Commit ee5b145f authored by Rachel Clipp's avatar Rachel Clipp
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Updated the validation matrices for the showcase scenarios to use our markdown...

Updated the validation matrices for the showcase scenarios to use our markdown format rather than pdfs, updated the references in sources.bib, and updated the System Methodology report with the new matrices and outlined new required tables. Still finishing the showcase scenarios.
parent 135b5202
......@@ -484,6 +484,10 @@ Four scenarios were created to showcase the ability of the open-source physiolog
A team of soldiers is conducting a patrol when an explosive device detonates, injuring one of the soldiers. The squad medic applies direct pressure to a hemorrhaging wound, and, suspecting a tension pneumothorax, performs a needle decompression. Direct pressure is not controlling the bleeding, so a tourniquet is applied. Morphine and IV fluids are administered.
<center><br>
*Table 9. The validation results for the Combat Multitrauma Showcase scenario.*
</center>
See <a href="CombatMultitraumaValidation.pdf">Combat Multitrauma Validation Matrix</a> for complete details on validation.
<center>
......@@ -507,7 +511,27 @@ See <a href="CombatMultitraumaValidation.pdf">Combat Multitrauma Validation Matr
A 40 year old female with a history of asthma is having an asthma attack. She arrives at the hospital ten minutes after the beginning of the attack. A doctor administers albuterol and her condition improves.
See <a href="AsthmaAttackValidation.pdf">Asthma Attack Validation Matrix</a> for complete details on validation.
<center><br>
*Table 10. The validation results for the Asthma Attack Showcase scenario.*
</center>
| Segment | Notes | Action Occurrence Time (s) | Sample Scenario Time (s) | Heart Rate (beats/min) | Heart Stroke Volume (mL) | Mean Arterial Pressure (mmHg) | Systolic Pressure (mmHg) | Cardiac Output (mL/min) | Respiration Rate (breaths/min) | Oxygen Saturation (fraction) | End Tidal CO2 (fraction) | PaO2 (mmHg) | PaCO2 (mmHg) | pH (mmHg) |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| "Begin Asthma Attack
(Severity 0.7)" | 10 minutes of asthma attack | 60 | 660 |<span class="success"> Increase @cite adams2012patient </span>|<span class="success"> "Decrease @cite bergeronSME
Decrease is expected with increased heart rate" </span>|<span class="success"> Increase @cite adams2012patient </span>|<span class="warning"> Increase @cite adams2012patient </span>|<span class="warning"> Increase @cite adams2012patient </span>|<span class="success"> Increase @cite adams2012patient @cite Raimondi2013acid </span>|<span class="success"> Decrease @cite adams2012patient </span>|<span class="success"> Decreased peak @cite Nowak1983arterial </span>|<span class="success"> 71.5 ± 12 @cite Nowak1983arterial </span>|<span class="success"> 35.8 ± 6.9 @cite Nowak1983arterial </span>|<span class="danger"> Increase @cite Mountain1990acid @cite Raimondi2013acid </span>|
| "Administer Albuterol
(Albuterol inhaler used correctly, 90.0 ug dose, nozzle loss fraction 0.04)" | Drug Onset in < | 660 | 960 |<span class="danger"> Decrease @cite adams2012patient </span>|<span class="warning"> No Change @cite bergeronSME </span>|<span class="warning"> Decrease @cite adams2012patient </span>|<span class="success"> Decrease @cite adams2012patient </span>|<span class="warning"> No Change @cite bergeronSME </span>|<span class="success"> Decrease @cite adams2012patient @cite Raimondi2013acid </span>|<span class="success"> Increase back to baseline @cite adams2012patient </span>|<span class="warning"> Back to baseline @cite metoyer2016SME </span>|<span class="success"> 78.0 ± 12.7 @cite Nowak1983arterial </span>|<span class="success"> 32.3 ± 4.6 @cite Nowak1983arterial </span>|<span class="success"> Back to baseline @cite Mountain1990acid @cite Raimondi2013acid </span>|
<center>
<table border="0">
<tr>
<td><img src="./plots/System/AsthmaAttack_PFT.jpg" width="550"></td>
</tr>
</table>
</center>
<center><i>Figure 12. The pulmonary function test for the asthma patient shows overall good agreement with the expected results. The residual volume may appear lower than expected. @cite bergeronSME</i></center>
<center>
<table border="0">
......@@ -524,13 +548,45 @@ See <a href="AsthmaAttackValidation.pdf">Asthma Attack Validation Matrix</a> for
</tr>
</table>
</center>
<center><i>Figure 12. Select outputs from the Asthma Attack showcase scenario.</i></center>
<center><i>Figure 13. Select outputs from the Asthma Attack showcase scenario.</i></center>
### Heat Stroke
A 25 year old male is hiking towards a rock formation to begin a recreational free climb. During the hike, he is working at ~10% of his maximum capacity. The man arrives at a rock formation and begins climbing at an intensity of ~1/2 of his maximum capacity. At the top of the rock formation, the man becomes dizzy and passes out. An off-duty medic takes action to treat a heat injury.
See <a href="HeatStrokeValidation.pdf">Heat Stroke Validation Matrix</a> for complete details on validation.
<center><br>
*Table 11. The validation results for the Heat Stroke Showcase scenario.*
</center>
| Segment | Notes | Action Occurrence Time (s) | Sample Scenario Time (s) | Heart Rate (beats/min) | Heart Stroke Volume (mL) | Mean Arterial Pressure (mmHg) | Systolic Arterial Pressure (mmHg) | Diastolic Arterial Pressure (mmHg) | Oxygen Saturation (mmHg) | Core Temperate (C) | Skin Temperature (C) | Sweat Rate (mL/min) |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| "Hike
(Hiking at exercise intensity 0.1)" | Exercising heavily for 20 minutes in bulky clothing at an ambient temperature of 16 to 20C | 60 | 1260 </span>|<span class="success"> > 80 @cite metoyer2016SME </span>|<span class="danger"> Increase @cite rmetoyer2016SME </span>|<span class="danger"> Increase @cite Pickering1982blood </span>|<span class="danger"> "Increase
< 34.4% above resting (168) Christie1987clinical
< 28.8% above resting (161) [7]" </span>|<span class="warning"> No significant change (86) @cite Christie1987clinical, (80) @cite Pickering1982blood </span>|<span class="success"> Decreasing @cite Brutsaert2000higher </span>|<span class="success"> Increase @cite rmetoyer2016SME </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success"> For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969heat </span>|
| "Rest
" | | 1260 | 1320 </span>|<span class="danger"> Decrease @cite metoyer2016SME </span>|<span class="success"> Some recovery@cite rmetoyer2016SME </span>|<span class="danger"> Some recovery @cite rmetoyer2016SME </span>|<span class="success"> Some recovery @cite rmetoyer2016SME </span>|<span class="danger"> Some recovery @cite rmetoyer2016SME </span>|<span class="danger"> Some recovery @cite rmetoyer2016SME </span>|<span class="success"> No change @cite rmetoyer2016SME </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success"> No change @cite rmetoyer2016SME </span>|
| "Climb
(Climbing at exercise intensity 0.45)" | Heat stroke is evident after 10 more minutes of exercise at a rising temperature | 1320 | 1920 </span>|<span class="success"> 120 - 180 @cite Pickering1982blood |<span class="danger"> "121.9 @cite ODonnell1977hemodynamic
101 - 121 @cite Christie1987clinical" </span>|<span class="success"> Increasing @cite Pickering1982blood then decreasing with heat stroke @cite ODonnell1977hemodynamic </span>|<span class="danger"> "Increase toward max exertion values
34.4% above resting (168) @cite Christie1987clinical
28.8% above resting (161) @cite Pickering1982blood" </span>|<span class="warning"> No significant change (86) @cite Christie1987clinical, (80) @cite Pickering1982blood </span>|<span class="danger"> Decreasing @cite Brutsaert2000higher </span>|<span class="warning"> >40 degC @cite Bouchama2002heat </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success"> "
For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969heat" </span>|
| "Bystander Actions
(Move to cooler environment, remove clothing, apply cold pack, and start IV fluids)" | The patient's clothing is removed. IV saline is administered and active cooling begun. | 1920 | 2010 </span>|<span class="success"> Decreasing (to baseline over 12 hours) @cite ODonnell1977hemodynamic </span>|<span class="danger"> Decreasing (to baseline over 12 hours) @cite ODonnell1977hemodynamic </span>|<span class="danger"> Decrease @cite ODonnell1977hemodynamic </span>|<span class="danger"> < 120 @cite Bouchama2002heat </span>|<span class="warning"> "No significant change (86) @cite Christie1987clinical, (80) @cite Pickering1982blood
Possible slight decrease @cite Bouchama2002heat, @cite Benzinger1969heat" </span>|<span class="danger"> Increase @cite rmetoyer2016SME </span>|<span class="warning"> Decreasing with treatment @cite rmetoyer2016SME </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success"> "
For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969heat" </span>|
| Transportation | The patient is transported to a medical treatment facility. | 2010 | 2610 </span>|<span class="success"> Decreasing (to baseline over 12 hours) @cite ODonnell1977hemodynamic </span>|<span class="danger"> Decreasing (to baseline over 12 hours) @cite ODonnell1977hemodynamic </span>|<span class="success"> Decrease @cite ODonnell1977hemodynamic </span>|<span class="danger"> < 120 @cite Bouchama2002heat </span>|<span class="warning"> "No significant change (86) @cite Christie1987clinical, (80) @cite Pickering1982blood
Possible slight decrease @cite Bouchama2002heat, @cite Benzinger1969heat" </span>|<span class="success"> Increase @cite rmetoyer2016SME </span>|<span class="success"> Decreasing with treatment @cite rmetoyer2016SME </span>|<span class="success"> < Core @cite Benzinger1969heat </span>|<span class="success">
For direct calc = 2.3045e-5*(core-37.1) NOTE this may be low @cite Benzinger1969heat </span>|
A blood chemistry panel assessment is completed at the end of the scenario. The results are shown in Table 11.
<center><br>
*Table 11. The validation results for the blood chemistry assessment for the heat stroke patient.*
</center>
<center>
<table border="0">
......@@ -547,13 +603,34 @@ See <a href="HeatStrokeValidation.pdf">Heat Stroke Validation Matrix</a> for com
</tr>
</table>
</center>
<center><i>Figure 13. Select outputs from the Heat Stroke showcase scenario.</i></center>
<center><i>Figure 14. Select outputs from the Heat Stroke showcase scenario.</i></center>
### %Environment Exposure
A 17 year old female leaves her Alaskan home in the mid-winter to retrieve a newspaper. The door closes as she exits the house. She is stuck outside for 45 minutes where it is -10<sup>o</sup>C. When the woman's housemates realize that she is outside, they bring her back in and sit her next to a fire.
See <a href="EnvironmentExposureValidation.pdf">Environment Exposure Validation Matrix</a> for complete details on validation.
<center><br>
*Table 12. The validation results for the Environmental Exposure Showcase scenario.*
</center>
| Segment | Notes | Action Occurrence Time (s) | Sample Scenario Time (s) | Heart Rate (beats/min) | "Mean Arterial Pressure
(mmHg)" | "Systolic Arterial Pressure
(mmHg)" | "Respiration Rate
(Breaths/min)" | "Core Temperature
(C)" | "Oxygen Consumption
(mL/min)" | "Carbon Dioxide Production
(mL/min)" | "Metabolic Rate
(W)" |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| "Cold Exposure
(Environment change to Alaska outdoors for 10 minutes)" | Patient exposed to very low temeratures for 10 minutes | 60 | 2460 </span>|<span class="warning"> Increase initially then decrease @cite mallet2002pathophysiology </span>|<span class="success"> Small rise then gradual fall below baseline @cite reuler1978hypothermia </span>|<span class="success"> Small rise then gradual fall below baseline @cite reuler1978hypothermia </span>|<span class="success"> Increasing @cite mallet2002pathophysiology </span>|<span class="warning"> < 35 @cite reuler1978hypothermia </span>|<span class="success"> "Decrease in hypothermia @cite reuler1978hypothermia
1130 - 1320 with light activity [1]" </span>|<span class="success"> Decrease in hypothermia @cite reuler1978hypothermia </span>|<span class="warning"> approximately 350% increase over BMR (304.38 W for this patient) @cite williams2005rewarming </span>|
| "Active Heating and Additional Clothing
(Environment change to indoors and active heating applied to skin)" | Patient indoors and actively heated for 10 minutes | 2460 | 3090 </span>|<span class="warning"> Back toward baseline @cite rmetoyer2016SME </span>|<span class="success"> "Increasing back to baseline @cite reuler1978hypothermia
Back to baseline @cite rmetoyer2016SME" </span>|<span class="success"> Increasing back to baseline reuler1978hypothermia </span>|<span class="success"> Decreasing to baseline @cite mallet2002pathophysiology </span>|<span class="success"> > 35 @cite reuler1978hypothermia </span>|<span class="success"> Increase @cite reuler1978hypothermia </span>|<span class="success"> Increase @cite reuler1978hypothermia </span>|<span class="success"> Back toward baseline @cite rmetoyer2016SME </span>|
<center>
<table border="0">
......@@ -572,6 +649,13 @@ See <a href="EnvironmentExposureValidation.pdf">Environment Exposure Validation
</center>
<center><i>Figure 14. Select outputs from the %Environment Exposure showcase scenario.</i></center>
### %COVID-18
<center><br>
*Table 13. The validation results for the COVID-19 Showcase scenario.*
</center>
## Conclusion
The engine has successfully leveraged the CDM to model and
......
Methodology Sources and References
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}
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}
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}
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author = {Bouchama, Abderrezak and Knochel, James P.},
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}
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}
@article{adams2012patient,
author = {Adams, Jason Y and Sutter, Mark E and Albertson, Timothy E},
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file = {:C$\backslash$:/Users/rachel.clipp/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Adams, Sutter, Albertson - Unknown - The Patient with Asthma in the Emergency Department.pdf:pdf},
journal = {Clinical Review of Allergy and Immunology},
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}
@article{gault1966patterns,
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......
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