Candidate Metrics Research Articles

Proposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review.

Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.

Measuring data similarity in population-based structural health monitoring using distance metrics

Population-based structural health monitoring (PBSHM) expands structural health monitoring (SHM) from a single structure to a group of structures, allowing inferences to be made within and between populations by transferring knowledge across them. Within the populations of interest, the similarity of structures, via their corresponding data, should be assessed to successfully implement PBSHM. This paper focusses on using distance metrics to assess similarity at the very start of the analysis chain, to discover information about a population for which there is little prior knowledge and before any analysis has taken place on individual structures. By doing so, it is possible to quickly and automatically identify abnormalities within the population, group similarly behaving structures together, and inform further decisions. The suitability of several candidate metrics that are not widely employed in SHM are tested using a number of commonly occurring feature behaviours, such as varying amplitudes and temporary mean shifts. The effect of data normalisation/standardisation on the metrics is also explored to identify interesting behaviours within the data. A case study is then presented where distance metrics are used to discover similarities and dissimilarities within temperature data from turbines in an offshore wind farm.

Analysis of Injury Metrics From Experimental Cardiac Injuries From Behind Armor Blunt Trauma Using Live Swine Tests: A Pilot Study.

Warfighters are issued hard body armor designed to defeat ballistic projectiles. The resulting backface deformation can injure different thoracoabdominal organs. Developed over decades ago, the behind armor blunt impact criterion of maximum 44 mm depth in clay continues to be used independent of armor type or impact location on the thoracoabdominal region covered by the armor. Because thoracoabdominal components have different energy absorption capabilities, their mode of failures and mechanical properties are different. These considerations underscore the lack of effectiveness of using the single standard to cover all thoracoabdominal components to represent the same level of injury risk. The objective of this pilot study is to conduct cardiac impact tests with a live animal model and analyze biomechanical injury candidate metrics for behind armor blunt trauma applications. Live swine tests were conducted after obtaining approvals from the U.S. DoD. Trachea tubes. An intravenous line were introduced into the swine before administering anesthesia. Pressure transducers were inserted into lungs and aorta. An indenter simulating backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers delivered impact to the heart region. The approved test protocol included 6-hour monitoring and necropsies. Indenter accelerometer signals were processed to compute the velocity and deflection, and their peak magnitudes were obtained. The deflection-time signal was normalized with respect to chest depth along the impact axis. The peak magnitude of the viscous criterion, kinetic energy, force, momentum and stiffness were obtained. Out of the 8 specimens, 2 were sham controls. The mean total body mass and soft tissue thickness at the impact site were 81.1 ± 4.1 kg and 3.8 ± 1.1 cm. The peak velocities ranged from 30 to 59 m/s, normalized deflections ranged from 15 to 21%, and energies ranged from 105 to 407 J. The range in momentum and stiffness were 7.0 to 13.9 kg-m/s and 22.3 to 79.9 N/m. The maximum forces and impulse data ranged from 2.9 to 11.7 kN and 1.9 to 5.8 N-s. The peak viscous criterion ranged from 2.0 to 5.3 m/s. One animal did not sustain any injuries, 2 had cardiac injuries, and others had lung and skeletal injuries. The present study applied blunt impact loads to the live swine cardiac region and determined potential candidate injury metrics for characterization. The sample size of 6 swine produced injuries ranging from none to pure skeletal to pure organ trauma. The viscous criterion metric associated with the response of the animal demonstrated a differing pattern than other variables with increasing velocity. These findings demonstrate that our live animal experimental design can be effectively used with testing additional samples to develop behind armor blunt injury criteria for cardiac trauma in the form of risk curves. Injury criteria obtained for cardiac trauma can be used to enhance the effectiveness of the body armor, reduce morbidity and mortality, and improve warfighter readiness in combat operations.

Matched-pair hybrid test paradigm for behind armor blunt trauma using an experimental animal model

BackgroundThe current behind armor blunt trauma (BABT) injury criterion uses a single penetration limit of 44 mm in Roma Plastilina clay and is not specific to thoracoabdominal regions. However, different...

Identification, Characterization, and Ranking of Candidate Metrics for Selection to Anesthesiology Residency: An Iterative Survey of Program Directors

Identification, Characterization, and Ranking of Candidate Metrics for Selection to Anesthesiology Residency: An Iterative Survey of Program Directors

Development of a disease-based hospital-level diagnostic intensity index.

Low-value care is associated with increased healthcare costs and direct harm to patients. We sought to develop and validate a simple diagnostic intensity index (DII) to quantify hospital-level diagnostic intensity, defined by the prevalence of advanced imaging among patients with selected clinical diagnoses that may not require imaging, and to describe hospital characteristics associated with high diagnostic intensity. We utilized State Inpatient Database data for inpatient hospitalizations with one or more pre-defined discharge diagnoses at acute care hospitals. We measured receipt of advanced imaging for an associated diagnosis. Candidate metrics were defined by the proportion of inpatients at a hospital with a given diagnosis who underwent associated imaging. Candidate metrics exhibiting temporal stability and internal consistency were included in the final DII. Hospitals were stratified according to the DII, and the relationship between hospital characteristics and DII score was described. Multilevel regression was used to externally validate the index using pre-specified Medicare county-level cost measures, a Dartmouth Atlas measure, and a previously developed hospital-level utilization index. This novel DII, comprised of eight metrics, correlated in a dose-dependent fashion with four of these five measures. The strongest relationship was with imaging costs (odds ratio of 3.41 of being in a higher DII tertile when comparing tertiles three and one of imaging costs (95 % CI 2.02-5.75)). A small set of medical conditions and related imaging can be used to draw meaningful inferences more broadly on hospital diagnostic intensity. This could be used to better understand hospital characteristics associated with low-value care.

Development of lake macroinvertebrate-based multimetric index for monitoring ecological health in North Central Nigeria.

The use of organisms like macroinvertebrates in developing bioassessment tools, such as multimetric indices (MMIs), is gaining global recognition in monitoring the health status of lakes. The transition from traditional methods of physico-chemical parameters is due to the financial and time costs involved in their analysis while failing to provide accurate early warning signals on ecosystem conditions. Currently, there is scanty information on the use of MMIs in the conservation and management of lakes in Nigeria. This study aimed at developing a macroinvertebrate-based MMI to assess the ecological status of lakes in North Central Nigeria. The study was conducted on Tagwai and Old Gawu Lakes, from April to October 2022. Sampling sites were clustered based on organic pollution and categorized into reference (four) and impaired (four) sites. Out of 54 macroinvertebrate-based candidate metrics, only five were selected after discriminatory, stability, and redundancy tests (performed using R software). The final metrics were abundance of Ephemeroptera + Trichoptera; abundance of Coleoptera + Ephemeroptera; Gastropoda richness; Shannon Wiener index; and percentages of shredders + predators + scrapers, hereafter referred to as North Central Nigeria-Lakes Multimetric Index (NCN-LMMI). The NCN-LMMI values ranged as follows: 21-25, 16-20, 11-15, and 5-10 corresponding to categories I, II, III, and IV for water quality, as indications of good, fair, poor, and very poor ecological status of the lake, respectively. The developed NCN-LMMI will be a useful tool for aquatic resource managers and environmentalists to assess the ecological condition of lakes, mainly the North Central Nigeria municipal lakes.

A Comprehensive Multi-Metric Index for Health Assessment of the Poyang Lake Wetland

The Poyang Lake wetland is home to many unique and threatened species. However, it has been severely degraded in recent decades due to the joint effects of human influence and climate change. Here we establish a wetland health index (WHI) for Poyang Lake, which considers five types of attributes (biological, water quality, sediment, land use and remote sensing, and socio-economic attributes) of the wetland to evaluate wetland conditions. Forty-nine variables across five categories were assembled as candidate metrics for the WHI through field surveys conducted in 2019 at 30 sample sites. Principal component analyses were performed to identify the most important variables in each of the five categories as the primary metrics of each index category (e.g., biological index). Eighteen variables were finally selected from the five categories to construct the WHI. The WHI scores varied from 0.34 to 0.80 at the 30 sample sites, with a mean of 0.55. The Poyang Lake wetland is generally in fair condition according to our WHI scores. Sample sites where connected rivers flow into the lake were assessed to be in a poor condition, highlighting the importance of reducing pollution input from rivers for wetland conservation. Scores of individual indices of the five categories were not highly correlated (0.29 ≤ pairwise Spearman’s r ≤ 0.69), suggesting that information provided by each index is different and might be complementary. The composite WHI as well as the individual category indices can provide comprehensive information on wetland conditions that would facilitate the development of more targeted and effective strategies for wetland management.

Development of macroinvertebrate based multimetric index for ecological health monitoring in Lake Hawassa, Ethiopia

Little information is available on the use and applicability of biotic indices in aquatic resource conservation and management in Eastern Africa, especially in lentic ecosystems. The aim of this study was to develop a macroinvertebrate multimetric index (MMIH) to assess the ecological condition of Lake Hawassa. Sampling sites were clustered based on percentage disturbance score (PDS) and categorized into minimally (three sites), moderately (three sites) and highly disturbed (three sites). Physicochemical and invertebrate sampling was done at these clustered sites along the lakeshore area from February to November 2015 and 2016. Out of a total of 35 macroinvertebrate candidate metrics, ten core metrics were selected based on redundancy analysis, metrics response to environmental parameters, percent discriminatory efficiency (%DE) and box and whisker plots, and incorporated in the development of MMIH. The developed MMIH index performed well and showed a clear demarcation between the reference and non-reference sites and between the three-disturbance levels. The validation of the MMIH index performed well in discriminating the independent data sets taken from Lake Hawassa and L. Ziway. Besides, it also showed a strong but inverse relation with PDS (R2 = 0.91, P = 0.0003). Hence, in a lentic ecosystem, this index should be considered as a starting point in terms of lake bio-assessment in Ethiopia, but additional data in all ecoregions of the country are necessary to determine the long-term reliability and usefulness of the MMIH. In the short-term, this index will provide resource managers and aquatic environmentalists with a tool to assess the ecological condition of freshwater lakes.

Incorporating functional metrics into the development of a diatom-based index of biotic integrity (D-IBI) in Thousand Islands Lake (TIL) catchment, China

Incorporating functional metrics into the development of a diatom-based index of biotic integrity (D-IBI) is conducive to a more comprehensive assessment of water quality and the degree of external impact on ecosystem function. A D-IBI was developed by incorporating functional metrics to candidate metrics. Four metrics were selected and divided into five levels to evaluate 147 sampling sites. By comparing the D-IBI scores in Thousand Islands Lake (TIL) catchment, we found that the total D-IBI score ranged from 20 to 100 (median was 45). Compared with reference sites, the resource competition of impaired sites was weaker, and the community was more stable. In response to basin damage, we recommend source protection, long-term monitoring, increased hydrological connectivity, and ecological management of small watersheds. For the assessment of water environmental health, we suggest that the functional metrics should be included in the biological assessment, and the candidate metrics that are greatly affected by the dispersal process should be excluded. Moreover, the assessment should be conducted at the multi-dimension level and watershed scale.

Complementary and alternative metrics for tracking population-level trends in child linear growth

Stunting prevalence is commonly used to track population-level child nutritional status. However, other metrics derived from anthropometric datasets may be used as alternatives to stunting or provide complementary perspectives on the status of linear growth faltering in low- and middle-income countries (LMICs). Data from 156 Demographic and Health Surveys in 63 LMICs (years 2000 to 2020) were used to generate 2 types of linear growth metrics: (i) measures of location of height distributions (including stunting) for under-5 years (<5y) and 2 to 5 years (2-5y); (ii) model-derived metrics including predicted mean height-for-age z-score (HAZ) at 0, 2, and 5 years; interval slopes of HAZ, height-for-age difference (HAD), and growth delay (GD) from 1 month to 2 years (1mo-2y) and 2-5y; and the SITAR intensity parameter (SITAR-IP) for <5y. Using Spearman's rank correlation coefficient (r), metrics were considered alternatives to stunting if very strongly correlated with stunting (|r|≥0.95) and at least as strongly correlated as stunting with selected population indicators (under 5y mortality, gross domestic product, maternal education). Metrics were considered complementary if less strongly correlated with stunting (|r|<0.95) yet correlated with population indicators. We identified 6 of 15 candidate metrics (stunting 2-5y, mean HAZ <5y and 2-5y, p25 HAZ <5y and 2-5y, predicted HAZ at 2y) as potential alternatives to stunting and 6 as complementary metrics (SITAR-IP, predicted HAZ at 5y, HAZ slope 1m-2y, HAD slope 1m-2y, GD slopes 1m-2y and 2-5y). Three metrics (HAZ slope 2-5y, HAD slope 2-5y years and predicted HAZ at birth) had weak correlations with population indicators (|r| ≤ 0.43). In conclusion, several linear growth metrics could serve as alternatives to stunting prevalence and others may be complementary to stunting in tracking global progress in child health and nutrition. Further research is needed to explore the real-world utility of these alternative and complementary metrics.

The ultrarelativistic limit of Kerr

The massless (or ultrarelativistic) limit of a Schwarzschild black hole with fixed energy was determined long ago in the form of the Aichelburg-Sexl shockwave, but the status of the same limit for a Kerr black hole is less clear. In this paper, we explore the ultrarelativistic limit of Kerr in the class of Kerr-Schild impulsive pp-waves by exploiting a relation between the metric profile and the eikonal phase associated with scattering between a scalar and the source of the metric. This gives a map between candidate metrics and tree-level, 4-point scattering amplitudes. At large distances from the source, we find that all candidates for the massless limit of Kerr in this class do not have spin effects. This includes the metric corresponding to the massless limit of the amplitude for gravitational scattering between a scalar and a massive particle of infinite spin. One metric, discovered by Balasin and Nachbagauer, does have spin and finite size effects at short distances, leading to a remarkably compact scattering amplitude with many interesting properties. We also discuss the classical single copy of the ultrarelativistic limit of Kerr in electromagnetism.

Ecological health assessment using Macroinvertebrate - based Index of Biotic Integrity (M-IBI): Case study Lake Gunung Putri, West Java, Indonesia

Macroinvertebrate Index of Biotic Integrity (M-IBI) is one of the most widely used to assess the health of the aquatic ecosystem. However, few studies of M-IBI on the lake ecosystem. Lake Gunung Putri, which is one of the small lakes in Bogor Regency, West Java affected anthropogenic activities. We collected macroinvertebrates with an Ekman Grab sampler at five different sampling sites of Lake Gunung Putri in February – April 2019. Metric variability, sensitivity, redundancy, and responsiveness to environmental gradients were tested on 22 candidate metrics of properties of richness, taxonomic composition, tolerance, and functional feeding. The selected metrics were the number of taxa, Shannon-Wiener diversity index, percentage of dominant taxa, and Biological Monitoring Working Party (BMWP). Application of M-IBI in the Lake Gunung Putri ranged between 20 to 4 with represented criteria of good, fair, poor, and very poor condition.

Evaluating the Tropical Reservoir Health by using the Index of Biotic Integrity as a Management Tool for Resource Conservation Planning

Biotic Integrity index (IBI) is widely utilized for biomonitoring in aquatic ecosystems, especially in assessing aquatic ecosystem health worldwide. Environmental changes significantly impact the aquatic ecosystem’s health of Subang Reservoir, which consequently affects the aquatic biodiversity. This study was conducted to determine its ecosystem’s health by assessing the IBI of freshwater fish in Subang Reservoir. In this study, thirty-four metrics were firstly selected as candidate metrics, and later, these thirty-four metrics underwent several statistical tests such as range, responsiveness, redundancy, and metrics scoring to screen and select the most appropriate metrics. A final eight metrics were selected after the statistical analysis, and a total score of 24 indicated that the Subang Reservoir’s ecosystem shows some stress due to an imbalanced fish guild. This showed that the ecosystem’s health of Subang Reservoir is in fair condition. This is because of the limitation of fish entering Subang Reservoir. The implementation of biomonitoring can be improved by modifying and selecting the most appropriate techniques, and the usage of biomonitoring can be increased in Malaysia’s freshwater ecosystems. The result reported in this study can be used as a scientific base data for implementing biomonitoring.

Quantitative Assessment of Boiling Histotripsy Progression Based on Color Doppler Measurements.

Boiling histotripsy (BH) is a mechanical tissue liquefaction method that uses sequences of millisecond-long high intensity focused ultrasound (HIFU) pulses with shock fronts. The BH treatment generates bubbles that move within the sonicated volume due to acoustic radiation force. Since the velocity of the bubbles and tissue debris is expected to depend on the lesion size and liquefaction completeness, it could provide a quantitative metric of the treatment progression. In this study, the motion of bubble remnants and tissue debris immediately following BH pulses was investigated using high-pulse repetition frequency (PRF) plane-wave color Doppler ultrasound in ex vivo myocardium tissue. A 256-element 1.5 MHz spiral HIFU array with a coaxially integrated ultrasound imaging probe (ATL P4-2) produced 10 ms BH pulses to form volumetric lesions with electronic beam steering. Prior to performing volumetric BH treatments, the motion of intact myocardium tissue and anticoagulated bovine blood following isolated BH pulses was assessed as two limiting cases. In the liquid blood the velocity of BH-induced streaming at the focus reached over 200 cm/s, whereas the intact tissue was observed to move toward the HIFU array consistent with elastic rebound of tissue. Over the course of volumetric BH treatments tissue motion at the focus locations was dependent on the axial size of the forming lesion relative to the corresponding size of the HIFU focal area. For axially small lesions, the maximum velocity after the BH pulse was directed toward the HIFU transducer and monotonically increased over time from about 20-100 cm/s as liquefaction progressed, then saturated when tissue was fully liquefied. For larger lesions obtained by merging multiple smaller lesions in the axial direction, the high-speed streaming away from the HIFU transducer was observed at the point of full liquefaction. Based on these observations, the maximum directional velocity and its location along the HIFU propagation axis were proposed and evaluated as candidate metrics of BH treatment completeness.

Macroinvertebrate-Based Biomonitoring of Coastal Wetlands in Mediterranean Chile: Testing Potential Metrics Able to Detect Anthropogenic Impacts

Coastal wetlands are suffering from anthropogenic alterations worldwide. Aquatic monitoring based on macroinvertebrates has been successfully used to assess the ecological condition of many aquatic systems worldwide. Nonetheless, studies are still insufficient for the coastal wetlands of the South Pacific. Here, we present a preliminary attempt to select metrics based on aquatic macroinvertebrates to incorporate into coastal wetlands biomonitoring in the Chilean Mediterranean ecoregion. We sampled 25 sites in ten coastal wetlands during the austral spring of 2019. We used an integrated index that considers both human activities at catchment and at local scales to identify sites less or more disturbed. We tested a total of 70 metrics (either traditional or new metrics) representing different aspects of community structure/composition, functions and tolerance to pollution. Two metrics were finally retained: detritivore abundance (traditional metric) and geometric mean body size (new metric). These metrics were able to detect sites impacted by human activities. Thus, they might be considered as candidate metrics for the biomonitoring of these systems and to develop future indices. Moreover, because of their generality, they might also be applicable to coastal wetlands in other Mediterranean regions, including sites where taxonomic identification is still a challenge.

Metrics for Performance Improvement in Organisations Using Scrum, ITIL and CMMI

It is very important to understand the metrics that are applied within IT processes in today’s industry, why they are important, and in what types of companies they are used. This article presents the results of a systematic literature review of some of the most widely used metrics exposed in the literature, referring to Scrum, ITIL and CMMi practices. The objective is to determine the scientific progress in this field and to identify the candidate metrics that can be used later in a metrics integration model, designed to help monitor IT services to improving the performance of organisations that use Scrum, CMMi and ITIL. The exploratory search found 1,196 articles, of which 198 were reviewed, from which 31 were finally chosen. From these, a total of 297 metrics were identified, of which 112 (38%) are for Scrum, 98 metrics (33%) are for ITIL, and 87 (29%) are for CMMi. Most of these metrics are used in European companies.

Development and validation of the planktonic index of biotic integrity (P-IBI) for Qin River, a main tributary of the Yellow River in China.

To evaluate the ecosystem health of Qin River, a main tributary of the Yellow River, a planktonic index of biotic integrity (P-IBI) that includes phytoplankton and zooplankton was established based on five metrics using a dataset covering 61 sampling sites in Qin River and its largest tributary the Dan River from October to November 2020. First, an index based on land use pattern and water quality was constructed to select reference sites and impaired sites. Then, five of an initial 38 candidate metrics (phytoplankton density, Palmer algal genus pollution index, zooplankton biomass/phytoplankton biomass, zooplankton Margalef richness index, and zooplankton Simpson diversity index) were selected to establish P-IBI based on their ranges, sensitivity, and redundancy. Finally, five statuses (excellent, good, fair, poor, and very poor) were classified by ratio score method on the basis of their final P-IBI scores. Sites with "excellent and good" and "poor and very poor" status accounted for 26.2% and 49.2%, respectively. "Very poor" sites were mainly located in the Dan River, and "poor" sites were mainly located in the middle reach of the Qin River and upper-middle reach of the Dan River in Jincheng region. Significantly negative correlations between Cl-, SO42-, and F- concentrations and P-IBI values indicated that the P-IBI might reflect domestic and industrial wastewater pollution in the Qin and Dan River in Jincheng region. The P-IBI strongly differentiated reference and impaired sites, suggesting the suitability of the index in the study.

A Blueprint for Increasing Ethnic and Racial Diversity in U.S. Residency Training Programs.

People who identify as African Americans, Latinos, or from indigenous backgrounds, are dramatically underrepresented in the U.S. physician workforce. It is critical for academic health centers to recognize racial and ethnic diversity at the residency level and implement changes to enhance diversity among trainees. The Office of Graduate Medical Education (GME) at the University of Pennsylvania Health System (UPHS) developed a multipronged approach to enhance diversity and inclusion (D&I) among residency trainees. The approach included the development of an underrepresented in medicine (UIM) professional network; UIM-focused visiting clerkship programs; holistic review implementation by selection committees; and targeted outreach to UIM candidates, overseen by an associate designated institutional official for UIM Affairs. The authors reported demographic data on residency applicants invited for interviews and matching for all programs at UPHS from 2014-2015 (baseline) to 2020-2021. They also reported data on maximum ranking number programs reached to fill their positions and the average United States Medical License Examination (USMLE) Step 1 scores of matched candidates. Finally, they discussed the implications for leaders who wish to enhance D&I at academic health centers. During the baseline year (2014-2015), UIMs represented 12.1% of interviewees and 8.7% of all matched candidates into UPHS residency programs. Over the successive 6 years after incremental implementation of the approach, UIM representation steadily increased. In 2020-2021, UIMs represented 23.2% of interviewees and 26.4% of matched candidates. Programs' maximum rank number to fill and USMLE Step 1 scores of matched candidates remained relatively unchanged. The UPHS Office of GME incorporated a purposeful approach to enhance the D&I of its residents. Across 6 years of implementation, UIM representation among resident matches tripled while quantitative program and candidate metrics remained unchanged. Similar efforts should be given further consideration for implementation and evaluation nationwide.

Integration of ABC curve, three dimensions of alpha diversity indices, and spatial patterns of fish assemblages into the health assessment of the Chishui River basin, China.

Index of biotic integrity (IBI) based on fish has been applied globally. However, few have considered that fish assemblages change among different aggregate ecoregions when conducted their health assessment. Indeed, some comprehensive indices, such as functional and phylogenetic diversity indices and ABC curve, can be used to identify aspects that are not captured by traditional metrics. Consequently, we try to integrate comprehensive indices and spatial patterns of fish assemblages to develop IBI systems and then verified their effectiveness and accuracy for assessing the environmental health of the Chishui River basin. The comprehensive disturbance index (CDI), based on 11 water quality parameters and 4 human land use, was set to distinguish reference sites and impaired sites. According to the spatial patterns of fish assemblages, the 40 sites were finally divided into 2 aggregate ecoregions, include wadeable streams and nonwadeable rivers. 97 candidate metrics were selected to develop our IBI systems based on the systematic screening method. The result also showed that our IBI systems performed well in discriminating anthropogenic disturbances at both aggregate ecoregions, which suggests that our systems could provide a reliable evaluation. The mean IBI score of the Chishui River basin was 72.09 ± 16.58, and was classified as good status. However, S1 (Chishuiyuan Town), Baisha River, Tongzi River, and Xishui River were disturbed by various human activities. We conclude that the spatial patterns of fish assemblages should be combined with more comprehensive indices to assess river health. On the other hand, we do believe that the process of developing and verifying our IBI systems could be regarded as a reference for biomonitoring in more mountain river systems.