e., with the same structure. Energy savings from fault corrections were estimated to be up to 25% of the primary energy consumption, while the HVAC system was initially considered to have an excellent performance. In the third case study, a demand-driven ventilation system (DCV) was analysed. The analysis showed that the 4S3F method works also to identify faults on an air ventilation system.
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In this article a generic fault detection and diagnosis (FDD) method for demand controlled ventilation (DCV) systems is presented. By automated fault detection both indoor air quality (IAQ) and energy performance are strongly increased. This method is derived from a reference architecture based on a network with 3 generic types of faults (component, control and model faults) and 4 generic types of symptoms (balance, energy performance, operational state and additional symptoms). This 4S3F architecture, originally set up for energy performance diagnosis of thermal energy plants is applied on the control of IAQ by variable air volume (VAV) systems. The proposed method, using diagnosis Bayesian networks (DBNs), overcomes problems encountered in current FDD methods for VAV systems, problems which inhibits in practice their wide application. Unambiguous fault diagnosis stays difficult, most methods are very system specific, and finally, methods are implemented at a very late stage, while an implementation during the design of the HVAC system and its control is needed. The IAQ 4S3F method, which solves these problems, is demonstrated for a common VAV system with demand controlled ventilation in an office with the use of a whole year hourly historic Building Management System (BMS) data and showed it applicability successfully. Next to this, the influence of prior and conditional probabilities on the diagnosis is studied. Link to the formal publication via its DOI https://doi.org/10.1016/j.buildenv.2019.106632
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Considering activity level propositions in the evaluation of forensic biology findings is becoming more common place. There are increasing numbers of publications demonstrating different transfer mechanisms that can occur under a variety of circumstances. Some of these publications have shown the possibility of DNA transfer from site to site on an exhibit, for instance as a result of packaging and transport. If such a possibility exists, and the case circumstances are such that the area on an exhibit where DNA is present or absent is an observation that is an important diagnostic characteristic given the propositions, then site to site transfer should be taken into account during the evaluation of observations. In this work we demonstrate the ways in which site to site transfer can be built into Bayesian networks when carrying out activity level evaluations of forensic biology findings. We explore the effects of considering qualitative vs quantitative categorisation of DNA results. We also show the importance of taking into account multiple individual’s DNA being transferred (such as unknown or wearer DNA), even if the main focus of the evaluation is the activity of one individual.
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We present a novel architecture for an AI system that allows a priori knowledge to combine with deep learning. In traditional neural networks, all available data is pooled at the input layer. Our alternative neural network is constructed so that partial representations (invariants) are learned in the intermediate layers, which can then be combined with a priori knowledge or with other predictive analyses of the same data. This leads to smaller training datasets due to more efficient learning. In addition, because this architecture allows inclusion of a priori knowledge and interpretable predictive models, the interpretability of the entire system increases while the data can still be used in a black box neural network. Our system makes use of networks of neurons rather than single neurons to enable the representation of approximations (invariants) of the output.
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Het doel van dit onderzoek is te onderzoeken onder welke omstandigheden en onder welke condities relatief moderne modelleringstechnieken zoals support vector machines, neural networks en random forests voordelen zouden kunnen hebben in medisch-wetenschappelijk onderzoek en in de medische praktijk in vergelijking met meer traditionele modelleringstechnieken, zoals lineaire regressie, logistische regressie en Cox regressie.
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The full potential of predictive maintenance has not yet been utilised. Current solutions focus on individual steps of the predictive maintenance cycle and only work for very specific settings. The overarching challenge of predictive maintenance is to leverage these individual building blocks to obtain a framework that supports optimal maintenance and asset management. The PrimaVera project has identified four obstacles to tackle in order to utilise predictive maintenance at its full potential: lack of orchestration and automation of the predictive maintenance workflow, inaccurate or incomplete data and the role of human and organisational factors in data-driven decision support tools. Furthermore, an intuitive generic applicable predictive maintenance process model is presented in this paper to provide a structured way of deploying predictive maintenance solutions https://doi.org/10.3390/app10238348 LinkedIn: https://www.linkedin.com/in/john-bolte-0856134/
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Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. Methods: A multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. Results: Nine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up. Conclusion: Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.
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