on behal(ofa working group* established by the European Office of the World Health Organisation, Copenhagen ABSTRACT The value of non-invasive procedures for predicting pulmonary arterial pressure was investigated in 370 patients with chronic obstructive lung diseases and in 73 with fibrosing alveolitis in a combined study at nine centres in six European countries. Measurements included forced expiratory volume in one second, arterial blood gas tensions, standard electrocardiogram, radiographic dimensions ofpulmonary artery, right ventricle dimensions by M mode echocardiography, and myocardial scintigraphy with thallium-201; and certain clinical signs were also used. No single variable was correlated closely enough to allow accurate prediction of pulmonary arterial pressure. Four methods were used to incorporate several variables into mathematical functions for predicting pulmonary arterial pressure. In patients with chronic obstructive lung disease multiple stepwise regression explained 49% of the variance in pulmonary arterial pressure but was not useful for prediction. Discriminant analysis allowed patients to be allocated to bands of pulmonary arterial pressure, as did two non-parametric procedures, in which decision trees were established using either the Kolmogoroff-Smirnoff statistic or Fisher's exact test. Patients with a pulmonary arterial pressure of 30 mm Hg or more were identified with a sensitivity of 83% and a specificity of 91%. The nonparametric tests gave better results than discriminant function. A further 54 patients were studied to validate the functions. Of these, 90% with a pulmonary arterial pressure above 20 mm Hg were correctly identified, and 80% of those with a pulmonary arterial pressure above 29 mm Hg. Similar results were obtained in subjects with fibrosing alveolitis. These mathematical functions allow the use of combinations of non-invasive procedures to select from populations at risk of pulmonary hypertension those in whom direct measurement is required. The mathematical functions are capable of further development by incorporation of variables from newer non-invasive procedures.
We studied the relative importance of the initial BP and associated factors in adolescents to predict stable high BP. Out of 17,634 children aged 12-13 yrs an upper group/the upper 5% of the distribution curves for both SBP and DBP/a lower group/10% random from the remainder/were yearly followed for 4 yrs/boys: 1680, girls: 1643/. About 2/3 of children remained at the same percentile point: less than 30% and greater than or equal to 70% of SBP and half of them of DBP distribution. Significant positive tracking correlations were found both for SBP and DBP between the initial BP and follow-up BP readings in the same individual. Stepwise regression analysis showed that the SBP taken at the fourth follow-up can be explained by 29% in boys, 24% in girls on the basis of screening SBP and by 47% in boys, 42% in girls on the basis of SBP measured at the four previous examinations. Using discriminant analysis, 6-9 variables out of 18 studied could correctly allocate adolescents with stable SBP or DBP/less than 70% or greater than or equal to 70% at least 3 examinations/. Our study shows the importance of initial BP and a number of factors associated with stable high BP.
Digitalization in cities – often branded as smart city (SC) transition – carry the potential for highly inclusive, evidence-based decision making in urban planning, responding to the increasing pressures cities face. However, investments have thus far been slower to deliver the expected impacts. Thus, the attention of the discourse is turning towards organizational structures addressing complexity, scalability, and procedural challenges of SC transition. Given such turn has regime-challenging implications, there is a need for practice-based research in the niches of SC transition, supporting policymaking inductively. This study outlines the barriers inherent in conventional organizational models (public sector, private-supplier, and academic-professional) to SC transition, and makes a case for alternative models. The barriers are retrieved through an extensive literature review, and a series of focus groups with key stakeholders involved in SC transition, and processed as a design problem for a new organizational model. The final design is a nested platform model based on open innovation and a lean approach to urban planning. The paper concludes with a proof of concept to overcome organizational barriers, validated by the stakeholder focus groups. Keywords: urban planning, platform, open innovation, assessment, smart city, organizational models
The global phenomena of growing urbanization and ICT technological advancements enable the digital transformation and renewal of cities embodied in the ‘Smart Cities’ concept. A myriad of conceptualized models and frameworks have been proposed by multiple stakeholders; however, an easily adaptable, widely applicable and robust smart city model is not yet available, which leaves space for yet untapped fields of research. This article attempts to explore the factors hindering SC developments for European medium-sized cities based on a sample of Hungarian medium-sized cities. The study utilizes Porter's Five Forces Framework from the field of strategic management, which is currently rather neglected in the discussion of ‘Smart Cities’. Findings show that the main barriers are ‘Knowledge gaps’, ‘Availability and Quality of Data’, ‘Vendor Lock-in’, ‘Biased Approaches’ and the ‘Lack of Standards’.
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