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Sample records for case-mix system multicentre

  1. The cataract national data set electronic multi-centre audit of 55,567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture.

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    Sparrow, J M; Taylor, H; Qureshi, K; Smith, R; Johnston, R L

    2011-08-01

    To develop a methodology for case-mix adjustment of surgical outcomes for individual cataract surgeons using electronically collected multi-centre data conforming to the cataract national data set (CND). Routinely collected anonymised data were remotely extracted from electronic patient record (EPR) systems in 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were carried out to risk adjust outcomes for posterior capsule rupture rates for individual surgeons, with stratification by surgical grade. A total of 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations between November 2001 and July 2006 (86% from January 2004). In all, 283 surgeons contributed data on >25 cases, providing 54,319 operations suitable for detailed analysis. Case-mix adjusted results of individual surgeons are presented as funnel plots for all surgeons together, and separately for three different grades of surgeon. Plots include 95 and 99.8% confidence limits around the case-mix adjusted outcomes for detection of surgical outliers. Routinely collected electronic data conforming to the CND provides sufficient detail for case-mix adjustment of cataract surgical outcomes. The validation of these risk indicators should be carried out using fresh data to confirm the validity of the risk model. Once validated this model should provide an equitable approach for peer-to-peer comparisons in the context of revalidation.

  2. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

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    Flor-Serra Ferran

    2009-06-01

    Full Text Available Abstract Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit, dependent variables (mean number of visits, episodes and direct costs, co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others, referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits costs of the variables for each patient attended/year (N = 350,000 inhabitants. The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50. The correlation between the efficiency (relative-weights and synthetic (by centre and physician indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000 will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression

  3. Coding response to a case-mix measurement system based on multiple diagnoses.

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    Preyra, Colin

    2004-08-01

    To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

  4. Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

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    Preyra, Colin

    2004-01-01

    Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

  5. Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

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    Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

    2011-01-01

    Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

  6. Using existing case-mix methods to fund trauma cases.

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    Monakova, Julia; Blais, Irene; Botz, Charles; Chechulin, Yuriy; Picciano, Gino; Basinski, Antoni

    2010-01-01

    Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases. The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.

  7. Case report 375: Multicentric reticulohistiocytosis

    International Nuclear Information System (INIS)

    Scutellari, P.N.; Orzincolo, C.; Trotta, F.

    1986-01-01

    In summary, a case of multicentric reticulohistiocytosis in an 18-year-old girl is presented, with dramatic demonstration of the progressive lesions of the hands demonstrated in xeroradiographs. The association of nodules in the skin, particularly around the distal interphalangeal joints of the hands is stressed and the generally progressive nature of the disorder is emphasized and illustrated in this patient. The end result in most instances is that of an 'arthritis mutilans', with extensive deformities, particularly of the distal phalanges of the hands. The clinical, radiological and pathological aspects of the disorder are discussed and a review of the literature is included. The differential diagnosis, particularly including rheumatoid arthritis, is described in detail. The pathogenesis of the disorder is considered. (orig./SHA)

  8. Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system.

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    Hollenbeak, Christopher S; Rubin, Robert J; Tzivelekis, Spiros; Stephens, J Mark

    2015-06-01

    The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008. Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence. Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+. Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

  9. Masquerade Syndrome of Multicentre Primary Central Nervous System Lymphoma

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    Silvana Guerriero

    2011-01-01

    Full Text Available Purpose. In Italy we say that the most unlucky things can happen to physicians when they get sick, despite the attention of colleagues. To confirm this rumor, we report the sad story of a surgeon with bilateral vitreitis and glaucoma unresponsive to traditional therapies. Methods/Design. Case report. Results. After one year of steroidal and immunosuppressive therapy, a vitrectomy, and a trabeculectomy for unresponsive bilateral vitreitis and glaucoma, MRI showed a multicentre primary central nervous system lymphoma, which was the underlying cause of the masquerade syndrome. Conclusions. All ophthalmologists and clinicians must be aware of masquerade syndromes, in order to avoid delays in diagnosis.

  10. Challenges of rehabilitation case mix measurement in Ontario hospitals.

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    Sutherland, Jason Murray; Walker, Jan

    2008-03-01

    Case mix classification systems have been adopted in many countries as a method to manage and finance healthcare in acute care settings; the most popular systems are based on diagnosis related groups. The most successful of those case mix systems differentiate patient types by reflecting both the intensity of resources consumed and patient acuity. Case mix systems for use with non-acute hospital activity have not been as wide-spread; other than in the United States, little attention has been directed towards case mix classification for rehabilitation activity. In a province with over 13 million inhabitants with 2496 rehabilitation beds, inpatient rehabilitation is an important component of hospital care in Ontario, Canada, and consists of the spectrum of intensive rehabilitation activities intended to restore function. Although case mix adjusted activity has been the currency in Ontario's Integrated Population Based Allocation hospital funding formula, rehabilitation activity has not been subjected to case mix measurement. A project to examine case mix classification for adult inpatient rehabilitation activity was initiated by the Ontario Ministry of Health and Long-Term Care whose outcome was a case mix system and associated cost weights that would result in rehabilitation activity being incorporated into the hospital funding formula. The process described in this study provides Ontario's provincial government with a case mix classification system for adult inpatient rehabilitation activity although there remain areas for improvement.

  11. Quality control and data-handling in multicentre studies: the case of the Multicentre Project for Tuberculosis Research

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    Caloto Teresa

    2001-12-01

    Full Text Available Abstract Background The Multicentre Project for Tuberculosis Research (MPTR was a clinical-epidemiological study on tuberculosis carried out in Spain from 1996 to 1998. In total, 96 centres scattered all over the country participated in the project, 19935 "possible cases" of tuberculosis were examined and 10053 finally included. Data-handling and quality control procedures implemented in the MPTR are described. Methods The study was divided in three phases: 1 preliminary phase, 2 field work 3 final phase. Quality control procedures during the three phases are described. Results: Preliminary phase: a organisation of the research team; b design of epidemiological tools; training of researchers. Field work: a data collection; b data computerisation; c data transmission; d data cleaning; e quality control audits; f confidentiality. Final phase: a final data cleaning; b final analysis. Conclusion The undertaking of a multicentre project implies the need to work with a heterogeneous research team and yet at the same time attain a common goal by following a homogeneous methodology. This demands an additional effort on quality control.

  12. Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

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    Rusnak, James E.

    1987-01-01

    Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

  13. Hospital accreditation, reimbursement and case mix: links and insights for contractual systems.

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    Ammar, Walid; Khalife, Jade; El-Jardali, Fadi; Romanos, Jenny; Harb, Hilda; Hamadeh, Ghassan; Dimassi, Hani

    2013-12-05

    Resource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate. Our study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion. Hospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies. Our results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in

  14. Contemplating case mix: A primer on case mix classification and management.

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    Costa, Andrew P; Poss, Jeffery W; McKillop, Ian

    2015-01-01

    Case mix classifications are the frameworks that underlie many healthcare funding schemes, including the so-called activity-based funding. Now more than ever, Canadian healthcare administrators are evaluating case mix-based funding and deciphering how they will influence their organization. Case mix is a topic fraught with technical jargon and largely relegated to government agencies or private industries. This article provides an abridged review of case mix classification as well as its implications for management in healthcare. © 2015 The Canadian College of Health Leaders.

  15. Nursing home case-mix reimbursement in Mississippi and South Dakota.

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    Arling, Greg; Daneman, Barry

    2002-04-01

    To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

  16. [Case-mix index and length of hospitalization].

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    D'Andrea, V; Catania, A; Di Matteo, F M; Savino, G; Greco, R; Di Marco, C; De Antoni, E

    2010-05-01

    The ACG (Adjusted Clinical Groups) case-mix system is a classification method of diseases of patients, focused on the person. Depending on the pattern of these morbid conditions, the ACG system assigns each patient to a single group (an ACG group), which allows to capture the effects of a group of diseases in estimates of resource use. Diseases are classified into a diagnostic group (ADG) according to 5 clinical dimensions: duration (acute, recurrent or chronic), severity (minor/major vs stable/unstable), diagnostic assessment (symptoms vs diseases), etiology (infectious, traumatic or other), specialty (medical, surgical, obstetric, ...). All diseases can be classified into these dimensions and into one of 32 groups. The ACG case-mix system uses an algorithm to classify each patient into one of 93 ACG categories. Each person is assigned to an ACG according to his ADG combination, his age and his gender. With the repayment system "case-mix", surgery has become central for all great hospitals in virtue of its great productive potential. The case-mix index is one of the factors which influence the duration of hospitalization. The case-mix system has emphasized the importance of the duration of hospitalization, encouraging the planning of programs in order to discharge patients early after surgical operations. It has also stimulated the surgical activity in operating units with "budget" forecasts in which resources are provided according to an expected level of specialist surgery.

  17. MANAGEMENT AND OUTCOMES FROM APPENDECTOMY: AN INTERNATIONAL, PROSPECTIVE, MULTICENTRE STUDY.

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    Camilleri-Brennan, J; Drake, T; Spence, R; Bhangu, A; Harrison, E

    2017-09-01

    To identify variation in surgical management and outcomes of appendicitis across low, middle and high Human Development Index (HDI) country groups. Multi-centre, international prospective cohort study of consecutive patients undergoing emergency appendectomy over a 6-month period. Follow-up lasted 30 days. Primary outcome measure was overall complication rate. 4546 patients from 52 countries underwent appendectomy (2499 high, 1540 middle and 507 low HDI groups). Complications were more frequent in low-HDI (OR 3.81, 95% CI 2.78 to 5.19, p accounting for case-mix, laparoscopy was still associated with fewer complications (OR 0.55, 95% CI 0.42 to 0.71, pintroduction of laparoscopy that if overcome, could result in significantly improved outcomes for patients in low-resource environments, with potential for wider health-system benefits.

  18. A case-mix in-service education program.

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    Arons, R R

    1985-01-01

    The new case-mix in-service education program at the Presbyterian Hospital in the City of New York is a fine example of physicians and administration working together to achieve success under the new prospective pricing system. The hospital's office of Case-Mix Studies has developed an accurate computer-based information system with historical, clinical, and demographic data for patients discharged from the hospital over the past five years. Reports regarding the cases, diagnoses, finances, and characteristics are shared in meetings with the hospital administration and directors of sixteen clinical departments, their staff, attending physicians, and house officers in training. The informative case-mix reports provide revealing sociodemographic summaries and have proven to be an invaluable tool for planning, marketing, and program evaluation.

  19. The effect of misclassification errors on case mix measurement.

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    Sutherland, Jason M; Botz, Chas K

    2006-12-01

    Case mix systems have been implemented for hospital reimbursement and performance measurement across Europe and North America. Case mix categorizes patients into discrete groups based on clinical information obtained from patient charts in an attempt to identify clinical or cost difference amongst these groups. The diagnosis related group (DRG) case mix system is the most common methodology, with variants adopted in many countries. External validation studies of coding quality have confirmed that widespread variability exists between originally recorded diagnoses and re-abstracted clinical information. DRG assignment errors in hospitals that share patient level cost data for the purpose of establishing cost weights affects cost weight accuracy. The purpose of this study is to estimate bias in cost weights due to measurement error of reported clinical information. DRG assignment error rates are simulated based on recent clinical re-abstraction study results. Our simulation study estimates that 47% of cost weights representing the least severe cases are over weight by 10%, while 32% of cost weights representing the most severe cases are under weight by 10%. Applying the simulated weights to a cross-section of hospitals, we find that teaching hospitals tend to be under weight. Since inaccurate cost weights challenges the ability of case mix systems to accurately reflect patient mix and may lead to potential distortions in hospital funding, bias in hospital case mix measurement highlights the role clinical data quality plays in hospital funding in countries that use DRG-type case mix systems. Quality of clinical information should be carefully considered from hospitals that contribute financial data for establishing cost weights.

  20. HIV-associated multicentric Castleman’s disease

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    Fauzia de Fátima Naime

    2012-09-01

    Full Text Available Multicentric Castleman’s disease (MCD is a rare lymphoproliferative disorder. It is found with higher frequency in patients with HIV infection, with systemic symptoms and poor prognosis. We present the case of a 32-year old man with HIV disease, Kaposi’s sarcoma, lymphadenopathy, fever and hemolytic anemia. A diagnosis of Castleman’s disease is confirmed through biopsy and treatment is often based only on published case reports. Systemic treatments for MCD have included chemotherapy, anti-herpes virus, highly active antiretroviral therapy and, more recently, monoclonal antibodies against both IL6 and CD20.

  1. Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

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    Fridh Gerd

    2006-06-01

    Full Text Available Abstract Background Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. Methods The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60–96 years in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. Results In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9%, whereas the specificity was 88.5%, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3%, with a specificity of 90.1%. This increased the number of correctly classified by 5.6% and the area under the curve by 11.1%. Conclusion The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that

  2. Case report 446: Multicentric, metachronous, low-grade, sclerosing osteogenic sarcoma

    International Nuclear Information System (INIS)

    McCarthy, E.F.; Tolo, V.T.; Dorfman, H.D.

    1987-01-01

    This case of multicentric osteosarcoma has overlying features of the clinical subgroups described by Amstutz and Mahoney. This 38-year-old woman has survived 6 years with metachronous multifocal osteosarcomas. She presently has at least seven sites of involvement. The lesions are all densely sclerotic and are confined to the axial skeleton. She has had no treatment except for release of compression syndromes. She has no evidence of pulmonary or other visceral metastases. The low grade nature of this type of multifocal osteosarcoma is confirmed by a six year survival in the absence of ablative surgery, radiotherapy or chemotherapy. (orig.)

  3. Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

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    Rusnak, James E.

    1987-01-01

    Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...

  4. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study.

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    Sicras-Mainar, Antoni; Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Retrospective study (multicentres) conducted using computerised medical records. 13 primary care teams in 2008 were included. All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R(2)). The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation.

  5. Multicentric reticulohistiocytosis (lipoid dermatoarthritis)

    International Nuclear Information System (INIS)

    Fiumicelli, A.; Bruni, L.

    1990-01-01

    The authors report their experience with 3 cases of multicentric reticulohistiocytosis observed over 6 years of outpatient radiological practice. The condition presents with the following radiological patterns: 1) clear-cut erosions of the articular surfaces, especially in the distal interphalangeal joints of the hand and in the metatarso-phalangeal joints of the feet, with symmetrical distributions (not necessarily); 2) osteolytic punched-out areas in the epiphyseal spongiosa, ranging in size from 1 mm to over 1 cm; 3) no osteoporosis, no osteoproliferative or periosteal reactions, not even in the presence of large osteoarticular destructions; 4) frequent atlanto-epistropheal subluxation; 5) articular ankylosis at the sacroiliac joints only. The association of the above patterns and the relativity benign clinical course distinguish multicentric reticulohistiocytosis from rheumatoid arthritis, psoriasic arthritis, erosive osteoarthritis, and gout. Reliable diagnosis can be suggested on the basis of radiological findings alone, even before cutaneous or mucosal lesions appear -which are, at any rate, not sure to appear and typical of nails only. An unquestionable diagnosis can be made at histology of synovial and/or cutaneous nodules. Multicentric reticulohistiocytosis is considered an uncommon condition (nearly 100 cases in international literature to 1989); the authors believe it to be commoner though often misdiagnosed as a 'variant of rehumatoid arthritis'

  6. Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

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    Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

    2018-05-13

    Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

  7. Medicaid prospective payment: Case-mix increase

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    Baker, Samuel L.; Kronenfeld, Jennie J.

    1990-01-01

    South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

  8. [Establishment and Management of Multicentral Collection Bio-sample Banks of Malignant Tumors from Digestive System].

    Science.gov (United States)

    Shen, Si; Shen, Junwei; Zhu, Liang; Wu, Chaoqun; Li, Dongliang; Yu, Hongyu; Qiu, Yuanyuan; Zhou, Yi

    2015-11-01

    To establish and manage of multicentral collection bio-sample banks of malignant tumors from digestive system, the paper designed a multicentral management system, established the standard operation procedures (SOPs) and leaded ten hospitals nationwide to collect tumor samples. The biobank has been established for half a year, and has collected 695 samples from patients with digestive system malignant tumor. The clinical data is full and complete, labeled in a unified way and classified to be managed. The clinical and molecular biology researches were based on the biobank, and obtained achievements. The biobank provides a research platform for malignant tumor of digestive system from different regions and of different types.

  9. HIV quality report cards: impact of case-mix adjustment and statistical methods.

    Science.gov (United States)

    Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

    2014-10-15

    There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  10. Case mix planning in hospitals: a review and future agenda.

    Science.gov (United States)

    Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

    2017-06-01

    The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

  11. Development of a Medicaid Behavioral Health Case-Mix Model

    Science.gov (United States)

    Robst, John

    2009-01-01

    Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…

  12. 29 CFR 1614.302 - Mixed case complaints.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

  13. Synchronous multicentric osteosarcoma: the case for metastases

    International Nuclear Information System (INIS)

    Daffner, R.H.; Kennedy, S.L.; Fox, K.R.; Crowley, J.J.; Sauser, D.D.; Cooperstein, L.A.

    1997-01-01

    Objective. There is a current debate whether multicentric osteosarcoma represents synchronous multiple primary osteosarcomas or metastatic disease. The purpose of this report is to evaluate the etiology, presentation, and classification of this entity. Design and patients. Six patients ranging in age from 7 to 29 years were studied. The clinical, radiographic, and pathologic findings are reported. In addition, a review of the literature was undertaken. Results. The clinical courses of our six patients as well as a review of the literature suggest that multicentric osteosarcoma represent one extreme of a continuous scale of metastatic osteosarcoma rather than multiple synchronous primary tumors. The presentation is unusual and the clinical behavior distinctive, but the mechanism of spread remains the same: blood-borne and lymphatic-borne. Conclusions. Our experience with these six patients supports the concept in the recent literature that synchronous osteosarcoma is one extreme of the spectrum of metastatic osteosarcoma. Its unique features are: (1) multiple radiodense lesions that present simultaneously with or without pulmonary metastases; (2) a single ''dominant'' lesion with multiple smaller lesions; and (3) a uniformly rapid, fatal prognosis. Osteosarcoma should be regarded as a metastatic disease, even when only a single primary lesion is found at the initial presentation. (orig.)

  14. 12 CFR 268.302 - Mixed case complaints.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Mixed case complaints. 268.302 Section 268.302... RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

  15. Association of invasive breast carcinoma and multicentric high grade astrocytoma: a case report with a review.

    Science.gov (United States)

    Pour, P Hossein; Forouzandeh, M; Beni, A Naderi; Beni, Z Naderi; Hoseinpour, P

    2011-03-01

    Breast cancer is the most common cancer in women. Multicentric gliomas are uncommon lesions of the central nervous system (CNS) with an unprecise rate of occurrence that diffusely infiltrate large portions of the brain. High grade astrocytoma is the most agressive form of gliomas and often has a distinct neuroimaging pattern with a poor prognosis. We report a case of a 29-year-old woman patient with primary breast carcinoma and high grade astrocytoma subsequently developed. The woman was treated by mastectomy and 20 months post-diagnosis of the cancer she exhibited a transient facial paralysis. Magnetic resonance imaging (MRI) revealed two cranial masses suspicious of metastasis. A complete tumor removal from the brain was performed. On histological examination, this tumor was a high grade astrocytoma.

  16. Validación retrospectiva del Johns-Hopkins ACG Case-Mix System en la población Española Validating the Adjusted Clinical Groups [ACG] Case-mix System in a Spanish population setting: a multicenter study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2009-06-01

    Full Text Available Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs, and morbidity. The determination coefficient (R²; p<0.05 was used to measure the explained variability. Results: A total of 81,873 patients were included with a mean (standard deviation number of 4.8 (3.5 episodes and 8.0 (8.1 visits/patient/year. The explained variance (R² of ACG classification was 73.1% (75.5% log transformation for episodes, 43.2% (54.0% log transformation for visits, 19.6% (54.8% log transformation for primary care costs, and 22.7% (48.3% log transformation for total costs (p<0.001. Conclusion: The ACG system classified a defined population on the basis of morbidity and individual resource consumption. Moreover, the ACG system was useful to assess the clinical (comorbidity and economical information of each center.

  17. Case-mix payment for nursing home care: lessons from Maryland.

    Science.gov (United States)

    Feder, J; Scanlon, W

    1989-01-01

    Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

  18. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

    Science.gov (United States)

    Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

    2008-01-01

    Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may

  19. Case-mix reimbursement for nursing home services: Simulation approach

    Science.gov (United States)

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  20. Case-mix reimbursement for nursing home services: simulation approach.

    Science.gov (United States)

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  1. Adjusting case mix payment amounts for inaccurately reported comorbidity data.

    Science.gov (United States)

    Sutherland, Jason M; Hamm, Jeremy; Hatcher, Jeff

    2010-03-01

    Case mix methods such as diagnosis related groups have become a basis of payment for inpatient hospitalizations in many countries. Specifying cost weight values for case mix system payment has important consequences; recent evidence suggests case mix cost weight inaccuracies influence the supply of some hospital-based services. To begin to address the question of case mix cost weight accuracy, this paper is motivated by the objective of improving the accuracy of cost weight values due to inaccurate or incomplete comorbidity data. The methods are suitable to case mix methods that incorporate disease severity or comorbidity adjustments. The methods are based on the availability of detailed clinical and cost information linked at the patient level and leverage recent results from clinical data audits. A Bayesian framework is used to synthesize clinical data audit information regarding misclassification probabilities into cost weight value calculations. The models are implemented through Markov chain Monte Carlo methods. An example used to demonstrate the methods finds that inaccurate comorbidity data affects cost weight values by biasing cost weight values (and payments) downward. The implications for hospital payments are discussed and the generalizability of the approach is explored.

  2. Functional mapping of hospitals by diagnosis-dominant case-mix analysis

    Directory of Open Access Journals (Sweden)

    Horiguchi Hiromasa

    2007-04-01

    Full Text Available Abstract Background Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC, and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations. Methods By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups. Results On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals. Conclusion We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers.

  3. Is Case-Mix Adjustment Necessary for an Expanded Dialysis Bundle?

    OpenAIRE

    Hirth, Richard A.; Wolfe, Robert A.; Wheeler, John R.C.; Roys, Erik C.; Tedeschi, Philip J.; Pozniak, Alyssa S.; Wright, Glenn T.

    2003-01-01

    Congress has required CMS to expand the Medicare outpatient prospective payment system (PPS) for dialysis services to include as many drugs and diagnostic procedures provided to end stage renal disease (ESRD) patients as possible. One important implementation question is whether dialysis facility case mix should be reflected in payment. We use fiscal year (FY) 2000 cost report and patient billing and clinical data to determine the relationship between costs and case mix, as represented by sev...

  4. Retrospective exposure assessment and quality control in an international multi-centre case-control study

    DEFF Research Database (Denmark)

    Tinnerberg, H; Heikkilä, P; Huici-Montagud, A

    2003-01-01

    The paper presents the exposure assessment method and quality control procedure used in an international, multi-centre case-control study within a joint Nordic and Italian cohort. This study was conducted to evaluate whether occupational exposure to carcinogens influenced the predictivity of high...... was higher among the original assessors (the assessor from the same country as the subject) than the average prevalence assessed by the other four in the quality control round. The original assessors classified more job situations as exposed than the others. Several reasons for this are plausible: real...... country-specific differences, differences in information available to the home assessor and the others and misunderstandings or difficulties in translation of information. To ensure the consistency of exposure assessments in international retrospective case-control studies it is important to have a well...

  5. Case-Mix Adjustment of the Bereaved Family Survey.

    Science.gov (United States)

    Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

    2018-01-01

    Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

  6. Multicentric Giant Cell Tumor of Bone: Synchronous and Metachronous Presentation

    Directory of Open Access Journals (Sweden)

    Reiner Wirbel

    2013-01-01

    Full Text Available A 27-year-old man treated 2.5 years ago for synchronous multicentric giant cell tumor of bone located at the right proximal humerus and the right 5th finger presented now with complaints of pain in his right hip and wrist of two-month duration. Radiology and magnetic resonance revealed multicentric giant cell tumor lesions of the right proximal femur, the left ileum, the right distal radius, and the left distal tibia. The patient has an eighteen-year history of a healed osteosarcoma of the right tibia that was treated with chemotherapy, resection, and allograft reconstruction. A literature review establishes this as the first reported case of a patient with synchronous and metachronous multicentric giant cell tumor who also has a history of osteosarcoma.

  7. Utilising a collective case study system theory mixed methods approach: a rural health example.

    Science.gov (United States)

    Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

    2014-07-28

    Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services

  8. The effect of state medicaid case-mix payment on nursing home resident acuity.

    Science.gov (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

    2006-08-01

    To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

  9. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care.

    Science.gov (United States)

    Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders

    2009-09-18

    Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  10. Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.

    Science.gov (United States)

    Rosenbaum, Benjamin P; Lorenz, Robert R; Luther, Ralph B; Knowles-Ward, Lisa; Kelly, Dianne L; Weil, Robert J

    2014-01-01

    Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.

  11. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

    Directory of Open Access Journals (Sweden)

    Kronogård Maria

    2009-09-01

    Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  12. Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology.

    Science.gov (United States)

    Hensen, P; Fürstenberg, T; Luger, T A; Steinhoff, M; Roeder, N

    2005-09-01

    The changing healthcare environment world-wide is leading to extensive use of per case payment systems based on diagnosis-related groups (DRG). The aim of this study was to examine the impact of application of different DRG systems used in the German healthcare system. We retrospectively analysed 2334 clinical data sets of inpatients discharged from an academic dermatological inpatient unit in 2003. Data were regarded as providing high coding quality in compliance with the diagnosis and procedure classifications as well as coding standards. The application of the Australian AR-DRG version 4.1, the German G-DRG version 1.0, and the German G-DRG version 2004 was considered in detail. To evaluate more specific aspects, data were broken down into 11 groups based on the principle diagnosis. DRG cost weights and case mix index were used to compare coverage of inpatient dermatological services. Economic impacts were illustrated by case mix volumes and calculation of DRG payments. Case mix index results and the pending prospective revenues vary tremendously from the application of one or another of the DRG systems. The G-DRG version 2004 provides increased levels of case mix index that encourages, in particular, medical dermatology. The AR-DRG version 4.1 and the first German DRG version 1.0 appear to be less suitable to adequately cover inpatient dermatology. The G-DRG version 2004 has been greatly improved, probably due to proceeding calculation standards and DRG adjustments. The future of inpatient dermatology is subject to appropriate depiction of well-established treatment standards.

  13. Multicentric Castleman's disease & HIV infection.

    LENUS (Irish Health Repository)

    Cotter, A

    2009-10-01

    We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman\\'s Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.

  14. Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

    Science.gov (United States)

    Hanley, Gillian E; Morgan, Steve; Reid, Robert J

    2010-05-01

    Given that prescription drugs have become a major financial component of health care, there is an increased need to explain variations in the use of and expenditure on medicines. Case-mix systems built from existing administrative datasets may prove very useful for such prediction. We estimated the concurrent and prospective predictive validity of the adjusted clinical groups (ACG) system in pharmaceutical research and compared the ACG system with the Charlson index of comorbidity. We ran a generalized linear models to examine the predictive validity of the ACG system and the Charlson index and report the correlation between the predicted and observed expenditures. We reported mean predictive ratios across medical condition and cost-defined groups. When predicting use of medicines, we used C-statistics to summarize the area under the receiver operating characteristic curve. The 3,908,533 British Columbia residents who were registered for the universal health care plan for 275+ days in the calendar years 2004 and 2005. Outcomes were total pharmaceutical expenditures, use of any medicines, and use of medicines from 4+ different therapeutic categories. The ACG case mix system predicted drug expenditures better than the Charlson index. The mean predictive ratios for the ACG system models were all within 4% of the actual costs when examining medical condition group and the C-stats for the 2 dichotomous outcomes were between 0.82 and 0.89. ACG case-mix adjusters are a valuable predictor of pharmaceutical use and expenditures with much higher predictive power than age, sex, and the Charlson index of comorbidity.

  15. Multicentric primary extramammary Paget disease: a Toker cell disorder?

    Science.gov (United States)

    Hashemi, Pantea; Kao, Grace F; Konia, Thomas; Kauffman, Lisa C; Tam, Christine C; Sina, Bahram

    2014-07-01

    Toker cells are epithelial clear cells found in the areolar and nipple areas of the breast, vulvar region, and other apocrine gland-bearing areas of the skin. Toker cells have been implicated in the pathogenesis of clear cell papulosis, cutaneous hamartoma with pagetoid cells, and rare cases of primary extramammary Paget disease (EMPD) but not in secondary EMPD with underlying adenocarcinoma. The pathogenesis of primary EMPD is not well defined. We report a case of multicentric primary EMPD with evidence of Toker cell proliferation and nonaggressive biologic behavior in a 63-year-old white man. A detailed description of the morphologic and biologic features of Toker cells and their possible carcinogenetic links also are discussed. Based on the observation and follow-up of our patient, we hypothesize that multicentric primary EMPD starts with Toker cell hyperplasia and can potentially evolve to carcinoma in the genital region.

  16. Inherited multicentric osteolysis: case report of three siblings treated with bisphosphonate

    Directory of Open Access Journals (Sweden)

    Whitewood Colin

    2010-04-01

    Full Text Available Abstract Inherited Multicentric Osteolysis (IMO is an uncommon familial condition of idiopathic pathophysiology causing bone osteolysis and dysplasia. These patients present with common rheumatologic complaints of pain, dysfunction and disability, and are often initially misdiagnosed as a chronic rheumatic disease of childhood such as juvenile idiopathic arthritis. We report a case of three siblings diagnosed with IMO. Diagnosis was made during childhood, with each sibling having different manifestations and course of disease. One had a previous history of bilateral hip dysplasia. Two had osteolysis of the foot, distal tibia and femur (lower limb bones, whilst one had osteolysis of the rib and unusual clavicular fractures. Unusually, all siblings appear to experience decreased pain sensation compared to norms. All siblings were treated with bisphosphonates and experienced a rapid improvement in pain symptoms, decreased analgesic requirements. Two had bone mineral density testing performed and both had increases post-bisphosphonate. In all three, there was subjective evidence of stabilisation of bone disease. Testing for matrix metalloproteinase-2 (MMP2 gene was negative.

  17. Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

    Science.gov (United States)

    Baraff, L J; Cameron, J M; Sekhon, R

    1991-01-01

    To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients

  18. HPV and cofactors for invasive cervical cancer in Morocco: a multicentre case-control study.

    Science.gov (United States)

    Berraho, Mohamed; Amarti-Riffi, Afaf; El-Mzibri, Mohammed; Bezad, Rachid; Benjaafar, Noureddine; Benideer, Abdelatif; Matar, Noureddine; Qmichou, Zinab; Abda, Naima; Attaleb, Mohammed; Znati, Kaoutar; El Fatemi, Hind; Bendahhou, Karima; Obtel, Majdouline; Filali Adib, Abdelhai; Mathoulin-Pelissier, Simone; Nejjari, Chakib

    2017-06-20

    Limited national information is available in Morocco on the prevalence and distribution of HPV-sub-types of cervical cancer and the role of other risk factors. The aim was to determine the frequency of HPV-sub-types of cervical cancer in Morocco and investigate risk factors for this disease. Between November 2009 and April 2012 a multicentre case-control study was carried out. A total of 144 cases of cervical cancer and 288 age-matched controls were included. Odds-ratios and corresponding confidence-intervals were computed by conditional logistic regression models. Current HPV infection was detected in 92.5% of cases and 13.9% of controls. HPV16 was the most common type for both cases and controls. Very strong associations between HPV-sub-types and cervical cancer were observed: total-HPV (OR = 39), HPV16 (OR = 49), HPV18 (OR = 31), and multiple infections (OR = 13). Education, high parity, sexual intercourse during menstruation, history of sexually transmitted infections, and husband's multiple sexual partners were also significantly associated with cervical cancer in the multivariate analysis. Our results could be used to establish a primary prevention program and to prioritize limited screening to women who have specific characteristics that may put them at an increased risk of cervical cancer.

  19. Hypercalcaemic multicentric lymphoma in a dog presenting as clitoromegaly

    Directory of Open Access Journals (Sweden)

    Anthony B. Zambelli

    2013-12-01

    Full Text Available Clitoromegaly is a clinical manifestation of various local and systemic conditions in all species. The external genitalia are a very rare site of primary or metastatic lymphoma in canines, with only one previously-reported case in a dog and only sparse reports in the medical literature. Lymphoma is also very rare in dogs less than four years of age. This account reports on a T-cell multicentric lymphoma in a 16-month-old Basset hound presented primarily for clitoromegaly. The patient survived for 68 days with cyclophosphamide-vincristine-prednisolone therapy. The causes of clitoromegaly in all species, including humans, are tabulated with references.

  20. Case mix adjusted variation in cesarean section rate in Sweden.

    Science.gov (United States)

    Mesterton, Johan; Ladfors, Lars; Ekenberg Abreu, Anna; Lindgren, Peter; Saltvedt, Sissel; Weichselbraun, Marianne; Amer-Wåhlin, Isis

    2017-05-01

    Cesarean section (CS) rate is a well-established indicator of performance in maternity care and is also related to resource use. Case mix adjustment of CS rates when performing comparisons between hospitals is important. The objective of this study was to estimate case mix adjusted variation in CS rate between hospitals in Sweden. In total, 139 756 deliveries in 2011 and 2012 were identified in administrative systems in seven regions covering 67% of all deliveries in Sweden. Data were linked to the Medical birth register and population data. Twenty-three different sociodemographic and clinical characteristics were used for adjustment. Analyses were performed for the entire study population as well as for two subgroups. Logistic regression was used to analyze differences between hospitals. The overall CS rate was 16.9% (hospital minimum-maximum 12.1-22.6%). Significant variations in CS rate between hospitals were observed after case mix adjustment: hospital odds ratios for CS varied from 0.62 (95% CI 0.53-0.73) to 1.45 (95% CI 1.37-1.52). In nulliparous, cephalic, full-term, singletons the overall CS rate was 14.3% (hospital minimum-maximum: 9.0-19.0%), whereas it was 4.7% for multiparous, cephalic, full-term, singletons with no previous CS (hospital minimum-maximum: 3.2-6.7%). In both subgroups significant variations were observed in case mix adjusted CS rates. Significant differences in CS rate between Swedish hospitals were found after adjusting for differences in case mix. This indicates a potential for fewer interventions and lower resource use in Swedish childbirth care. Best practice sharing and continuous monitoring are important tools for improving childbirth care. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. A Mixed Methods Sampling Methodology for a Multisite Case Study

    Science.gov (United States)

    Sharp, Julia L.; Mobley, Catherine; Hammond, Cathy; Withington, Cairen; Drew, Sam; Stringfield, Sam; Stipanovic, Natalie

    2012-01-01

    The flexibility of mixed methods research strategies makes such approaches especially suitable for multisite case studies. Yet the utilization of mixed methods to select sites for these studies is rarely reported. The authors describe their pragmatic mixed methods approach to select a sample for their multisite mixed methods case study of a…

  2. Small angle scattering from soft matter-application to complex mixed systems

    International Nuclear Information System (INIS)

    Boue, F.; Cousin, F.; Gummel, J.; Carrot, G.; El Harrak, A.; Oberdisse, J.

    2007-01-01

    The advantage of small angle neutron scattering associated with isotopic labelling through deuteration is illustrated in the case of mixed systems, created by associating already well-known systems of characteristic structures; this is also important for applications. Our first mixed system associates charged polymer chains, polyelectrolyte (here polystyrene sulfonate, PSS), with oppositely charged particles, proteins (here lysozyme). Different fractions of deuterated water (D 2 O) mixed with normal water are used to match the scattering length density of the protein or of the polymer in non-deuterated or deuterated version. First, this allows us to separate the protein and the polymer signal: we can then distinguish a case where the structures of each species alone in water are hardly modified by mixing, except for interconnections yielding a gel, and a case inducing complete change into a structure common to both species, made of aggregated globules. Secondly, using, for counter-ions of the poly-ions, deuterated Tetramethylammonium, together with matching both protein and polymer, we establish unambiguously the counter-ion release into the solvent. Thirdly, matching only a fraction of polymer chains, the other being deuterated, we extrapolate at zero deuterated fraction their form factor and describe the chain conformation inside the complexes. Fourthly, we illustrate the possibilities of modelling the signal on a second example of mixed system: a nano-composite made of silica particles surrounded by polymer dispersed into a deuterated polymer matrix. Chains are then visible in such reinforced polymer system, in particular when it is submitted to elongation: we discuss a possible model for an ideal system, introducing the scattering contribution from deformed chains. (authors)

  3. Spatial Analysis of Case-Mix and Dialysis Modality Associations.

    Science.gov (United States)

    Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

    2016-01-01

    ♦ Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of

  4. Colorectal cancer and its association with the metabolic syndrome: a Malaysian multi-centric case-control study.

    Science.gov (United States)

    Ulaganathan, V; Kandiah, M; Zalilah, M S; Faizal, J A; Fijeraid, H; Normayah, K; Gooi, B H; Othman, R

    2012-01-01

    Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two. Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280). MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed. This study provides evidence for a positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.

  5. Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

    Science.gov (United States)

    Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

    2015-08-01

    When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

    Science.gov (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

    2008-01-01

    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  7. Treatment of unicentric and multicentric Castleman disease and the role of radiotherapy.

    Science.gov (United States)

    Chronowski, G M; Ha, C S; Wilder, R B; Cabanillas, F; Manning, J; Cox, J D

    2001-08-01

    Although surgery is considered standard therapy for unicentric Castleman disease, favorable responses to radiotherapy also have been documented. The authors undertook this study to analyze the clinical factors, treatment approaches, and outcomes of patients with unicentric or multicentric Castleman disease, and to report the outcomes of patients with unicentric Castleman disease treated with radiotherapy. The authors reviewed the medical records of 22 patients who had received a histologic diagnosis of Castleman disease at the University of Texas M. D. Anderson Cancer Center between 1988 and 1999. One patient with a concurrent histopathologic diagnosis of nonsecretory multiple myeloma was excluded from the study. In all patients, the diagnosis of Castleman disease was based on the results of lymph node biopsies. Disease was categorized as being either unicentric or multicentric and further subdivided into hyaline vascular, plasma cell, or mixed variant histologic types. Clinical variables and outcomes were analyzed according to treatment, which consisted of surgery, chemotherapy, or radiotherapy. Records from 21 patients were analyzed: 12 had unicentric disease, and 9 had multicentric disease. The mean follow-up time for the entire series was 51 months (median, 40 months). Four patients with unicentric disease were treated with radiotherapy alone: 2 remain alive and symptom free, 2 died of causes unrelated to Castleman disease and had no evidence of disease at last follow-up. Eight patients with unicentric disease were treated with complete or partial surgical resection, and all are alive and asymptomatic. All nine patients with multicentric disease were treated with combination chemotherapy: five are alive with no evidence of disease, and four are alive with progressive disease. Surgery results in excellent rates of cure in patients with unicentric Castleman disease; radiotherapy can also achieve clinical response and cure in selected patients. Multicentric

  8. Mixed-Media File Systems

    NARCIS (Netherlands)

    Bosch, H.G.P.

    1999-01-01

    This thesis addresses the problem of implementing mixed-media storage systems. In this work a mixed-media file system is defined to be a system that stores both conventional (best-effort) file data and real-time continuous-media data. Continuous-media data is usually bulky, and servers storing and

  9. Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.

    Science.gov (United States)

    Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A

    2017-05-01

    Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied. Patient and procedure details were used to generate a case mix-adjusted predictive model of total direct costs. Observed to expected costs for each center were evaluated between centers based on overall procedure volume. Patient and procedure characteristics were significantly different between volume tertiles. Observed costs at high-volume centers were less than at middle- and low-volume centers. According to our predictive model, high-volume centers cared for a less expensive case mix than middle- and low-volume centers ($12,786 vs $13,236 and $14,497, P case mix at low-volume centers, which may lead to perceived poor performance at these centers. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. An Integrating Framework for Mixed Systems

    Science.gov (United States)

    Coutrix, Céline; Nigay, Laurence

    Technological advances in hardware manufacturing led to an extended range of possibilities for designing physical-digital objects involved in a mixed system. Mixed systems can take various forms and include augmented reality, augmented virtuality, and tangible systems. In this very dynamic context, it is difficult to compare existing mixed systems and to systematically explore the design space. Addressing this design problem, this chapter presents a unified point of view on mixed systems by focusing on mixed objects involved in interaction, i.e., hybrid physical-digital objects straddling physical and digital worlds. Our integrating framework is made of two complementary facets of a mixed object: we define intrinsic as well as extrinsic characteristics of an object by considering its role in the interaction. Such characteristics of an object are useful for comparing existing mixed systems at a fine-grain level. The taxonomic power of these characteristics is discussed in the context of existing mixed systems from the literature. Their generative power is illustrated by considering a system, Roam, which we designed and developed.

  11. Superconductivity in mixed boson-fermion systems

    International Nuclear Information System (INIS)

    Ioffe, L.; Larkin, A.I.; Ovchinnikov, Yu.N.; Yu, L.

    1989-12-01

    The superconductivity of mixed boson-fermion systems is studied using a simple boson-fermion transformation model. The critical temperature of the superconducting transition is calculated over a wide range of the narrow boson band position relative to the Fermi level. The BCS scenario and boson condensation picture are recovered in two limiting cases of high and low positions of boson band, respectively, with modifications due to boson-fermion interaction. (author). 11 refs

  12. Design of Mixed-Criticality Applications on Distributed Real-Time Systems

    DEFF Research Database (Denmark)

    Tamas-Selicean, Domitian

    the concept of virtual links, and temporal separation, enforced through schedule tables for TT messages and bandwidth allocation for RC messages. The objective of this thesis is to develop methods and tools for distributed mixed-criticality real-time systems. At the processor level, we are interested......A mixed-criticality system implements applications of different safety-criticality levels onto the same platform. In such cases, the certification standards require that applications of different criticality levels are protected so they cannot influence each other. Otherwise, all tasks have...

  13. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

    Directory of Open Access Journals (Sweden)

    Varun Sharma Tandra

    2015-01-01

    Full Text Available Giant cell tumour (GCT is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

  14. Case-Mix for Performance Management: A Risk Algorithm Based on ICD-10-CM.

    Science.gov (United States)

    Gao, Jian; Moran, Eileen; Almenoff, Peter L

    2018-06-01

    Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement. To develop a case-mix algorithm that hospitals and payers can use to measure and compare cost and quality performance of their providers. All 6,048,895 patients with valid diagnoses and cost recorded in the US Veterans health care system in fiscal year 2016 were included in this study. The dependent variable was total cost at the patient level, and the explanatory variables were age, sex, and comorbidities represented by 762 clinically homogeneous groups, which were created by expanding the 283 categories from Clinical Classifications Software based on ICD-10-CM codes. The split-sample method was used to assess model overfitting and coefficient stability. The predictive power of the algorithms was ascertained by comparing the R, mean absolute percentage error, root mean square error, predictive ratios, and c-statistics. The expansion of the Clinical Classifications Software categories resulted in higher predictive power. The R reached 0.72 and 0.52 for the transformed and raw scale cost, respectively. The case-mix algorithm we developed based on age, sex, and diagnoses outperformed the existing case-mix models reported in the literature. The method developed in this study can be used by other health systems to produce tailored risk models for their specific purpose.

  15. Multicentric malignant gastrointestinal stromal tumor

    International Nuclear Information System (INIS)

    Shukla, Shailaja; Singh, Sanjeet K; Pujani, Mukta

    2009-01-01

    Malignant gastrointestinal stromal tumor (GIST) is a rare type of sarcoma that is found in the digestive system, most often in the wall of the stomach. Multiple GISTs are extremely rare and usually associated with type 1 neurofibromatosis and familial GIST. We report here a case of a 70-year-old woman who reported pain in the abdomen, loss of appetite, and weight loss for six months. Ultrasound examination showed a small bowel mass along with multiple peritoneal deposits and a mass within the liver. Barium studies were suggestive of a neoplastic pathology of the distal ileum. A differential diagnosis of adenocarcinoma/lymphoma with metastases was entertained. Perioperative findings showed two large growths arising from the jejunum and the distal ileum, along with multiple smaller nodules on the serosal surface and adjoining mesentery of the involved bowel segments. Segmental resection of the involved portions of the intestine was performed. Histopathological features were consistent with those of multicentric malignant GIST-not otherwise specified (GIST-NOS). Follow-up examination three months after surgery showed no evidence of recurrence. (author)

  16. I-MOVE multi-centre case control study 2010-11: overall and stratified estimates of influenza vaccine effectiveness in Europe.

    Directory of Open Access Journals (Sweden)

    Esther Kissling

    Full Text Available BACKGROUND: In the third season of I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in eight European Union (EU member states to estimate 2010/11 influenza vaccine effectiveness (VE against medically-attended influenza-like illness (ILI laboratory-confirmed as influenza. METHODS: Using systematic sampling, practitioners swabbed ILI/ARI patients within seven days of symptom onset. We compared influenza-positive to influenza laboratory-negative patients among those meeting the EU ILI case definition. A valid vaccination corresponded to > 14 days between receiving a dose of vaccine and symptom onset. We used multiple imputation with chained equations to estimate missing values. Using logistic regression with study as fixed effect we calculated influenza VE adjusting for potential confounders. We estimated influenza VE overall, by influenza type, age group and among the target group for vaccination. RESULTS: We included 2019 cases and 2391 controls in the analysis. Adjusted VE was 52% (95% CI 30-67 overall (N = 4410, 55% (95% CI 29-72 against A(H1N1 and 50% (95% CI 14-71 against influenza B. Adjusted VE against all influenza subtypes was 66% (95% CI 15-86, 41% (95% CI -3-66 and 60% (95% CI 17-81 among those aged 0-14, 15-59 and ≥60 respectively. Among target groups for vaccination (N = 1004, VE was 56% (95% CI 34-71 overall, 59% (95% CI 32-75 against A(H1N1 and 63% (95% CI 31-81 against influenza B. CONCLUSIONS: Results suggest moderate protection from 2010-11 trivalent influenza vaccines against medically-attended ILI laboratory-confirmed as influenza across Europe. Adjusted and stratified influenza VE estimates are possible with the large sample size of this multi-centre case-control. I-MOVE shows how a network can provide precise summary VE measures across Europe.

  17. Case-mix adjustment for diabetes indicators: a systematic review.

    Science.gov (United States)

    Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

    2016-02-01

    Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

  18. Case mix in paediatric rheumatology: implications for training in Australia.

    Science.gov (United States)

    Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

    2012-05-01

    Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  19. Case mix management education in a Canadian hospital.

    Science.gov (United States)

    Moffat, M; Prociw, M

    1992-01-01

    The Sunnybrook Health Science Centre's matrix organization model includes a traditional departmental structure, a strategic program-based structure and a case management-based structure--the Clinical Unit structure. The Clinical Unit structure allows the centre to give responsibility for the management of case mix and volume to decentralized Clinical Unit teams, each of which manages its own budget. To train physicians and nurses in their respective roles of Medical Unit directors and Nursing Unit directors, Sunnybrook designed unique short courses on financial management and budgeting, and case-costing and case mix management. This paper discusses how these courses were organized, details their contents and explains how they fit into Sunnybrook's program of decentralized management.

  20. Inflammatory Bowel Disease Phenotype as Risk Factor for Cancer in a Prospective Multicentre Nested Case-Control IG-IBD Study.

    Science.gov (United States)

    Biancone, Livia; Armuzzi, Alessandro; Scribano, Maria Lia; D'Inca, Renata; Castiglione, Fabiana; Papi, Claudio; Angelucci, Erika; Daperno, Marco; Mocciaro, Filippo; Riegler, Gabriele; Fries, Walter; Meucci, Gianmichele; Alvisi, Patrizia; Spina, Luisa; Ardizzone, Sandro; Petruzziello, Carmelina; Ruffa, Alessandra; Kohn, Anna; Vecchi, Maurizio; Guidi, Luisa; Di Mitri, Roberto; Renna, Sara; Emma, Calabrese; Rogai, Francesca; Rossi, Alessandra; Orlando, Ambrogio; Pallone, Francesco

    2016-08-01

    Cancer risk in inflammatory bowel disease [IBD] is still debated. In a prospective, multicentre, nested case-control study, we aimed to characterise incident cases of cancer in IBD. The role of immunomodulators vs clinical characteristics of IBD as risk factors for cancer was also investigated. From January 2012 to December 2014, each IBD patient with incident cancer was matched with two IBD patients without cancer for: IBD type, gender, and age. Risk factors were assessed by multivariate regression analysis. IBD patients considered numbered 44619: 21953 Crohn's disease [CD], 22666 ulcerative colitis [UC]. Cancer occurred in 174 patients: 99 CD [CD-K], 75 UC [UC-K]. Controls included 198 CD [CD-C], 150 UC [UC-C]. Cancer incidence in IBD was 3.9/1000, higher in CD (4.5/1000 [99/21,953]) than in UC (3.3/1000 [75/22,666]; p = 0.042). Cancers involved: digestive system [36.8%], skin [13.2%], urinary tract [12.1%], lung [8.6%], breast [8%], genital tract [6.9%], thyroid [4.6%], lymphoma [3.5%], others [6.3%]. In CD, penetrating behaviour and combined thiopurines and tumour necrosis factor alpha [TNFα] antagonists were risk factors for cancer overall: odds ratio [OR] (95% confidence interval [CI] 2.33 [1.01-5.47]); 1.97 [1.1-3.5]; and for extracolonic cancers 3.9 [1.56-10.1]; 2.15 [1.17-4.1], respectively. In UC, risk factors were pancolitis and disease-related surgery for cancer overall (OR: 2.52 [1.26-5.1]; 5.09 [1.73-17.1]); disease-related surgery for colorectal cancer [CRC] (OR 3.6 [1.0-12]); and extensive and left-sided vs distal UC for extracolonic cancers (OR: 2.55 [1.15-5.9]; 2.6 [1.04-6.6]), respectively. In a multicentre study, penetrating CD and extensive UC were risk factors for cancer overall. Cancer incidence was higher in CD than in UC. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  1. Building a Multi-centre Clinical Research Facilitation Network: The ARC Experience

    Directory of Open Access Journals (Sweden)

    Ian Nicholson

    2017-06-01

    Full Text Available Introduction: In order to practice evidence-based veterinary medicine, good quality clinical evidence needs to be produced, in order that it can be apprasied systematically by the EBVM network, and used by vets. There is very little good-quality veterinary evidence for most of the veterinary procedures carried out every day across the world. Very few, if any, individuals have all the necessary qualities (case-load, time, research expertise, financial support to be able to systematically produce good-quality, and relevant, clinical research on their own, in a timely manner. The Association for Veterinary Soft Tissue Surgery (AVSTS www.avsts.org.uk is an affiliate group with the British Small Animal Veterinary Association (BSAVA, and functions as a clinical network of like-minded individuals. In 2013 AVSTS sought to create a role for itself in facilitating the production (by its members of multi-centre clinical research of relevance to its members.Materials and methods: Members of AVSTS were asked to join the AVSTS Research Cooperative (ARC, with a veterinary epidemiologist and an experienced multi-centre veterinary clinical researcher (to help with study design and statistical planning, and the Animal Health Trust clinical research ethics committee. An email list was established, and a page was set up on the AVSTS website, to allow information to be disseminated. The AVSTS spring and autumn meetings were used as a regular forum by ARC, to discuss its direction, to generate interest, to create and promote specific studies (in order to widen participation amongst different centres, and to update members about previous studies.Results: Membership of ARC has grown to 224 people, although the epidemiologist left. One multi-centre study has been published, two have been presented and await publication, one has been accepted for presentation, two other studies are gathering data at present, and further studies are in the pipeline. There has been

  2. MIXED AND MIXING SYSTEMS WORLDWIDE: A PREFACE

    Directory of Open Access Journals (Sweden)

    Seán Patrick Donlan

    2012-09-01

    Full Text Available This issue of the Potchefstroom Electronic Law Journal (South Africa sees thepublication of a selection of articles derived from the Third International Congress ofthe World Society of Mixed Jurisdiction Jurists (WSMJJ. That Congress was held atthe Hebrew University of Jerusalem, Israel in the summer of 2011. It reflected athriving Society consolidating its core scholarship on classical mixed jurisdictions(Israel, Louisiana, the Philippines, Puerto Rico, Quebec, Scotland, and South Africawhile reaching to new horizons (including Cyprus, Hong Kong and Macau, Malta,Nepal, etc. This publication reflects in microcosm the complexity of contemporaryscholarship on mixed and plural legal systems. This complexity is, of course, wellunderstoodby South African jurists whose system is derived both from the dominantEuropean traditions as well as from African customary systems, including both thosethat make up part of the official law of the state as well as those non-state norms thatcontinue to be important in the daily lives of many South Africans.

  3. Deep Attack Weapons Mix Study (DAWMS) Case Study

    National Research Council Canada - National Science Library

    Bexfield, James

    2001-01-01

    .... This report describes the process used to conduct the Deep Attack Weapons Mix Study (DAWMS) in 1995-1997. This case study focuses on the weapons being procured by the Services and whether a joint viewpoint would result in a more effective mix...

  4. [Multicentric inflammatory pseudotumor with asynchronic presentation in meninges, liver, spleen and lymph nodes in a patient with seronegative spondiloarthropathy. Case report and review of the literature].

    Science.gov (United States)

    Vicuña-González, R M; Rivera-Salgado, M I; García-Velarde, P M Pasquel; de León-Bojorge, B; Ortiz-Hidalgo, C

    Inflammatory pseudotumor is a reactive process in which the etiology and pathogenesis are not well defined, that can be found in any location. The cases with central nervous system affection have been described in meninges, brain, choroid plexus and cranial and spinal nerves. Multicentric cases, synchronous and asynchronous have been described. A 45 years-old woman with a rheumatologic disease (a seronegative spondiloarthropathy) who developed an inflammatory pseudotumor in spleen, liver and abdominal lymph nodes in 1995, associated to fever of unknown origin, six years later she presented with an inflammatory pseudotumor of the meninges in the convexity of the right frontoparietal region, with fever, malaise, and increase of globular sedimentation rate, microcytic hypochromic anemia and thrombocytosis. The clinicopathologic features of this lesion are revised, including the different theories in regard to the etiology and pathogenesis, and the role of cytokines produced by inflammatory cells in the tumor.

  5. Multicentric Castleman's Disease in a Hepatitis C-Positive Intravenous Drug User: A Case Report

    Directory of Open Access Journals (Sweden)

    D. Y. Talukder

    2011-01-01

    Full Text Available Introduction. We report a rare presentation of Castleman's disease in a hepatitis C-positive patient and present a short review of treatments described in other similar case reports and studies. Case Presentation. A 46-year-old male with untreated hepatitis C and a 16-year history of intravenous drug use presented with pleuritic chest pain and bony pain in the knee, hip, and lower back, on a background of unexplained weight loss of 40 kilograms, fevers, night sweats, and repeated infections over the last two years. Examination discovered tender hepatomegaly, a warm right knee effusion, and painless lymphadenopathy. The patient was reactive to Epstein Barr virus and cytomegalovirus; however, HIV and HHV-8 viral testing was negative. Osteomyelitis of vertebrae T8–T11 and septic arthritis of the knee were found on investigation. A lymph node biopsy revealed histology suggestive of plasmacytic Castleman's disease. The patient is to commence rituximab treatment. Conclusion. Castleman's disease continues to present in novel ways, which may lead to difficulties in clinicopathologic diagnosis. A growing body of evidence suggests larger studies are required to determine the best treatment for multicentric Castleman's disease, particularly in patients with a concomitant disease, including hepatitis C.

  6. On the use of administrative databases to support planning activities: the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems.

    Science.gov (United States)

    Fantini, M P; Cisbani, L; Manzoli, L; Vertrees, J; Lorenzoni, L

    2003-06-01

    There are several versions of the Diagnosis Related Group (DRG) classification systems that are used for case-mix analysis, utilization review, prospective payment, and planning applications. The objective of this study was to assess the adequacy of two of these DRG systems--Medicare DRG and All Patient Refined DRG--to classify neonatal patients. The first part of the paper contains a descriptive analysis that outlines the major differences between the two systems in terms of classification logic and variables used in the assignment process. The second part examines the statistical performance of each system on the basis of the administrative data collected in all public hospitals of the Emilia-Romagna region relating to neonates discharged in 1997 and 1998. The Medicare DRG are less developed in terms of classification structure and yield a poorer statistical performance in terms of reduction in variance for length of stay. This is important because, for specific areas, a more refined system can prove useful at regional level to remove systematic biases in the measurement of case-mix due to the structural characteristics of the Medicare DRGs classification system.

  7. Decision-case mix model for analyzing variation in cesarean rates.

    Science.gov (United States)

    Eldenburg, L; Waller, W S

    2001-01-01

    This article contributes a decision-case mix model for analyzing variation in c-section rates. Like recent contributions to the literature, the model systematically takes into account the effect of case mix. Going beyond past research, the model highlights differences in physician decision making in response to obstetric factors. Distinguishing the effects of physician decision making and case mix is important in understanding why c-section rates vary and in developing programs to effect change in physician behavior. The model was applied to a sample of deliveries at a hospital where physicians exhibited considerable variation in their c-section rates. Comparing groups with a low versus high rate, the authors' general conclusion is that the difference in physician decision tendencies (to perform a c-section), in response to specific obstetric factors, is at least as important as case mix in explaining variation in c-section rates. The exact effects of decision making versus case mix depend on how the model application defines the obstetric condition of interest and on the weighting of deliveries by their estimated "risk of Cesarean." The general conclusion is supported by an additional analysis that uses the model's elements to predict individual physicians' annual c-section rates.

  8. BDA special care case mix model.

    Science.gov (United States)

    Bateman, P; Arnold, C; Brown, R; Foster, L V; Greening, S; Monaghan, N; Zoitopoulos, L

    2010-04-10

    Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

  9. Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

    International Nuclear Information System (INIS)

    Malpani, A.R.; Sundaram, M.; Ramani, S.K.

    1989-01-01

    This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

  10. Effect of Hospital Case Mix on the Hospital Consumer Assessment of Healthcare Providers and Systems Star Scores: Are All Stars the Same?

    Science.gov (United States)

    Thiels, Cornelius A; Hanson, Kristine T; Yost, Kathleen J; Zielinski, Martin D; Habermann, Elizabeth B; Cima, Robert R

    2016-10-01

    We aimed to evaluate variations in patient experience measures across different surgical specialties and to assess the impact of further case-mix adjustment. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patients' hospital experiences that directly influence Medicare reimbursement. All adult surgical inpatients meeting criteria for HCAHPS sampling from 2013 to 2014 at a single academic center were identified. HCAHPS measures were analyzed according to published top-box and Star-rating methodologies, and were dichotomized ("high" vs "low"). Multivariable logistic regression was used to identify independent associations of high patient scores on various HCAHPS measures with specialty, diagnosis-related group complexity, cancer diagnosis, sex, and emergency admission after adjusting for HCAHPS case-mix adjusters (education, overall health status, language, and age). We identified 36,551 eligible patients, of which 30.8% (n = 11,273) completed HCAHPS. Women [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.72-0.85, P cases (OR 0.90, 95% CI 0.82-0.99, P = 0.02), and emergency admissions (OR 0.67, 95% CI 0.55-0.82, P case-mix adjustment does not include adjustment for specialty or diagnosis, which may result in artificially lower scores for centers that provide a high level of complex care. Further research is needed to ensure that the HCAHPS is an unbiased comparison tool.

  11. Cornell Mixing Zone Expert System

    Science.gov (United States)

    This page provides an overview Cornell Mixing Zone Expert System water quality modeling and decision support system designed for environmental impact assessment of mixing zones resulting from wastewater discharge from point sources

  12. Evaluation of web-based annotation of ophthalmic images for multicentric clinical trials.

    Science.gov (United States)

    Chalam, K V; Jain, P; Shah, V A; Shah, Gaurav Y

    2006-06-01

    An Internet browser-based annotation system can be used to identify and describe features in digitalized retinal images, in multicentric clinical trials, in real time. In this web-based annotation system, the user employs a mouse to draw and create annotations on a transparent layer, that encapsulates the observations and interpretations of a specific image. Multiple annotation layers may be overlaid on a single image. These layers may correspond to annotations by different users on the same image or annotations of a temporal sequence of images of a disease process, over a period of time. In addition, geometrical properties of annotated figures may be computed and measured. The annotations are stored in a central repository database on a server, which can be retrieved by multiple users in real time. This system facilitates objective evaluation of digital images and comparison of double-blind readings of digital photographs, with an identifiable audit trail. Annotation of ophthalmic images allowed clinically feasible and useful interpretation to track properties of an area of fundus pathology. This provided an objective method to monitor properties of pathologies over time, an essential component of multicentric clinical trials. The annotation system also allowed users to view stereoscopic images that are stereo pairs. This web-based annotation system is useful and valuable in monitoring patient care, in multicentric clinical trials, telemedicine, teaching and routine clinical settings.

  13. System equivalent model mixing

    Science.gov (United States)

    Klaassen, Steven W. B.; van der Seijs, Maarten V.; de Klerk, Dennis

    2018-05-01

    This paper introduces SEMM: a method based on Frequency Based Substructuring (FBS) techniques that enables the construction of hybrid dynamic models. With System Equivalent Model Mixing (SEMM) frequency based models, either of numerical or experimental nature, can be mixed to form a hybrid model. This model follows the dynamic behaviour of a predefined weighted master model. A large variety of applications can be thought of, such as the DoF-space expansion of relatively small experimental models using numerical models, or the blending of different models in the frequency spectrum. SEMM is outlined, both mathematically and conceptually, based on a notation commonly used in FBS. A critical physical interpretation of the theory is provided next, along with a comparison to similar techniques; namely DoF expansion techniques. SEMM's concept is further illustrated by means of a numerical example. It will become apparent that the basic method of SEMM has some shortcomings which warrant a few extensions to the method. One of the main applications is tested in a practical case, performed on a validated benchmark structure; it will emphasize the practicality of the method.

  14. Special Features In Turbulent Mixing. Comparison between Periodic and Non Periodic Case

    Directory of Open Access Journals (Sweden)

    Mihai Costescu

    2006-12-01

    Full Text Available After hundreds of years of stability study, the problems of flow kinematics are far from complete solving. A modern theory appears in this field: the mixing theory. Its mathematical methods and techniques developed the significant relation between turbulence and chaos. The turbulence is an important feature of dynamic systems with few freedom degrees, the so-called far from equilibrium systems. These are widespread between the models of excitable media.Studying a mixing for a flow implies the analysis of successive stretching and folding phenomena for its particles, the influence of parameters and initial conditions. In the previous works, the study of the 3D non-periodic models exhibited a quite complicated behavior, involving some significant events - the so-called rare events. The variation of parameters had a great influence on the length and surface deformations. The 2D (periodic case is simpler, but significant events can also issue for irrational values of the length and surface versors, as was the situation in 3D case.The comparison between 2D and 3D case revealed interesting properties; therefore a modified 2D (periodic model is tested. The numerical simulations were realized in MapleVI, for searching special mathematical events. Continuing this work both from analytical and numeric standpoint would relieve useful properties for the turbulent mixing. A proximal target is to test some special functions for the periodic model, and to study the behavior of the structures realized by the model.

  15. [Multicentric hyaline vascular Castleman's disease. A POEMS type variant].

    Science.gov (United States)

    Gracia-Ramos, Abraham Edgar; Cruz-Domínguez, María del Pilar; Vera-Lastra, Olga Lidia

    2013-01-01

    Castleman's disease is an atypical lymphoproliferative disorder which may be compatible with paraneoplastic manifestations of POEMS syndrome. a 53 year old man with a history of type 2 diabetes, hypothyroidism and Addison's disease presented with numbness and weakness in limbs, dyspnea, skin hardening, Raynaud's phenomenon, weight loss and fatigue. A physical exam showed tachypnea, generalized cutaneous hyperpigmentation and skin hardening of extremities, muscle weakness, hypoesthesia and hyporeflexia. Laboratory showed hyperprolactinemia, low testosterone, hypothyroidism and Addison's disease. Electrophoresis of proteins showed polyclonal hypergammaglobulinemia. Somatosensory evoked potentials reported peripheral neuropathy and severe axonal polyneuropathy by electromyography. Chest X-rays showed bilateral reticular infiltrates and mediastinal widening. An echocardiogram displayed moderate pulmonary hypertension. Skin biopsy had no evidence of scleroderma. CT reported axillar, mediastinal and retroperitoneal nodes. The mediastinal lesion biopsy reported hyaline vascular Castleman's disease, multicentric variety. He was treated with rituximab. the case meet criteria for multicentric hyaline vascular Castleman's disease, POEMS variant, treated with rituximab.

  16. Measuring case-mix complexity of tertiary care hospitals using DRGs.

    Science.gov (United States)

    Park, Hayoung; Shin, Youngsoo

    2004-02-01

    The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

  17. Protein 53 expression in a mixed Labrador subcutaneous lymphoma

    Directory of Open Access Journals (Sweden)

    Annahita Rezaie

    2012-06-01

    Full Text Available An 11 year – old mixed female Labrador was presented with two masses in trunk and neck. The tumoral masses were excised and sent for histopathological and immunohistochemical analyses. Histopathological examination of masses revealed diffuse infiltration of small sized lymphoid cells in subcutaneous tissue which were intense around the blood vessels. More than 10% lymphoid cells were CD3 positive in the immunohistochemical staining and most of them were accumulated around vessels. Protein 53 (p53 expression was detected by brown nuclei in immunohistochemical staining. Subcutaneous lymphoma was diagnosed according to histopathological results. After 6 months the case was referred with multicentric lymphoma and based on the owner request euthanasia was performed. These findings emphasize on poor prognosis for tumors with p53 mutation.

  18. Nursing home performance under case-mix reimbursement: responding to heavy-care incentives and market changes.

    Science.gov (United States)

    Davis, M A; Freeman, J W; Kirby, E C

    1998-10-01

    To examine the effect of case mix-adjusted reimbursement policy and market factors on nursing home performance. Data from Medicaid certification inspection surveys, Medicaid cost reports, and the Kentucky State Center for Health Statistics for the years 1989 and 1991, to examine changes in nursing home performance stemming from the adoption of case mix-adjusted reimbursement in 1990. In addition to cross-sectional regressions, a first-difference approach to fixed-effects regression analyses was employed to control for facility differences that were essentially fixed during the survey years and to estimate the effects of time-varying predictors on changes in facility expenditures, efficiency, and profitability. Facilities that increased the proportion of Medicaid residents and eliminated excess capacity experienced higher profitability gains during the beginning phase of case-mix reimbursement. Having a heavy-care resident population was positively related to expenditures prior to reimbursement reform, and it was negatively related to expenditures after the case-mix reimbursement policy was introduced. While facility-level changes in case mix had no reliable influence on costs or profits, nursing homes showing an increased prevalence of poor-quality nursing practices exhibited increases in efficiency and profitability. At the market level, reductions in excess or empty nursing home beds were accompanied by a significant growth in home health services. Moreover, nursing homes located in markets with expanding home health services exhibited higher increases in costs per case-mix unit. Characteristics of the reimbursement system appear to reward a cost minimization orientation with potentially detrimental effects on quality of care. These effects, exacerbated by a supply-constrained market, may be mitigated by policies that encourage the expansion of home health service availability.

  19. The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

    Science.gov (United States)

    Reilly, Karen E; Mueller, Christine; Zimmerman, David R

    2007-01-01

    This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

  20. 'Away Days' in multi-centre randomised controlled trials: a questionnaire survey of their use and a case study on the effect of one Away Day on patient recruitment.

    Science.gov (United States)

    Jefferson, Laura; Cook, Liz; Keding, Ada; Brealey, Stephen; Handoll, Helen; Rangan, Amar

    2015-11-06

    'Away Days' (trial promotion and training events for trial site personnel) are a well-established method used by trialists to encourage engagement of research sites in the recruitment of patients to multi-centre randomised controlled trials (RCTs). We explored the use of Away Days in multi-centre RCTs and analysed the effect on patient recruitment in a case study. Members of the United Kingdom Trial Managers' Network were surveyed in June 2013 to investigate their experiences in the design and conduct of Away Days in RCTs. We used data from a multi-centre pragmatic surgical trial to explore the effects of an Away Day on the screening and recruitment of patients. A total of 94 people responded to the survey. The majority (78%), who confirmed had organised an Away Day previously, found them to be useful. This is despite their costs.. There was no evidence, however, from the analysis of data from a surgical trial that attendance at an Away Day increased the number of patients screened or recruited at participating sites. Although those responsible for managing RCTs in the UK tend to believe that trial Away Days are beneficial, evidence from a multi-centre surgical trial shows no improvement on a key indicator of trial success. This points to the need to carefully consider the aims, design and conduct of Away Days. Further more rigorous research nested within RCTs would be valuable to evaluate the design and conduct of Away Days. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Diagnosis of intracranial mixed tumor with CT and MRI (report of 7 cases)

    International Nuclear Information System (INIS)

    Guan Changqun; Zhou Huaiwei; Xue Hongli; Zhang Yuzhong; Hu Lianyuan

    1998-01-01

    Purpose: To recognize the images of intracranial mixed tumor. Materials and methods: Seven cases were studied with CT and MRI. All were proved by pathology, including mixed tumor of meningioma with glioblastoma 2 cases, meningioma with pituitary tumor 2 cases, glioblastoma multiform with angioblastoma 1 cases, cholesteatoma with melanoma 1 case, and pituitary tumor with meningioma 1 case. The authors analysed the CT and MRI manifestations of intracranial mixed tumor retrospectively. Results: The CT and MRI manifestations of intracranial mixed tumor were exactly like meningioma, glioma, and hypophysoma, etc, therefore it was usually misdiagnosed the common tumor. Four cases intracranial mixed tumor displayed two kinds of characteristic CT and MRI manifestation on the same region of the same tumor in contrast with the clinic and pathologic change. Conclusion: There were no characteristic CT and MRI manifestations; the diagnosis should be made in combination with clinical information

  2. EBV+ HHV-8+ Multicentric Castleman Disease With Plasmablastic Aggregates in an HIV+ Man: An Evolving Clinicopathologic Entity.

    Science.gov (United States)

    Shivane, Aditya; Pearce, Amy; Khatib, Nadia; Smith, Mark E F

    2018-06-01

    We report a case of EBV+ and HHV-8+ multicentric Castleman disease with plasmablastic aggregates in an HIV-positive individual. A 41-year-old man presented in early 2015 with fevers, sweats, weight loss, intractable itching, and on subsequent testing was found to be HIV positive. Investigations showed cervical lymphadenopathy and splenomegaly. He was treated for HIV and his symptoms resolved. His symptoms recurred in January 2016, and a provisional diagnosis of multicentric Castleman disease was entertained. The HHV-8 (human herpesvirus-8) and EBV (Epstein-Barr virus) viral load was elevated. A left supraclavicular lymph node core biopsy was performed, which showed features of multicentric Castleman disease with plasmablastic aggregates that are EBV (EBER) and HHV-8 positive. He responded well to rituximab treatment and remains well with no symptoms at recent follow-up.

  3. A unique approach to quantifying the changing workload and case mix in laparoscopic colorectal surgery.

    Science.gov (United States)

    Shah, P R; Gupta, V; Haray, P N

    2011-03-01

    Laparoscopic colorectal surgery includes a range of operations with differing technical difficulty, and traditional parameters, such as conversion and complication rates, may not be sensitive enough to assess the complexity of these procedures. This study aims to define a reproducible and reliable tool for quantifying the total workload and the complexity of the case mix. This is a review of a single surgeon's 10-year experience. The intermediate equivalent value scoring system was used to code complexity of cases. To assess changes in the workload and case mix, the period has been divided into five phases. Three hundred and forty-nine laparoscopic operations were performed, of which there were 264 (75.6%) resections. The overall conversion rate was 17.8%, with progressive improvement over the phases. Complex major operation (CMO), as defined in the British United Provident Association (BUPA) schedule of procedures, accounted for 35% of the workload. In spite of similar numbers of cases in each phase, there was a steady increase in the workload score, correlating with the increasing complexity of the case mix. There was no significant difference in the conversion and complications rates between CMO and non-CMO. The paradoxical increase in the mean operating time with increasing experience corresponded to the progressive increase in the workload score, reflecting the increasing complexity of the case mix. This article establishes a reliable and reproducible tool for quantifying the total laparoscopic colorectal workload of an individual surgeon or of an entire department, while at the same time providing a measure of the complexity of the case mix. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  4. Variability in case-mix adjusted in-hospital cardiac arrest rates.

    Science.gov (United States)

    Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

    2012-02-01

    It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; PCase-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

  5. Advantages of the modified double ring areolar incision over the traditional areolar incision in multicentric breast fibroadenoma surgery.

    Science.gov (United States)

    Zhang, Mingliang; Shen, Gongjin; Zhang, Song; Cui, Zhen; Qian, Jun

    2017-09-01

    This study was conducted to investigate the clinical advantages of modified double ring areola incision (MDRAI) compared to ordinary areola incision (OAI) in multicentric breast fibroadenoma in women. Sixty cases of multicentric benign breast tumor were recruited from the First Affiliated Hospital of Bengbu Medical College from January to December 2016. The cases were divided into two groups according to surgical approach: MDRAI (n = 20) and OAI (n = 40). The operation duration, intraoperative blood loss, drainage time, and postoperative recurrence rate in the first six months were compared. The mean age and tumor locations were not statistically different between the groups (P > 0.05). However, more lesions and larger tumor diameter were found in the MDRAI group than in the OAI group, with statistical difference (P  0.05). However, the intraoperative blood loss was statistically different between the two groups (P < 0.05). All 60 cases received six months of follow-up. Eight recurrent cases were found in the OAI group, but none in the MDRAI group. The recurrence rate was significantly different (χ 2  = 4.62, P < 0.05). Compared with OAI, MDRAI offers greater advantages in the aspects of blood loss and recurrence for the treatment of breast benign tumor, especially for multicentric larger lesions. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  6. Assessing the role of case mix in cesarean delivery rates.

    Science.gov (United States)

    Lieberman, E; Lang, J M; Heffner, L J; Cohen, A

    1998-07-01

    Implicit in comparisons of unadjusted cesarean rates for hospitals and providers is the assumption that differences result from management practices rather than differences in case mix. This study proposes a method for comparison of cesarean rates that takes the effect of case mix into account. All women delivered of infants at our institution from December 1, 1994, through July 31, 1995, were classified according to whether they received care from community-based practitioners (N=3913) or from the hospital-based practice that serves a higher-risk population (N=1556). Women were categorized according to both obstetric history (nulliparas, multiparas without a previous cesarean, multiparas with a previous cesarean) and the presence of obstetric conditions influencing the risk of cesarean delivery (multiple birth, breech presentation or transverse lie, preterm, no trial of labor for a medical indication). We determined the percent of women in each parity-obstetric condition subgroup and calculated a standardized cesarean rate for the hospital-based practice using the case mix of the community-based practitioners as the standard. The crude cesarean rate was higher for the hospital-based practice (24.4%) than for the community-based practitioners (21.5%), a rate difference of 2.9% (95% confidence interval=0.4%, 5.4%; P=.02). However, the proportion of women falling into categories conferring a high risk of cesarean delivery (multiple pregnancy, breech presentation or transverse lie, preterm, no trial of labor permitted) was twice as high for the hospital-based practice (24.4% hospital, 12.1% community). The standardization indicates that if the hospital-based practitioners had the same case mix as community-based practitioners, their overall cesarean rate would be 20.1%, similar to the 21.5% rate of community providers (rate difference=-1.4%, 95% confidence interval =-3.1%, 0.3%; P=.11). Standardization for case mix provides a mechanism for distinguishing differences

  7. Mixing properties of quantum systems

    International Nuclear Information System (INIS)

    Narnhofer, H.; Thirring, W.

    1988-01-01

    We generalize the classical notion of topological mixing for automorphisms of C * -algebras in two ways. We show that for Galilean invariant Fermi systems the weaker form of mixing is satisfied. With some additional requirement on the range of the interaction we can also demonstrate the stronger mixing property. (Author)

  8. Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China.

    Science.gov (United States)

    Zhao, Ling; Zhang, Fu-wen; Li, Ying; Wu, Xi; Zheng, Hui; Cheng, Lin-hao; Liang, Fan-rong

    2011-03-24

    In order to evaluate the safety of acupuncture in China objectively, we investigated the adverse events associated with acupuncture based on three multicentre randomized controlled trials (RCTs) to assess the safety of acupuncture, identifying the common types of acupuncture adverse events, and analysing the related risk factors for their occurrence. This observational study included patients who received acupuncture from three multicentre RCTs respectively for migraine, functional dyspepsia and Bell's palsy. The 1968 patients and their acupuncturists documented adverse events associated with acupuncture after treatment. We collected data about adverse events due to acupuncture treatment from their case report forms. We analysed the incidence and details of the adverse effects, and studied the risk factors for acupuncture adverse events with non-conditional logistic regression analysis. Among the 1968 patients, 74 patients (3.76%) suffered at least one adverse event throughout the treatment period. We did not observe the occurrence of serious adverse events. 73 patients with adverse events recovered within 2 weeks through effective treatment such as physiotherapy or self-treatment. A total of 3 patients withdrew because of adverse events. There were 9 types of adverse events related to acupuncture, including subcutaneous haematoma, bleeding, skin bruising and needle site pain. Subcutaneous haematoma and haemorrhage in the needling points were the most common adverse events. Age and gender were related to the occurrence of acupuncture adverse events. The older the patients were, the higher the risk of adverse events was. In addition, male patients had slightly higher risk of an adverse event than female patients. Acupuncture is a safe therapy with low risk of adverse events in clinical practice. The risk factors for adverse events (AEs) were related to the patients' gender and age and the local anatomical structure of the acupoints. AEs could be reduced and

  9. Interhospital differences and case-mix in a nationwide prevalence survey.

    Science.gov (United States)

    Kanerva, M; Ollgren, J; Lyytikäinen, O

    2010-10-01

    A prevalence survey is a time-saving and useful tool for obtaining an overview of healthcare-associated infection (HCAI) either in a single hospital or nationally. Direct comparison of prevalence rates is difficult. We evaluated the impact of case-mix adjustment on hospital-specific prevalences. All five tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals took part in the first national prevalence survey in Finland in 2005. US Centers for Disease Control and Prevention criteria served to define HCAI. The information collected included demographic characteristics, severity of the underlying disease, use of catheters and a respirator, and previous surgery. Patients with HCAI related to another hospital were excluded. Case-mix-adjusted HCAI prevalences were calculated by using a multivariate logistic regression model for HCAI risk and an indirect standardisation method. Altogether, 587 (7.2%) of 8118 adult patients had at least one infection; hospital-specific prevalences ranged between 1.9% and 12.6%. Risk factors for HCAI that were previously known or identified by univariate analysis (age, male gender, intensive care, high Charlson comorbidity and McCabe indices, respirator, central venous or urinary catheters, and surgery during stay) were included in the multivariate analysis for standardisation. Case-mix-adjusted prevalences varied between 2.6% and 17.0%, and ranked the hospitals differently from the observed rates. In 11 (38%) hospitals, the observed prevalence rank was lower than predicted by the case-mix-adjusted figure. Case-mix should be taken into consideration in the interhospital comparison of prevalence rates. Copyright 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Medical biomodelling in surgical applications: results of a multicentric European validation of 466 cases.

    Science.gov (United States)

    Wulf, J; Vitt, K D; Erben, C M; Bill, J S; Busch, L C

    2003-01-01

    The study started in September 1999 and ended in April 2002. It is based on a questionnaire [www.phidias.org] assessing case-related questions due to the application of stereolithographic models. Each questionnaire contains over 50 items. These variables take into account diagnosis, indications and benefits of stereolithographic models with view on different steps of the surgical procedures: preoperative planning, intraoperative application and overall outcome after surgical intervervention. These questionnaires were completed by the surgeons who performed operation. Over the time course of our multicentric study (30 months), we evaluated 466 cases. The study population consists of n=231 male and n= 235 female patients. 54 surgeons from 9 European countries were involved. There are main groups of diagnosis that related to the use of a model. Most models were used in maxillofacial surgery. The operative planning may help to determine the resection line of tumor and optimize reconstructive procedures. Correction of large calvarian defects can be simulated and implants can be produced preoperatively. Overall in 58 % of all cases a time- saving effect was reported. The study strongly suggests, that medical modeling has utility in surgical specialities, especially in the craniofacial and maxillofacial area, however increasingly in the orthopedic field. Due to our results, medical modeling optimizes the preoperative surgical planning. Surgeons are enabeled to perform realistic and interactive simulations. The fabrication of implants, its design and fit on the model, allow to reduce operation time and in consequence risk and cost of operation. In addition, the understanging of volumetric data is improved, especially if medical models are combined with standart imaging modalities. Finally, surgeons are able to improve communication between their patientents and colleagues.

  11. Case Mix Complexity Differences between Teaching and Nonteaching Hospitals.

    Science.gov (United States)

    Ament, Richard P.; And Others

    1981-01-01

    The differences between teaching and nonteaching hospitals in complexity and variety of cases seen are described. The results show that teaching hospitals could be expected to cost somewhat more per patient even if case mix were the only factor. (Author/MLW)

  12. Mixed periapical lesion: differential diagnosis of a case.

    Science.gov (United States)

    Krithika, C; Kota, S; Gopal, K S; Koteeswaran, D

    2011-03-01

    A radicular cyst associated with carious teeth is a very common odontogenic lesion in the oral cavity, but calcifications in residual radicular cysts are quite rare. We report one such case where a routine pre-implant radiographic assessment revealed a mixed periapical radiopaque radiolucent lesion in the right maxillary central incisor region. Histological and radiographic studies show that there is a slow increase in the mineralized deposits within the cyst lumen with time. This becomes prominent histochemically in cysts more than 8 years old and radiographically 6 years later, as seen in our case. In this paper we would like to highlight the importance of a residual radicular cyst with calcifications in the differential diagnosis of a mixed periapical radiopaque radiolucent lesion.

  13. Application of case mix index in the allocation of nursing human resources.

    Science.gov (United States)

    Han, Binru; Chen, Xi; Li, Qiuping

    2018-02-23

    To investigate the feasibility of the case mix index and compare the allocation of nursing human resources between two departments of a hospital with different case mix indexes in China. The case mix index is used to assess the resource allocation of all cases in two departments of a hospital. Its values can determine the resource allocation required to diagnose and treat the patients. Clinical data were obtained from 23 different departments in 2015 and analysed retrospectively from October to November, 2016. Factors influencing the allocation of registered nurses were identified, and balanced quantities of patients with different case mix indexes were chosen from two departments. Spearman correlation analysis was performed. The per capita nursing workload was significant (r = .669, p = .000). The length of hospital stay, quantity of nurses, and department case mix index were correlated with the nursing workload (t = 4.211, p = .000; t = 2.962, p = .008; t = 2.266, p = .035). Education levels (Z = -1.391, p = .164) and the professional titles (Z = -1.832, p = .067) of the nurses were not statistically significant, whereas the registered nurse level differed between two departments (Z = -2.125, p = .034). The case management index provides references for the efficient allocation of registered nurses in clinical practice. © 2018 John Wiley & Sons Ltd.

  14. Gastric pyloric gland adenoma: a multicentre clinicopathological study of 67 cases.

    Science.gov (United States)

    Choi, Won-Tak; Brown, Ian; Ushiku, Tetsuo; Yozu, Masato; Setia, Namrata; Srivastava, Amitabh; Johncilla, Melanie; Pai, Rish K; Gill, Ryan M; Fukayama, Masashi; Misdraji, Joseph; Lauwers, Gregory Y

    2018-05-01

    There is limited information regarding the clinicopathological and immunohistochemical characteristics of gastric pyloric gland adenomas (PGAs). Sixty-seven cases of gastric PGA from 57 patients were analysed. PGAs occurred with similar frequency in men and women (47.4 and 52.6%, respectively), with a mean age of 66 years. Most presented in the gastric body/fundus (67.2%). Fifteen cases (22.4%) developed against a background of autoimmune gastritis (AIG), whereas normal mucosa was seen in 35.8%. Only 16.4% (11 cases) developed in patients with a genetic predisposition, most commonly familial adenomatous polyposis. Low-grade lesions had a mean size of 1.5 cm, while PGAs with high-grade dysplasia (HGD) or adenocarcinoma had a mean size of 3.5 cm (P < 0.001) and more commonly showed tubulovillous architecture (50.0 versus 25.6% in low-grade dysplasia; P = 0.040). Most PGAs (61.2%) co-expressed mucin (MUC)5AC and MUC6 (mixed type), which was associated significantly with HGD or adenocarcinoma (P = 0.013). AIG was also associated with HGD (P = 0.027), but genetic predisposition did not correlate with the grade of dysplasia (P = 0.793). The recurrence rate of PGA was similar for high- (11.8%) and low-grade lesions (7.4%) (P = 0.624). The risk of HGD increases with the size of PGA, tubulovillous architecture and the presence of AIG as well as mixed immunophenotype. As the overall local recurrence rate is less than 10%, PGAs may be treated conservatively, but they should be excised completely if possible, particularly if they are large or show high-grade features. © 2017 John Wiley & Sons Ltd.

  15. Paediatric case mix in a rural clinical school is relevant to future practice.

    Science.gov (United States)

    Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

    2017-11-29

    Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences

  16. System of breast cancer recognition

    International Nuclear Information System (INIS)

    Rozhkova, N.I.

    1984-01-01

    The paper is concerned with the resUlts of the multimodality system of breast cancer recognition using methods, of clinical X-ray and cytological examinations. Altogether 1671 women were examined; breast cancer was detected in 165. Stage 1 was detected in 63 patients, Stage 2 in 34, Stage 3 in 34, and Stage 4 in 8. In 7% of the cases, tumors were inpalpable and could be detected by X-ray only. In 9.9% of the cases, the multicentric nature of tumor growth was established. In 71% tumors had a mixed histological structure. The system of breast cancer recognition provided for accurate diagnosis in 98% of the cases making it possible to avoid surgical intervention in 38%. Good diagnostic results are possible under conditions of a special mammology unit where a roentgenologist working in a close contact with surgeonns working in a close contact with surgeos and morphologists, performs the first stages of diagnosis beginning from clinical examination up to special methods that require X-ray control (paracentesis, ductography, pneumocystography, preoperative marking of the breast and marking of the remote sectors of the breast)

  17. Mixed-space formalism for the dielectric response in periodic systems

    International Nuclear Information System (INIS)

    Blase, X.; Rubio, A.; Louie, S.G.; Cohen, M.L.

    1995-01-01

    We present a useful formalism for the calculation of the polarizability and dielectric response of periodic systems. Our approach is to introduce intermediate ''mixed-space'' functions with the full translational periodicity of the lattice. This is a considerable advantage over existing real-space methods since the decay length of a response function [such as ε(r,r'|ω)] can be significantly larger than the Wigner-Seitz cell radius. Further, we show that, in supercell calculations, these mixed-space functions decay as fast as the corresponding real-space quantities within one supercell, so that the present scheme can be combined with usual real-space cutoff techniques. The advantage of the present method compared to a standard reciprocal space approach is exemplified for the case of bulk silicon and for the case of a Si surface in a slab geometry

  18. Using case-mix information in strategic hospital marketing. Deriving market research from patient data.

    Science.gov (United States)

    Little, A

    1992-01-01

    Hospital survival requires adaptation, adaptation requires understanding, and understanding requires information. These are the basic equations behind hospital strategic marketing, and one of the answers may lie in hospitals' own patient-data systems. Marketers' and administrators' enlightened application of case-mix information could become one more hospital survival tool.

  19. A multidimensional approach to case mix for home health services

    Science.gov (United States)

    Manton, Kenneth G.; Hausner, Tony

    1987-01-01

    Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services. PMID:10312187

  20. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    Science.gov (United States)

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

  1. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  2. Medicare home health care patient case-mix before and after the Balanced Budget Act of 1997: effect on dual eligible beneficiaries.

    Science.gov (United States)

    Shih, Huai-Che; Temkin-Greener, Helena; Votava, Kathryn; Friedman, Bruce

    2014-01-01

    The Balanced Budget Act (BBA) of 1997 changed the payment system for Medicare home health care (HHC) from cost-based to prospective reimbursement. We used Medical Expenditure Panel Survey data to assess the impact of the BBA on Medicare HHC patient case-mix measured by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) model. There was a significant increase in Medicare HHC patient case-mix between the pre-BBA and Prospective Payment System (PPS) periods. The increase in the standardized-predicted risk score from the Interim Payment System period to PPS was nearly 4 times greater for the dual eligibles (Medicare-Medicaid) than for the Medicare-only population. This significantly greater rise in the HHC resources required by dual eligibles as compared to nonduals could be due to a shift in HHC payers from Medicare only to Medicaid rather than be an actual increase in case-mix per se.

  3. Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

    Science.gov (United States)

    Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

    2010-12-01

    Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

  4. A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value

    DEFF Research Database (Denmark)

    Jacobsen, S; Petersen, J; Ullman, S

    1998-01-01

    influence on survival related to mortality caused by infections. Diffuse central nervous system disease and myocarditis were related to increased SLE-related mortality, whereas photosensitivity predicted a decreased mortality. Non-fatal infections and thrombotic events predicted a decreased overall survival......In this Danish multicentre study, predictive clinical factors of mortality and survival were calculated for 513 patients with systemic lupus erythematosus (SLE), 122 of whom died within a mean observation period of 8.2 years equalling a mortality rate of 2.9% per year. Survival rates were 97%, 91...

  5. Advanced Off-Gas Control System Design For Radioactive And Mixed Waste Treatment

    International Nuclear Information System (INIS)

    Nick Soelberg

    2005-01-01

    Treatment of radioactive and mixed wastes is often required to destroy or immobilize hazardous constituents, reduce waste volume, and convert the waste to a form suitable for final disposal. These kinds of treatments usually evolve off-gas. Air emission regulations have become increasingly stringent in recent years. Mixed waste thermal treatment in the United States is now generally regulated under the Hazardous Waste Combustor (HWC) Maximum Achievable Control Technology (MACT) standards. These standards impose unprecedented requirements for operation, monitoring and control, and emissions control. Off-gas control technologies and system designs that were satisfactorily proven in mixed waste operation prior to the implementation of new regulatory standards are in some cases no longer suitable in new mixed waste treatment system designs. Some mixed waste treatment facilities have been shut down rather than have excessively restrictive feed rate limits or facility upgrades to comply with the new standards. New mixed waste treatment facilities in the U. S. are being designed to operate in compliance with the HWC MACT standards. Activities have been underway for the past 10 years at the INL and elsewhere to identify, develop, demonstrate, and design technologies for enabling HWC MACT compliance for mixed waste treatment facilities. Some specific off-gas control technologies and system designs have been identified and tested to show that even the stringent HWC MACT standards can be met, while minimizing treatment facility size and cost

  6. Immuno-related polymorphisms and cervical cancer risk: The IARC multicentric case-control study.

    Directory of Open Access Journals (Sweden)

    James McKay

    Full Text Available A small proportion of women who are exposed to infection with human-papillomavirus (HPV develop cervical cancer (CC. Genetic factors may affect the risk of progression from HPV infection to cervical precancer and cancer. We used samples from the International Agency for Research on Cancer (IARC multicentric case-control study to evaluate the association of selected genetic variants with CC. Overall, 790 CC cases and 717 controls from Algeria, Morocco, India and Thailand were included. Cervical exfoliated cells were obtained from control women and cervical exfoliated cells or biopsy specimens from cases. HPV-positivity was determined using a general primer GP5+/6+ mediated PCR. Unconditional logistic regression was used to estimate odds ratios (OR and corresponding 95% confidence intervals (CI of host genotypes with CC risk, using the homozygous wild type genotype as the referent category and adjusting by age and study centre. The association of polymorphisms with the risk of high-risk HPV-positivity among controls was also evaluated. A statistically significant association was observed between single nucleotide polymorphism (SNP CHR6 rs2844511 and CC risk: the OR for carriers of the GA or GG genotypes was 0.70 (95% CI: 0.43-1.14 and 0.61 (95% CI: 0.38-0.98, respectively, relative to carriers of AA genotype (p-value for trend 0.03. We also observed associations of borderline significance with the TIPARP rs2665390 polymorphism, which was previously found to be associated with ovarian and breast cancer, and with the EXOC1 rs13117307 polymorphism, which has been linked to cervical cancer in a large study in a Chinese population. We confirmed the association between CC and the rs2844511 polymorphism previously identified in a GWAS study in a Swedish population. The major histocompatibility region of chromosome 6, or perhaps other SNPs in linkage disequilibrium, may be involved in CC onset.

  7. Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis.

    Directory of Open Access Journals (Sweden)

    Andrea Párniczky

    Full Text Available The aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP.Eighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group.600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013.With respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality.Analysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP.

  8. Erysipelas of the leg (cellulitis in sub-Saharan Africa: A multicentric study of 562 cases

    Directory of Open Access Journals (Sweden)

    Bayaki Saka

    2017-01-01

    Full Text Available Introduction: Erysipelas of the leg is a common and serious infection. We carried out this study aiming at describing the epidemiological and clinical characteristics, and assessing the risks factors associated with the local complications of erysipelas of the leg in sub-Saharan Africa. Methods: This was a prospective multicentric study carried out in the dermatology units of Hospitals located in seven sub-Saharan African countries during a period of 12 months. Patients aged 15 and above with a first episode of erysipelas of the leg were recruited. Results: In this study, 562 patients were recruited, having a mean age of 43.7±16.9 years and a sex-ratio (M/F of 0.67. Patients infected on one leg were 562 while those infected with two were 27. Bullous forms of the disease were observed in 95 patients, while purpuric forms were observed in 167 patients. The existence of a point of entry (485 cases, obesity (230, lymph edema (130 and the use of bleaching agents (97 were the mains risk factors. Complications during the course of the infection such as necrotizing fasciitis (34 cases and abscesses (63 cases were observed. They were due to the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm. Conclusion: This study reveals that existence of a point of entry, obesity and lymph edema, and the use of bleaching agents were the mains risk factors influencing the local complications of erysipelas of the leg. Necrotizing fasciitis and abscesses were influenced by the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm.

  9. Imaging features of multicentric Castleman's disease in HIV infection

    International Nuclear Information System (INIS)

    Hillier, J.C.; Shaw, P.; Miller, R.F.; Cartledge, J.D.; Nelson, M.; Bower, M.; Francis, N.; Padley, S.P.

    2004-01-01

    AIM: To describe the computed tomography (CT) features of human immunodeficiency virus (HIV)-associated Castleman's disease. MATERIALS AND METHODS: Nine HIV-positive patients with biopsy-proven Castleman's disease were studied. Clinical and demographic data, CD4 count, histological diagnosis and human herpes type 8 (HHV8) serology or immunostaining results were recorded. CT images were reviewed independently by two radiologists. RESULTS: CT findings included splenomegaly (n=7) and peripheral lymph node enlargement (axillary n=8, inguinal n=4). All nodes displayed mild to avid enhancement after intravenous administration of contrast material. Hepatomegaly was evident in seven patients. Other features included abdominal (n=6) and mediastinal (n=5) lymph node enlargement and pulmonary abnormalities (n=4). Patterns of parenchymal abnormality included bronchovascular nodularity (n=2), consolidation (n=1) and pleural effusion (n=2). On histological examination eight patients (spleen n=3, lymph node n=9, lung n=1 bone marrow n=1) had the plasma cell variant and one had mixed hyaline-vascular/plasma cell variant. The majority had either positive immunostaining for HHV8 or positive serology (n=8). CONCLUSION: Common imaging features of multicentric Castleman's disease in HIV infection are hepatosplenomegaly and peripheral lymph node enlargement. Although these imaging features may suggest the diagnosis in the appropriate clinical context, they lack specificity and so biopsy is needed for diagnosis. In distinction from multicentric Castleman's disease in other populations the plasma cell variant is most commonly encountered, splenomegaly is a universal feature and there is a strong association with Kaposi's sarcoma

  10. Single-Case Designs and Qualitative Methods: Applying a Mixed Methods Research Perspective

    Science.gov (United States)

    Hitchcock, John H.; Nastasi, Bonnie K.; Summerville, Meredith

    2010-01-01

    The purpose of this conceptual paper is to describe a design that mixes single-case (sometimes referred to as single-subject) and qualitative methods, hereafter referred to as a single-case mixed methods design (SCD-MM). Minimal attention has been given to the topic of applying qualitative methods to SCD work in the literature. These two…

  11. Gas-mixing system for drift chambers using solenoid valves

    International Nuclear Information System (INIS)

    Cooper, W.E.; Sugano, K.; Trentlage, D.B.

    1983-04-01

    We describe an inexpensive system for mixing argon and ethane drift chamber gas which is used for the E-605 experiment at Fermilab. This system is based on the idea of intermittent mixing of gases with fixed mixing flow rates. A dual-action pressure switch senses the pressure in a mixed gas reservoir tank and operates solenoid valves to control mixing action and regulate reservoir pressure. This system has the advantages that simple controls accurately regulate the mixing ratio and that the mixing ratio is nearly flow rate independent. We also report the results of the gas analysis of various samplings, and the reliability of the system in long-term running

  12. Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.

    Science.gov (United States)

    Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

    2014-03-01

    Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

  13. The operating room case-mix problem under uncertainty and nurses capacity constraints.

    Science.gov (United States)

    Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

    2016-12-01

    Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

  14. Variation in fistula use across dialysis facilities: is it explained by case-mix?

    Science.gov (United States)

    Tangri, Navdeep; Moorthi, Ranjani; Tighiouhart, Hocine; Meyer, Klemens B; Miskulin, Dana C

    2010-02-01

    Arteriovenous fistulas (AVFs) remain the preferred vascular access for hemodialysis patients. Dialysis facilities that fail to meet Centers for Medicare & Medicaid Services goals cite patient case-mix as a reason for low AVF prevalence. This study aimed to determine the magnitude of the variability in AVF usage across dialysis facilities and the extent to which patient case-mix explains it. The vascular access used in 10,112 patients dialyzed at 173 Dialysis Clinic Inc. facilities from October 1 to December 31, 2004, was evaluated. The access in use was considered to be an AVF if it was used for >70% of hemodialysis treatments. Mixed-effects models with a random intercept for dialysis facilities evaluated the effect of facilities on AVF usage. Sequentially adjusted multivariate models measured the extent to which patient factors (case-mix) explain variation across facilities in AVF rates. 3787 patients (38%) were dialyzed using AVFs. There was a significant facility effect: 7.6% of variation in AVF use was attributable to facility. This was reduced to 7.1% after case-mix adjustment. There were no identified specific facility-level factors that explained the interfacility variation. AVF usage varies across dialysis facilities, and patient case-mix did not reduce this variation. In this study, 92% of the total variation in AVF usage was due to patient factors, but most were not measurable. A combination of patient factors and process indicators should be considered in adjudicating facility performance for this quality indicator.

  15. Case study application of the IAEA safeguards assessment methodology to a mixed oxide fuel fabrication facility

    International Nuclear Information System (INIS)

    Swartz, J.; McDaniel, T.

    1981-01-01

    Science Applications, Inc. has prepared a case study illustrating the application of an assessment methodology to an international system for safeguarding mixed oxide (MOX) fuel fabrication facilities. This study is the second in a series of case studies which support an effort by the International Atomic Energy Agency (IAEA) and an international Consultant Group to develop a methodology for assessing the effectiveness of IAEA safeguards. 3 refs

  16. Groundwater flow processes and mixing in active volcanic systems: the case of Guadalajara (Mexico)

    Science.gov (United States)

    Hernández-Antonio, A.; Mahlknecht, J.; Tamez-Meléndez, C.; Ramos-Leal, J.; Ramírez-Orozco, A.; Parra, R.; Ornelas-Soto, N.; Eastoe, C. J.

    2015-09-01

    Groundwater chemistry and isotopic data from 40 production wells in the Atemajac and Toluquilla valleys, located in and around the Guadalajara metropolitan area, were determined to develop a conceptual model of groundwater flow processes and mixing. Stable water isotopes (δ2H, δ18O) were used to trace hydrological processes and tritium (3H) to evaluate the relative contribution of modern water in samples. Multivariate analysis including cluster analysis and principal component analysis were used to elucidate distribution patterns of constituents and factors controlling groundwater chemistry. Based on this analysis, groundwater was classified into four groups: cold groundwater, hydrothermal groundwater, polluted groundwater and mixed groundwater. Cold groundwater is characterized by low temperature, salinity, and Cl and Na concentrations and is predominantly of Na-HCO3-type. It originates as recharge at "La Primavera" caldera and is found predominantly in wells in the upper Atemajac Valley. Hydrothermal groundwater is characterized by high salinity, temperature, Cl, Na and HCO3, and the presence of minor elements such as Li, Mn and F. It is a mixed-HCO3 type found in wells from Toluquilla Valley and represents regional flow circulation through basaltic and andesitic rocks. Polluted groundwater is characterized by elevated nitrate and sulfate concentrations and is usually derived from urban water cycling and subordinately from agricultural return flow. Mixed groundwaters between cold and hydrothermal components are predominantly found in the lower Atemajac Valley. Twenty-seven groundwater samples contain at least a small fraction of modern water. The application of a multivariate mixing model allowed the mixing proportions of hydrothermal fluids, polluted waters and cold groundwater in sampled water to be evaluated. This study will help local water authorities to identify and dimension groundwater contamination, and act accordingly. It may be broadly applicable to

  17. Transportable Vitrification System Demonstration on Mixed Waste

    International Nuclear Information System (INIS)

    Zamecnik, J.R.; Whitehouse, J.C.; Wilson, C.N.; Van Ryn, F.R.

    1998-01-01

    This paper describes preliminary results from the first demonstration of the Transportable Vitrification System (TVS) on actual mixed waste. The TVS is a fully integrated, transportable system for the treatment of mixed and low-level radioactive wastes. The demonstration was conducted at Oak Ridge's East Tennessee Technology Park (ETTP), formerly known as the K-25 site. The purpose of the demonstration was to show that mixed wastes could be vitrified safely on a 'field' scale using joule-heated melter technology and obtain information on system performance, waste form durability, air emissions, and costs

  18. Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Julie M.; Vavere, Andrea L.; Arbab-Zadeh, Armin; Bush, David E.; Lardo, Albert C.; Texter, John; Brinker, Jeffery; Lima, Joao A.C. [Johns Hopkins Hospital, Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD (United States); Dewey, Marc [Charite - Universitaetsmedizin Berlin, Medical School, Humboldt-Universitaet und Freie Universitaet zu Berlin, Department of Radiology, Berlin, PO Box 10098 (Germany); Rochitte, Carlos E.; Lemos, Pedro A. [University of Sao Paulo Medical School, Heart Institute (InCor), Sao Paulo (Brazil); Niinuma, Hiroyuki [Iwate Medical University, Department of Cardiology, Morioka (Japan); Paul, Narinder [Toronto General Hospital, Department of Medical Imaging, Toronto (Canada); Hoe, John [Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, Singapore (Singapore); Roos, Albert de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Yoshioka, Kunihiro [Iwate Medical University, Department of Radiology, Morioka (Japan); Cox, Christopher [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Clouse, Melvin E. [Harvard University, Department of Radiology, Beth Israel Deaconess, Boston, MA (United States)

    2009-04-15

    Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ''CORE-64'' trial (''Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors''). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows. (orig.)

  19. Cancer patient experience, hospital performance and case mix: evidence from England.

    Science.gov (United States)

    Abel, Gary A; Saunders, Catherine L; Lyratzopoulos, Georgios

    2014-01-01

      This study aims to explore differences between crude and case mix-adjusted estimates of hospital performance with respect to the experience of cancer patients. This study analyzed the English 2011/2012 Cancer Patient Experience Survey covering all English National Health Service hospitals providing cancer treatment (n = 160). Logistic regression analysis was used to predict hospital performance for each of the 64 evaluative questions, adjusting for age, gender, ethnic group and cancer diagnosis. The degree of reclassification was explored across three categories (bottom 20%, middle 60% and top 20% of hospitals). There was high concordance between crude and adjusted ranks of hospitals (median Kendall's τ = 0.84; interquartile range: 0.82-0.88). Across all questions, a median of 5.0% (eight) of hospitals (interquartile range: 3.8-6.4%; six to ten hospitals) moved out of the extreme performance categories after case mix adjustment. In this context, patient case mix has only a small impact on measured hospital performance for cancer patient experience.

  20. Multicentric osteoid osteoma with a nidus located in the epiphysis

    International Nuclear Information System (INIS)

    Tamam, Cueneyt; Yildirim, Duezguen; Tamam, Muge

    2009-01-01

    We present a 13-year-old girl who was referred to our clinic with a 5-month history of right leg pain relieved by salicylates. Initial CT examination demonstrated a lesion in the posterior tibial cortex in keeping with an osteoid osteoma. This was resected and the diagnosis confirmed by histology. However, her pain recurred 2 weeks after the operation and further imaging identified a further nidus in the epiphysis. We present the imaging findings in this unique case of multicentric osteoid osteoma with one nidus located in the epiphysis. (orig.)

  1. Mixed Reality Cultural Heritage Communication - The Zea Case

    DEFF Research Database (Denmark)

    Veirum, Niels Einar; Christensen, Mogens Fiil; Mayerhofer, Mikkel

    Case is a design scenario for the Museum of the Future showing how Cultural Heritage institutions can use a Glocal Approach to technology and architecture to reinvent the relation to the visitor and the neighbourhood. While Mixed Reality can be used for Cultural Heritage Communication in traditional...

  2. Small angle scattering from soft matter-application to complex mixed systems; Diffusion de neutrons aux petits angles par la matiere molle-application aux systemes mixtes

    Energy Technology Data Exchange (ETDEWEB)

    Boue, F.; Cousin, F.; Gummel, J.; Carrot, G.; El Harrak, A. [CEA Saclay, Lab. Leon Brillouin, CNRS, 91 - Gif-sur-Yvette (France); Oberdisse, J. [Montpellier-2 Univ., Lab. des Colloides, Verres et Nanomateriaux, UMR 5587, 34 (France)

    2007-09-15

    The advantage of small angle neutron scattering associated with isotopic labelling through deuteration is illustrated in the case of mixed systems, created by associating already well-known systems of characteristic structures; this is also important for applications. Our first mixed system associates charged polymer chains, polyelectrolyte (here polystyrene sulfonate, PSS), with oppositely charged particles, proteins (here lysozyme). Different fractions of deuterated water (D{sub 2}O) mixed with normal water are used to match the scattering length density of the protein or of the polymer in non-deuterated or deuterated version. First, this allows us to separate the protein and the polymer signal: we can then distinguish a case where the structures of each species alone in water are hardly modified by mixing, except for interconnections yielding a gel, and a case inducing complete change into a structure common to both species, made of aggregated globules. Secondly, using, for counter-ions of the poly-ions, deuterated Tetramethylammonium, together with matching both protein and polymer, we establish unambiguously the counter-ion release into the solvent. Thirdly, matching only a fraction of polymer chains, the other being deuterated, we extrapolate at zero deuterated fraction their form factor and describe the chain conformation inside the complexes. Fourthly, we illustrate the possibilities of modelling the signal on a second example of mixed system: a nano-composite made of silica particles surrounded by polymer dispersed into a deuterated polymer matrix. Chains are then visible in such reinforced polymer system, in particular when it is submitted to elongation: we discuss a possible model for an ideal system, introducing the scattering contribution from deformed chains. (authors)

  3. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

    Science.gov (United States)

    Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

    2008-05-01

    To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

  4. Meeting the challenges of recruitment to multicentre, community-based, lifestyle-change trials: a case study of the BeWEL trial.

    Science.gov (United States)

    Treweek, Shaun; Wilkie, Erna; Craigie, Angela M; Caswell, Stephen; Thompson, Joyce; Steele, Robert J C; Stead, Martine; Anderson, Annie S

    2013-12-18

    Recruiting participants to multicentre, community-based trials is a challenge. This case study describes how this challenge was met for the BeWEL trial, which evaluated the impact of a diet and physical activity intervention on body weight in people who had had pre-cancerous bowel polyps. The BeWEL trial was a community-based trial, involving centres linked to the Scottish National Health Service (NHS) colorectal cancer screening programme. BeWEL had a recruitment target of 316 and its primary recruitment route was the colonoscopy clinics of the Scottish Bowel Screening Programme. BeWEL exceeded its recruitment target but needed a 6-month no-cost extension from the funder to achieve this. The major causes of delay were lower consent rates (49% as opposed to 70% estimated from earlier work), the time taken for NHS research and development department approvals and the inclusion of two additional sites to increase recruitment, for which there were substantial bureaucratic delays. A range of specific interventions to increase recruitment, for example, telephone reminders and a shorter participant information leaflet, helped to increase the proportion of eligible individuals consenting and being randomized. Recruitment to multicentre trials is a challenge but can be successfully achieved with a committed team. In a UK context, NHS research and development approval can be a substantial source of delay. Investigators should be cautious when estimating consent rates. If consent rates are less than expected, qualitative analysis might be beneficial, to try and identify the reason. Finally, investigators should select trial sites on the basis of a formal assessment of a site's past performance and the likelihood of success in the trial being planned. Current Controlled Trials ISRCTN53033856.

  5. Application of Cascade Refrigeration System with Mixing Refrigerant in Cold Air Cutting

    Science.gov (United States)

    Yang, Y.; Tong, M. W.; Yang, G.; Wang, X. P.

    In the mechanical cutting process, the replacement of traditional cutting solution with cold air can avoid the pollution of environment. In order to high efficient the refrigerating device and flexible adjust the temperature of cold air, it is necessary to use cascade refrigeration system to supply cool quantity for the compressed air. The introduction of a two-component non-azeotropic mixing refrigerant into the cryogenic part of the cascade system, can effectively solve the problems of the system working at too high pressure and the volume expanding of refrigerant in case of the cascade refrigeration sets closed down. However, the filling ratio of mixing refrigerants impact on the relationships among the closing down pressure, refrigerating output and refrigerating efficiency. On the basis of computing and experiment, the optimal mixing ratio of refrigerant R22/R13 and a low temperature of -60° were obtained in this study. A cold air injecting device possessing high efficiency in energy saving has also been designed and manufactured. The cold air, generated from this cascade system and employed in a cutting process, takes good comprehensive effects on machining and cutting.

  6. Risk and protective factors for falls on one level in young children: multicentre case-control study.

    Science.gov (United States)

    Benford, P; Young, B; Coupland, C; Watson, M; Hindmarch, P; Hayes, M; Goodenough, T; Majsak-Newman, G; Kendrick, D

    2015-12-01

    Childhood falls are an important global public health problem, but there is lack of evidence about their prevention. Falls on one level result in considerable morbidity and they are costly to health services. To estimate ORs for falls on one level in children aged 0-4 years for a range of safety behaviours, safety equipment use and home hazards. Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Participants included 582 children less than 5 years of age with a medically attended fall injury occurring at home and 2460 controls matched on age, sex, calendar time and study centre. Fall on one level. Cases' most common injuries were bangs on the head (52%), cuts or grazes not needing stitches (29%) or cuts or grazes needing stitches (17%). Comparing cases to community controls in the adjusted analyses, significant findings were observed for only two exposures. Injured children were significantly less likely to live in a household without furniture corner covers (adjusted OR (AOR) 0.72, 95% CI 0.55 to 0.95), or without rugs and carpets firmly fixed to the floor (AOR 0.76, 95% CI 0.59 to 0.98). We did not find any safety practices, use of safety equipment or home hazards associated with a reduced risk of fall on one level. Our findings do not provide evidence to support changes to current injury prevention practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case-control study in the U.K.

    Science.gov (United States)

    Pallawela, S N S; Sullivan, A K; Macdonald, N; French, P; White, J; Dean, G; Smith, A; Winter, A J; Mandalia, S; Alexander, S; Ison, C; Ward, H

    2014-06-01

    Since 2003, over 2000 cases of lymphogranuloma venereum (LGV) have been diagnosed in the U.K. in men who have sex with men (MSM). Most cases present with proctitis, but there are limited data on how to differentiate clinically between LGV and other pathology. We analysed the clinical presentations of rectal LGV in MSM to identify clinical characteristics predictive of LGV proctitis and produced a clinical prediction model. A prospective multicentre case-control study was conducted at six U.K. hospitals from 2008 to 2010. Cases of rectal LGV were compared with controls with rectal symptoms but without LGV. Data from 98 LGV cases and 81 controls were collected from patients and clinicians using computer-assisted self-interviews and clinical report forms. Univariate and multivariate logistic regression was used to compare symptoms and signs. Clinical prediction models for LGV were compared using receiver operating curves. Tenesmus, constipation, anal discharge and weight loss were significantly more common in cases than controls. In multivariate analysis, tenesmus and constipation alone were suggestive of LGV (OR 2.98, 95% CI 0.99 to 8.98 and 2.87, 95% CI 1.01 to 8.15, respectively) and that tenesmus alone or in combination with constipation was a significant predictor of LGV (OR 6.97, 95% CI 2.71 to 17.92). The best clinical prediction was having one or more of tenesmus, constipation and exudate on proctoscopy, with a sensitivity of 77% and specificity of 65%. This study indicates that tenesmus alone or in combination with constipation makes a diagnosis of LGV in MSM presenting with rectal symptoms more likely. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. General practice performance in referral for suspected cancer: influence of number of cases and case-mix on publicly reported data.

    Science.gov (United States)

    Murchie, P; Chowdhury, A; Smith, S; Campbell, N C; Lee, A J; Linden, D; Burton, C D

    2015-05-26

    Publicly available data show variation in GPs' use of urgent suspected cancer (USC) referral pathways. We investigated whether this could be due to small numbers of cancer cases and random case-mix, rather than due to true variation in performance. We analysed individual GP practice USC referral detection rates (proportion of the practice's cancer cases that are detected via USC) and conversion rates (proportion of the practice's USC referrals that prove to be cancer) in routinely collected data from GP practices in all of England (over 4 years) and northeast Scotland (over 7 years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47). Much apparent variation in GPs' use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP-suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used, and more appropriate and robust methods should be developed.

  9. HEMS inter-facility transfer: a case-mix analysis.

    Science.gov (United States)

    Di Rocco, Damien; Pasquier, Mathieu; Albrecht, Eric; Carron, Pierre-Nicolas; Dami, Fabrice

    2018-05-16

    Helicopter emergency medical services (HEMS) are popular rescue systems despite inconsistent evidence in the scientific literature to support their use for primary interventions, as well as for inter-facility transfer (IFT). There is little research about IFT by HEMS, hence questions remain about the appropriateness of this method of transport. The aim of this study was to describe a case-mix of operational and medical characteristics for IFT activity of a sole HEMS base, and identify indicators of over-triage. This is a retrospective study on HEMS IFT over 36 months, from January 1st 2013 to December 31st 2015. Medical and operational data from the database of the Emergency Department of Lausanne University Hospital, which provides the emergency physicians for this helicopter base, were reviewed. It included distance and time of flight transport, type of care during flight, and estimated distance of transport if conducted by ground. There were 2194 HEMS missions including 979 IFT (44.6%). Most transfers involved adults (> 17 years old; 799 patients, 81.6%). Forty patients (4.1%) were classified as having benefitted from resuscitation or life-saving measures performed in flight, 615 (62.8%) from emergency treatment and 324 (33.1%) from simple clinical examination. The median distance by air between hospitals was 35.4 km. The estimated median distance by road was 47.7 km. The median duration time from origin to destination by air was 12 min. This case-mix of IFTs by HEMS presents a high severity. There are many signs in favour of over-triage. We propose indicators to help choosing whether HEMS is the most appropriate mean of transport to perform the transfer regarding patient condition, geography, and medical competences available aboard ground ambulances; this may reduce over-triage.

  10. Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care.

    Science.gov (United States)

    Damman, Olga C; Stubbe, Janine H; Hendriks, Michelle; Arah, Onyebuchi A; Spreeuwenberg, Peter; Delnoij, Diana M J; Groenewegen, Peter P

    2009-04-01

    Ratings on the quality of healthcare from the consumer's perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for analyzing healthcare performance data, it has rarely been used to assess case-mix adjustment of such data. The purpose of this article is to investigate whether multilevel regression analysis is a useful tool to detect case-mix adjusters in consumer assessment of healthcare. We used data on 11,539 consumers from 27 Dutch health plans, which were collected using the Dutch Consumer Quality Index health plan instrument. We conducted multilevel regression analyses of consumers' responses nested within health plans to assess the effects of consumer characteristics on consumer experience. We compared our findings to the results of another methodology: the impact factor approach, which combines the predictive effect of each case-mix variable with its heterogeneity across health plans. Both multilevel regression and impact factor analyses showed that age and education were the most important case-mix adjusters for consumer experience and ratings of health plans. With the exception of age, case-mix adjustment had little impact on the ranking of health plans. On both theoretical and practical grounds, multilevel modeling is useful for adequate case-mix adjustment and analysis of performance ratings.

  11. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    Science.gov (United States)

    Phillips, Charles D.

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

  12. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

    Science.gov (United States)

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

  13. The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    Directory of Open Access Journals (Sweden)

    Charles D. Phillips

    2015-01-01

    Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

  14. Scleroderma renal crisis in a case of mixed connective tissue disease

    Directory of Open Access Journals (Sweden)

    Mukul Vij

    2014-01-01

    Full Text Available Mixed connective tissue disease (MCTD is an overlap syndrome first defined in 1972 by Sharp et al. In this original study, the portrait emerged of a connective tissue disorder sharing features of systemic lupus erythematosus, systemic sclerosis (scleroderma and polymyositis. Scleroderma renal crisis (SRC is an extremely infrequent but serious complication that can occur in MCTD. The histologic picture of SRC is that of a thrombotic micro-angiopathic process. Renal biopsy plays an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in MCTD patients, helping to predict the clinical outcome and optimizing patient management. We herewith report a rare case of SRC in a patient with MCTD and review the relevant literature.

  15. Scleroderma renal crisis in a case of mixed connective tissue disease.

    Science.gov (United States)

    Vij, Mukul; Agrawal, Vinita; Jain, Manoj

    2014-07-01

    Mixed connective tissue disease (MCTD) is an overlap syndrome first defined in 1972 by Sharp et al. In this original study, the portrait emerged of a connective tissue disorder sharing features of systemic lupus erythematosus, systemic sclerosis (scleroderma) and polymyositis. Scleroderma renal crisis (SRC) is an extremely infrequent but serious complication that can occur in MCTD. The histologic picture of SRC is that of a thrombotic micro-angiopathic process. Renal biopsy plays an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in MCTD patients, helping to predict the clinical outcome and optimizing patient management. We herewith report a rare case of SRC in a patient with MCTD and review the relevant literature.

  16. Contribution of case-mix classification to profiling hospital characteristics and productivity.

    Science.gov (United States)

    Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

    2011-01-01

    Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.

  17. MARKETING MIX POLICIES IN FMCG CASE-STUDY: THE ADVERTISING STRATEGY

    OpenAIRE

    ANA MARIA BOBEICA

    2011-01-01

    This paper explores the relationships between selected marketing mix elements in the area of FMCG. It discusses the nature and sometimes negative consequences of the dominating marketing paradigm of today, marketing mix management, and furthermore discusses how modern research into, for example in the case of FMCG Companies, the marketing policies as well as customer relationship tactics shows that another approach to marketing is required. It proposes a conceptual framework in which marketin...

  18. Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

    Science.gov (United States)

    Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

    2011-11-01

    It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

  19. Photoemission studies of mixed valent systems

    International Nuclear Information System (INIS)

    Parks, R.D.; Raaen, S.; denBoer, M.L.; Williams, G.P.

    1984-01-01

    Photoemission spectroscopy has been used to study a number of aspects of the mixed valent state (corresponding to non-integral 4f occupation) in rare earth systems. Deep core photoemission (e.g., from 3d or 4d levels) allows the measurement of the 4f occupancy and surface valence shifts, and, as well, the indirect measurement of the effect of solid state environment on the energy of hybridization between 4f electrons and conduction electrons. 4f-Derived photoemission has been used to study surface valance and chemical shifts and to infer the nature of the mixed valent ground state. A combination of 4f-derived photoemission and add-electron spectroscopy provides a measurement of the rf Coulomb correlation energy, an important parameter in the mixed valent problem. A review of these approaches will be presented, with emphasis on Ce-based systems, whose behavior falls outside the usual description of 4f-unstable systems

  20. A Case Study of a Mixed Methods Study Engaged in Integrated Data Analysis

    Science.gov (United States)

    Schiazza, Daniela Marie

    2013-01-01

    The nascent field of mixed methods research has yet to develop a cohesive framework of guidelines and procedures for mixed methods data analysis (Greene, 2008). To support the field's development of analytical frameworks, this case study reflects on the development and implementation of a mixed methods study engaged in integrated data analysis.…

  1. At-Risk Phenotype of Neurofibromatose-1 Patients: A Multicentre Case-Control Study

    Directory of Open Access Journals (Sweden)

    Ferkal Salah

    2011-07-01

    Full Text Available Abstract Objectives To assess associations between subcutaneous neurofibromas (SC-NFs and internal neurofibromas in patients with neurofibromatosis type 1 (NF-1 and to determine whether the association between SC-NFs and peripheral neuropathy was ascribable to internal neurofibromas. Patients and methods Prospective multicentre case-control study. Between 2005 and 2008, 110 NF-1 adults having two or more SC-NFs were individually matched for age, sex and hospital with 110 controls who had no SC-NF. Patients underwent standardized MRI of the spinal cord, nerve roots and sciatic nerves and an electrophysiological study. Analyses used adjusted multinomial logistic regression (ORa to estimate the risk of the presence of internal neurofibromas or peripheral neuropathies associated with patients presented 2 to 9 SC-NFs, at least 10 SC-NFs as compared to patients without any (referential category. Results Cases had a mean age of 41 (± 13 years; 85 (80% had two to nine SC-NFs and 21 (19% at least ten SC-NFs. SC-NFs were more strongly associated with internal neurofibromas in patients with ten or more SC-NFs than in patients with fewer NF-SCs (e.g., sciatic nerve, aOR = 29.1 [8.5 to 100] vs. 4.3 [2.1 to 9.0]. The association with SC-NFs was stronger for diffuse, intradural, and > 3 cm internal neurofibromas than with other internal neurofibromas. Axonal neuropathy with slowed conduction velocities (SCV was more strongly associated with having at least ten SC-NFs (aOR = 29.9, 5.5 to 162.3 than with having fewer SC-NFs (aOR = 4.4, 0.9 to 22.0. Bivariate analyses showed that the association between axonal neuropathy with SCV and sciatic neurofibromas was mediated by the association between SC-NFs and sciatic neurofibromas. Conclusion The at-risk phenotype of NF-1 patients (i.e. NF-1 patients with SC-NFs is ascribable to associations linking SC-NFs to internal neurofibromas at risk for malignant transformation and to axonal neuropathies with slowed

  2. Scheduling of head-dependent cascaded hydro systems: Mixed-integer quadratic programming approach

    International Nuclear Information System (INIS)

    Catalao, J.P.S.; Pousinho, H.M.I.; Mendes, V.M.F.

    2010-01-01

    This paper is on the problem of short-term hydro scheduling, particularly concerning head-dependent cascaded hydro systems. We propose a novel mixed-integer quadratic programming approach, considering not only head-dependency, but also discontinuous operating regions and discharge ramping constraints. Thus, an enhanced short-term hydro scheduling is provided due to the more realistic modeling presented in this paper. Numerical results from two case studies, based on Portuguese cascaded hydro systems, illustrate the proficiency of the proposed approach.

  3. Wilson loops from multicentre and rotating branes, mass gaps and phase structure in gauge theories

    CERN Document Server

    Brandhuber, A.

    1999-01-01

    Within the AdS/CFT correspondence we use multicentre D3-brane metrics to investigate Wilson loops and compute the associated heavy quark-antiquark potentials for the strongly coupled SU(N) super-Yang-Mills gauge theory, when the gauge symmetry is broken by the expectation values of the scalar fields. For the case of a uniform distribution of D3-branes over a disc, we find that there exists a maximum separation beyond which there is no force between the quark and the antiquark, i.e. the screening is complete. We associate this phenomenon with the possible existence of a mass gap in the strongly coupled gauge theory. In the finite-temperature case, when the corresponding supergravity solution is a rotating D3-brane solution, there is a class of potentials interpolating between a Coulombic and a confining behaviour. However, above a certain critical value of the mass parameter, the potentials exhibit a behaviour characteristic of statistical systems undergoing phase transitions. The physical path preserves the c...

  4. Mixing phases of unstable two-level systems

    International Nuclear Information System (INIS)

    Sokolov, V.V.; Brentano, P. von.

    1993-01-01

    An unstable two-level system decaying into an arbitrary number of channels is considered. It is shown that the mixing phases of the two overlapping resonances can be expressed in the terms of their partial widths and one additional universal mixing parameter. Some applications to a doublet of 2 + resonances in 8 Be and to the ρ-ω systems are considered. 18 refs

  5. 29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Petitions to the EEOC from MSPB decisions on mixed case... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file. Individuals who have received a final decision from the MSPB on a mixed case appeal or on the appeal of a...

  6. Enhancing Health-Care Services with Mixed Reality Systems

    Science.gov (United States)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  7. Case Study of a Small Scale Reverse Osmosis System for Treatment of Mixed Brackish Water and STP Effluent

    Directory of Open Access Journals (Sweden)

    I Nyoman Widiasa

    2017-04-01

    Full Text Available A case study on utilizing reverse osmosis (RO technology to fulfill fresh water needs at a mall and a hotel has been done on Bali Island, Indonesia. A mix of brackish water and sewage treatment plant (STP effluent was used as feed water in the RO system. The system used 36 membrane elements (CSM RE 8040 BLN arranged into two stages: 8 pressure vessels (PVs in the first stage and 4 PVs in the second stage, each loaded with 3 membranes. The objectives of this research were to assess the cleaning effectivity in the plant, to evaluate the cleaning of 1 membrane element using a CIP system, and to assess the use of the membrane for filtration in the pre-treatment system. SEM and FTIR analysis indicated that the foulants on the membrane surface were dominated by organic foulants and inorganic deposits. To clean the discarded membrane the proposed method used NaOH solution (pH 12 and pH 13 and citric acid (pH 2 and pH 3. All membranes displayed a dramatic decline in rejection of about 80%. Based on the rejection tests of SO42-, Cl-, turbidity reduction approached 100%. It can be concluded that an RO membrane that has undergone selectivity decline can be re-used as a filtration membrane in the pre-treatment system.

  8. Shifting brachytherapy monotherapy case mix toward intermediate-risk prostate cancer.

    Science.gov (United States)

    Muralidhar, Vinayak; Mahal, Brandon A; Ziehr, David R; Chen, Yu-Wei; Nezolosky, Michelle D; Viswanathan, Vidya B; Beard, Clair J; Devlin, Phillip M; Martin, Neil E; Orio, Peter F; Nguyen, Paul L

    2015-01-01

    The relative use of brachytherapy (BT) for prostate cancer has declined in recent years. In this setting, we sought to determine whether the case mix of BT monotherapy-treated men has changed over time in terms of risk group composition. The Surveillance, Epidemiology, and End Results database was used to identify 30,939 patients diagnosed with prostate adenocarcinoma between 2004 and 2011 who received BT monotherapy. The case mix of BT monotherapy patients was calculated by patient risk group and year of diagnosis. Between 2004 and 2011, the use of BT monotherapy declined overall. The relative percentage of men undergoing BT with low-risk disease declined by 4.5%, whereas the relative percentage of patients with intermediate-risk disease increased by 4.7%. Non-white patients and those from poorer counties did not show shifts in the risk group makeup of BT monotherapy patients, whereas white patients and those from wealthier counties did. Although fewer patients with prostate cancer are undergoing BT monotherapy, men with intermediate-risk disease comprised a significantly larger portion of the BT case mix in 2011 compared with 2004. Future research efforts by brachytherapists should be directed toward improving BT technique, optimizing radiation doses, and obtaining long-term followup data for patients with intermediate-risk prostate cancer. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  9. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    Science.gov (United States)

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  10. Unambiguous discrimination of mixed states: A description based on system-ancilla coupling

    International Nuclear Information System (INIS)

    Zhou, Xiang-Fa; Zhang, Yong-Sheng; Guo, Guang-Can

    2007-01-01

    We propose a general description for the unambiguous discrimination of mixed states according to the system-environment coupling, and present a procedure to reduce this to a standard semidefinite programming problem. In the two-state case, we introduce the canonical vectors and partly simplify the problem to the case of discrimination between pairs of canonical vectors. By considering the positivity of the 2x2 matrices, we obtain a series of new upper bounds for the total success probability, which depends on both the prior probabilities and specific state structures

  11. Intersite interactions and susceptibility in mixed valence systems

    International Nuclear Information System (INIS)

    Xiaoqian Wang; Gao Lin; Bingjian Ni; Fusui Liu.

    1985-10-01

    This paper considers the effect of intersite processes on the susceptibility in mixed valence system. The method of thermodynamical perturbation used in this paper can also be generalized to study other properties of mixed valence system. The general formula of partition function of two-site interactions for the mixed valence system is given. The numerical calculations show that the intersite interaction is large enough to explain the minimum of susceptibility discovered in experiments. The different types of our theoretical curves predict that the susceptibility should exhibit a rich variety of behaviour at low temperature for various materials. (author)

  12. Three case studies involving Leptospira interrogans serovar pomona infection in mixed farming units : case report

    Directory of Open Access Journals (Sweden)

    B. Gummow

    1999-07-01

    Full Text Available Three case studies involving Leptospira interrogans serovar pomona outbreaks within mixed farming systems in South Africa are described. On 2 farms, pigs constituted the main enterprise with cattle and sheep of secondary importance. On each of these 2 farms, abortion due to L. pomona in sows was confirmed by culture, and antibody titres to pomona were detected in cattle, sheep, horses and dogs. On the 3rd farm, a piggery was ofsecondary importance to cattle farming. Abortion and death in cows occurred on this farmand serology showed titres to various serovars, including pomona. L. pomona was also isolated from bovine urine, an aborted bovine foetus and kidneys from slaughtered pigs. This particular case study was regarded as clinically atypical in that adult Jersey cattle died of acute leptospirosis in a semiarid region of South Africa. In all 3 case studies, the poor management of pig effluent and of the drinking water and its sources played a pivotal role in the transmission of the disease. Inadequate vaccination of animals against Leptospira and poor record-keeping within the secondary farming enterprises were also contributing factors to the spread of leptospirosis.

  13. Possible Association of Multicentric Castleman's Disease with Autoimmune Lymphoproliferative Syndrome

    Directory of Open Access Journals (Sweden)

    Hiroyuki Minemura

    2018-04-01

    Full Text Available Multicentric Castleman's disease (MCD is lymphoproliferative disorder characterized by systemic inflammatory symptoms such as fever and weight loss. Human herpes virus-8 (HHV-8 is thought to be a causable pathogen in all HIV-positive and some HIV-negative MCD patients. Furthermore, the term idiopathic MCD (iMCD was recently proposed to represent a group of HIV-negative and HHV-8-negative patients with unknown etiologies. Although the international diagnostic criteria for iMCD require exclusion of infection-related disorders, autoimmune/autoinflammatory diseases and malignant/lymphoproliferative disorders to make an iMCD diagnosis, the relationships and differences between these disorders and MCD have not yet been clarified. We recently reported the first case of MCD with autoimmune lymphoproliferative syndrome (ALPS. Although ALPS was included in the iMCD exclusion criteria as an autoimmune/autoinflammatory disease according to the international diagnostic criteria, there is a lack of evidence on the association between MCD and ALPS. In this study, we review the recent understanding of MCD and discuss the possible association between MCD with ALPS.

  14. Scheduling of head-dependent cascaded hydro systems: Mixed-integer quadratic programming approach

    Energy Technology Data Exchange (ETDEWEB)

    Catalao, J.P.S.; Pousinho, H.M.I. [Department of Electromechanical Engineering, University of Beira Interior, R. Fonte do Lameiro, 6201-001 Covilha (Portugal); Mendes, V.M.F. [Department of Electrical Engineering and Automation, Instituto Superior de Engenharia de Lisboa, R. Conselheiro Emidio Navarro, 1950-062 Lisbon (Portugal)

    2010-03-15

    This paper is on the problem of short-term hydro scheduling, particularly concerning head-dependent cascaded hydro systems. We propose a novel mixed-integer quadratic programming approach, considering not only head-dependency, but also discontinuous operating regions and discharge ramping constraints. Thus, an enhanced short-term hydro scheduling is provided due to the more realistic modeling presented in this paper. Numerical results from two case studies, based on Portuguese cascaded hydro systems, illustrate the proficiency of the proposed approach. (author)

  15. MULTICENTRIC T-CELL LYMPHOMA AND CUTANEOUS HEMANGIOSARCOMA IN A CAPTIVE CHEETAH (ACINONYX JUBATUS).

    Science.gov (United States)

    Lindemann, Dana M; Carpenter, James W; Nietfeld, Jerome C; Gonzalez, Estehela; Hallman, Mackenzie; Hause, Ben M

    2015-12-01

    A 13-yr-old intact male cheetah (Acinonyx jubatus) presented for evaluation after a 4-mo history of intermittent lethargy and increased expiratory effort. The clinical signs were initially noted after the diagnosis and death of its 13-yr-old male sibling with solitary hepatic T-cell lymphoma. Physical examination findings included thin body condition, harsh lung sounds, peripheral lymphadenopathy, and a cutaneous mass on the right medial tarsus and scrotum. Excisional biopsies diagnosed well-differentiated cutaneous hemangiosarcomas. Thoracic radiographs revealed a cranial mediastinal mass. Complete blood count and serum biochemical analyses showed a leukocytosis with persistent lymphocytosis, progressive azotemia, and markedly elevated alkaline phosphatase. Because of the cheetah's declining quality of life, euthanasia was elected. Postmortem examination, histopathology, and immunohistochemical staining revealed multicentric T-cell lymphoma. Feline leukemia virus (FeLV) enzyme-linked immunosorbent assay, FeLV polymerase chain reaction (whole blood), and viral metagenomic analysis were negative. This is the first case of cutaneous hemangiosarcoma and multicentric T-cell lymphoma reported in a FeLV-negative cheetah.

  16. Do Social Computing Make You Happy? A Case Study of Nomadic Children in Mixed Environments

    DEFF Research Database (Denmark)

    Christensen, Bent Guldbjerg

    2005-01-01

    In this paper I describe a perspective on ambient, ubiquitous, and pervasive computing called the happiness perspective. By using the happiness perspective, the application domain and how the technology is used and experienced, becomes a central and integral part of perceiving ambient technology....... will use the perspective in a case study on field test experiments with nomadic children in mixed environments using the eBag system....

  17. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

    Science.gov (United States)

    Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

    2016-01-01

    The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix

  18. A multi-centre clinical follow-up database as a systematic approach to the evaluation of mid- and long-term health consequences in Chernobyl acute radiation syndrome patients

    International Nuclear Information System (INIS)

    Fischer, B.; Weiss, M.; Fliedner, T.M.; Belyi, D.A.; Kovalenko, A.N.; Bebeshko, V.G.; Nadejina, N.M.; Galstian, I.A.

    1996-01-01

    This paper describes scope, design and first results of a multi-centre follow-up database that has been established for the evaluation of mid- and long-term health consequences of acute radiation syndrome (ARS) survivors. After the Chernobyl accident on 26 April 1986, 237 cases with suspected acute radiation syndrome have been reported. For 134 of these cases the diagnosis of ARS was confirmed in a consensus conference three years after the accident. Nearly all survivors underwent regular follow-up examinations in two specialized centres in Kiev and in Moscow. In collaboration with these centres we established a multi-centre clinical follow-up database that records the results of the follow-up examinations in a standardized schema. This database is an integral part of a five step approach to patient evaluation and aims at a comprehensive base for scientific analysis of the mid- and long-term consequences of accidental ionizing radiation. It will allow for a dynamic view on the development of the health status of individuals and groups of patients as well as the identification of critical organ systems that need early support, and an improvement of acute and follow-up treatment protocols for radiation accident victims

  19. MARKETING MIX POLICIES IN FMCG CASE-STUDY: THE ADVERTISING STRATEGY

    Directory of Open Access Journals (Sweden)

    ANA MARIA BOBEICA

    2011-04-01

    Full Text Available This paper explores the relationships between selected marketing mix elements in the area of FMCG. It discusses the nature and sometimes negative consequences of the dominating marketing paradigm of today, marketing mix management, and furthermore discusses how modern research into, for example in the case of FMCG Companies, the marketing policies as well as customer relationship tactics shows that another approach to marketing is required. It proposes a conceptual framework in which marketing elements are related to the dimensions of brand equity and brand awareness. It also presents a case study deriving from advertising strategies of FMCG Companies showing that the change in advertising spending is related to changes in market share, changes in product plans and changes in the number of competitors modified by the number of customers, their concentration and the size of the advertising budget.

  20. TA Treatment of Depression - A Hermeneutic Single-Case Efficacy Design Study - ‘Linda’ - a mixed outcome case

    Directory of Open Access Journals (Sweden)

    Mark Widdowson

    2013-07-01

    Full Text Available Hermeneutic Single-Case EfficacyDesign (HSCED is a systematic case study research method involving the cross-examination of mixed method data to generate both plausible arguments that the client changed due to therapy and alternative explanations. The present study is the fourth article of a case series which has investigated the process and outcome of transactional analysis psychotherapy using Hermeneutic Single-Case Efficacy Design (Elliott 2002. The client, Linda, was a 45 yearold white British woman with mild depression who attended nine sessions of therapy. The conclusion of the judges was that this was a mixed-outcome case:whilst the client improved over the course of therapy and was positive about her experience of therapy, her changes did not last when she experienced considerable stressful events during follow-up. Linda provided a detailed and idiosyncratic description of the aspects of the therapy which were most helpful for her. A cross-case comparison with other cases in this series suggests several interesting features which are worthy of further investigation. Specifically, the use of a shared theoretical framework and an egalitarian therapeutic relationship were helpful. As with other cases in this series, the client experienced positive changes in her interpersonal relationships suggesting that this outcome of TA therapy warrants further investigation

  1. Mixed H∞ and passive control for linear switched systems via hybrid control approach

    Science.gov (United States)

    Zheng, Qunxian; Ling, Youzhu; Wei, Lisheng; Zhang, Hongbin

    2018-03-01

    This paper investigates the mixed H∞ and passive control problem for linear switched systems based on a hybrid control strategy. To solve this problem, first, a new performance index is proposed. This performance index can be viewed as the mixed weighted H∞ and passivity performance. Then, the hybrid controllers are used to stabilise the switched systems. The hybrid controllers consist of dynamic output-feedback controllers for every subsystem and state updating controllers at the switching instant. The design of state updating controllers not only depends on the pre-switching subsystem and the post-switching subsystem, but also depends on the measurable output signal. The hybrid controllers proposed in this paper can include some existing ones as special cases. Combine the multiple Lyapunov functions approach with the average dwell time technique, new sufficient conditions are obtained. Under the new conditions, the closed-loop linear switched systems are globally uniformly asymptotically stable with a mixed H∞ and passivity performance index. Moreover, the desired hybrid controllers can be constructed by solving a set of linear matrix inequalities. Finally, a numerical example and a practical example are given.

  2. Job-mix modeling and system analysis of an aerospace multiprocessor.

    Science.gov (United States)

    Mallach, E. G.

    1972-01-01

    An aerospace guidance computer organization, consisting of multiple processors and memory units attached to a central time-multiplexed data bus, is described. A job mix for this type of computer is obtained by analysis of Apollo mission programs. Multiprocessor performance is then analyzed using: 1) queuing theory, under certain 'limiting case' assumptions; 2) Markov process methods; and 3) system simulation. Results of the analyses indicate: 1) Markov process analysis is a useful and efficient predictor of simulation results; 2) efficient job execution is not seriously impaired even when the system is so overloaded that new jobs are inordinately delayed in starting; 3) job scheduling is significant in determining system performance; and 4) a system having many slow processors may or may not perform better than a system of equal power having few fast processors, but will not perform significantly worse.

  3. Mixing height determination using remote sensing systems. General remarks

    Energy Technology Data Exchange (ETDEWEB)

    Beyrich, F. [BTU Cottbus, LS Umweltmeteorologie, Cottbus (Germany)

    1997-10-01

    Remote sensing systems can be considered today as a real alternative to classical soundings with respect to the MH (mixing height) determination. They have the basic advantage to allow continuous monitoring of the ABL (atmospheric boundary layer). Some technical issues which limit their operational use at present should be solved in the near future (frequency allocation, eye safety, costs). Taking into account specific operating conditions and the formulated-above requirements of a sounding system to be used for MH determination it becomes obvious that none of the available systems meets all of them, i.e., the `Mixing height-meter` does not exist. Therefore, reliable MH determination under a wide variety of conditions can be achieved only by integrating different instruments into a complex sounding system. The S-profiles provide a suitable data base for MH estimation from all types of remote sensing instruments. The criteria to deduce MH-values from these profiles should consider the structure type and the evolution stage of the ABL as well as the shape of the profiles. A certain kind of harmonization concerning these criteria should be achieved. MH values derived automatically from remote sensing data appear to be not yet reliable enough for direct operational use, they should be in any case critically examined by a trained analyst. Contemporary mathematical methods (wavelet transforms, fuzzy logics) are supposed to allow considerable progress in this field in the near future. (au) 19 refs.

  4. Multicentre quality assurance of intensity-modulated radiation therapy plans: a precursor to clinical trials

    International Nuclear Information System (INIS)

    Williams, M. J.; Bailey, M. J.; Forstner, D.; Metcalfe, P. E

    2007-01-01

    Full text: A multicentre planning study comparing intensity-modulated radiation therapy (IMRT) plans for the treatment of a head and neck cancer has been carried out. Three Australian radiotherapy centres, each with a different planning system, were supplied a fully contoured CT dataset and requested to generate an IMRT plan in accordance with the requirements of an IMRT-based radiation therapy oncology group clinical trial. Plan analysis was carried out using software developed specifically for reviewing multicentre clinical trial data. Two out of the three plans failed to meet the prescription requirements with one misinterpreting the prescription and the third failed to meet one of the constraints. Only one plan achieved all of the dose objectives for the critical structures and normal tissues. Although each centre used very similar planning parameters and beam arrangements the resulting plans were quite different. The subjective interpretation and application of the prescription and planning objectives emphasize one of the many difficulties in carrying out multicentre IMRT planning studies. The treatment prescription protocol in a clinical trial must be both lucid and unequivocally stated to avoid misinterpretation. Australian radiotherapy centres must show that they can produce a quality IMRT plan and that they can adhere to protocols for IMRT planning before using it in a clinical trial

  5. [Mixed valent and heavy ferimons and related systems

    International Nuclear Information System (INIS)

    Schlottmann, P.

    1991-01-01

    The main objective of the project is to gain a better understanding of highly correlated fermion systems. High correlations appear in a variety of solid state phenomena: mixed-valence and heavy-fermions or Kondo systems, superfluid and normal He 3 , high-temperature superconductors, magnetism in low dimensions, quantum Hall effect, spin-fluctuations in transition metals, giant magnetic moments, tunneling of an atom interacting with a degenerate electron gas, quantum dissipative systems, organic superconductors, etc. The primary focus of the work is on valence mixing and heavy fermions, but elated highly correlated systems are also studied. In this paper a brief summary of the achievements grouped under four headings, namely (1) heavy fermions-mixed valence-Kondo, (2) magnetism in low dimensions, (3) narrow band phenomena/Hubbard model and (4) collaborations with experimentalists

  6. Mixed - mode Operating System for Real - time Performance

    Directory of Open Access Journals (Sweden)

    Hasan M. M.

    2017-11-01

    Full Text Available The purpose of the mixed-mode system research is to handle devices with the accuracy of real-time systems and at the same time, having all the benefits and facilities of a matured Graphic User Interface(GUIoperating system which is typicallynon-real-time. This mixed-mode operating system comprising of a real-time portion and a non-real-time portion was studied and implemented to identify the feasibilities and performances in practical applications (in the context of scheduled the real-time events. In this research an i8751 microcontroller-based hardware was used to measure the performance of the system in real-time-only as well as non-real-time-only configurations. The real-time portion is an 486DX-40 IBM PC system running under DOS-based real-time kernel and the non-real-time portion is a Pentium IIIbased system running under Windows NT. It was found that mixed-mode systems performed as good as a typical real-time system and in fact, gave many additional benefits such as simplified/modular programming and load tolerance.

  7. Mixed-mode Operating System for Real-time Performance

    Directory of Open Access Journals (Sweden)

    M.M. Hasan

    2017-11-01

    Full Text Available The purpose of the mixed-mode system research is to handle devices with the accuracy of real-time systems and at the same time, having all the benefits and facilities of a matured Graphic User Interface (GUI operating system which is typically nonreal-time. This mixed-mode operating system comprising of a real-time portion and a non-real-time portion was studied and implemented to identify the feasibilities and performances in practical applications (in the context of scheduled the real-time events. In this research an i8751 microcontroller-based hardware was used to measure the performance of the system in real-time-only as well as non-real-time-only configurations. The real-time portion is an 486DX-40 IBM PC system running under DOS-based realtime kernel and the non-real-time portion is a Pentium III based system running under Windows NT. It was found that mixed-mode systems performed as good as a typical realtime system and in fact, gave many additional benefits such as simplified/modular programming and load tolerance.

  8. Mixed spin-3/2 and spin-5/2 Ising system on the Bethe lattice

    International Nuclear Information System (INIS)

    Albayrak, Erhan; Yigit, Ali

    2006-01-01

    In order to study the critical behaviors of the half-integer mixed spin-3/2 and spin-5/2 Blume-Capel Ising ferrimagnetic system, we have used the exact recursion relations on the Bethe lattice. The system was studied for the coordination numbers with q=3, 4, 5 and 6, and the obtained phase diagrams are illustrated on the (kT c /|J|,D A /|J|) plane for constant values of D B /|J|, the reduced crystal field of the sublattice with spin-5/2, and on the (kT c /|J|,D B /|J|) plane for constant values of D A /|J|, the reduced crystal field of the sublattice with spin-3/2, for q=3 only, since the cases corresponding to q=4, 5 and 6 reproduce results similar to the case for q=3. In addition we have also presented the phase diagram with equal strengths of the crystal fields for q=3, 4, 5 and 6. Besides the second- and first-order phase transitions, the system also exhibits compensation temperatures for appropriate values of the crystal fields. In this mixed spin system while the second-order phase transition lines never cut the reduced crystal field axes as in the single spin type spin-3/2 and spin-5/2 Ising models separately, the first-order phase transition lines never connect to the second-order phase transition lines and they end at the critical points, therefore the system does not give any tricritical points. In addition to this, this mixed-spin model exhibits one or two compensation temperatures depending on the values of the crystal fields, as a result the compensation temperature lines show reentrant behavior

  9. Mixed-mode Operating System for Real-time Performance

    OpenAIRE

    M.M. Hasan; S. Sultana; C.K. Foo

    2017-01-01

    The purpose of the mixed-mode system research is to handle devices with the accuracy of real-time systems and at the same time, having all the benefits and facilities of a matured Graphic User Interface (GUI) operating system which is typically nonreal-time. This mixed-mode operating system comprising of a real-time portion and a non-real-time portion was studied and implemented to identify the feasibilities and performances in practical applications (in the context of scheduled the real-time...

  10. Mixed - mode Operating System for Real - time Performance

    OpenAIRE

    Hasan M. M.; Sultana S.; Foo C.K.

    2017-01-01

    The purpose of the mixed-mode system research is to handle devices with the accuracy of real-time systems and at the same time, having all the benefits and facilities of a matured Graphic User Interface(GUI)operating system which is typicallynon-real-time. This mixed-mode operating system comprising of a real-time portion and a non-real-time portion was studied and implemented to identify the feasibilities and performances in practical applications (in the context of scheduled the real-time e...

  11. Complete en bloc urinary exenteration for synchronous multicentric transitional cell carcinoma with sarcomatoid features in a hemodialysis patient

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr

    2006-10-01

    Full Text Available The incidence of transitional cell carcinoma (TCC in patients submitted to hemodialysis is low. The presence of TCC with sarcomatoid features in this cohort is even scarcer. Herein, we describe a very rare case of synchronous multicentric muscle invasive bladder carcinoma with prostate invasion in a hemodialysis patient, submitted to complete en bloc urinary exenteration.

  12. Practical system for generating digital mixed reality video holograms.

    Science.gov (United States)

    Song, Joongseok; Kim, Changseob; Park, Hanhoon; Park, Jong-Il

    2016-07-10

    We propose a practical system that can effectively mix the depth data of real and virtual objects by using a Z buffer and can quickly generate digital mixed reality video holograms by using multiple graphic processing units (GPUs). In an experiment, we verify that real objects and virtual objects can be merged naturally in free viewing angles, and the occlusion problem is well handled. Furthermore, we demonstrate that the proposed system can generate mixed reality video holograms at 7.6 frames per second. Finally, the system performance is objectively verified by users' subjective evaluations.

  13. On-line gas mixing and multi-channel distribution system

    International Nuclear Information System (INIS)

    Kalmani, S.D.; Mondal, N.K.; Satyanarayana, B.; Verma, P.; Joshi, Avinash

    2009-01-01

    In this presentation, we describe a mass-flow controller based on-line gas mixing unit with the multi-channel distribution system. We highlight different aspects such as requirement, design, calibration, control and operation of this system. This unit has the capability to mix up to four different input gases and distribute over 16 output channels. Output in individual channels is controlled accurately by using capillary-based system. At present, we are using this gas mixing unit for prototype of iron calorimeter (ICAL) detector of India-based Neutrino Observatory (INO).

  14. Does Assisted Living Capacity Influence Case Mix at Nursing Homes?

    Science.gov (United States)

    Clement, Jan P; Khushalani, Jaya

    2015-01-01

    Assisted living facilities (ALFs) have grown over the past few decades. If they attract residents with lower care needs away from nursing homes (NHs), NHs may be left with higher case mix residents. We study the relationship between ALF bed market capacity and NH case mix in a state (Virginia) where ALF bed capacity stabilized after a period of growth. Similarly, NH capacity and use had been stable. While it is interesting to study markets in flux, for planning purposes, it is also important to examine what happens after periods of turbulence and adaptation. Our findings show some substitution of ALF for NH care, but the relationship is not linear with ALF market capacity. Communities need to consider the interplay of ALFs and NHs in planning for long-term care services and supports. Policies supporting ALFs may enable care needs to be met in a lower cost setting than the NH.

  15. Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

    Science.gov (United States)

    Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G

    2010-11-01

    Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. Mixed problems for linear symmetric hyperbolic systems with characteristic boundary conditions

    International Nuclear Information System (INIS)

    Secchi, P.

    1994-01-01

    We consider the initial-boundary value problem for symmetric hyperbolic systems with characteristic boundary of constant multiplicity. In the linear case we give some results about the existence of regular solutions in suitable functions spaces which take in account the loss of regularity in the normal direction to the characteristic boundary. We also consider the equations of ideal magneto-hydrodynamics under perfectly conducting wall boundary conditions and give some results about the solvability of such mixed problem. (author). 16 refs

  17. 42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

    Science.gov (United States)

    2010-10-01

    ... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

  18. Does Assisted Living Capacity Influence Case Mix at Nursing Homes?

    Directory of Open Access Journals (Sweden)

    Jan P. Clement PhD

    2015-05-01

    Full Text Available Assisted living facilities (ALFs have grown over the past few decades. If they attract residents with lower care needs away from nursing homes (NHs, NHs may be left with higher case mix residents. We study the relationship between ALF bed market capacity and NH case mix in a state (Virginia where ALF bed capacity stabilized after a period of growth. Similarly, NH capacity and use had been stable. While it is interesting to study markets in flux, for planning purposes, it is also important to examine what happens after periods of turbulence and adaptation. Our findings show some substitution of ALF for NH care, but the relationship is not linear with ALF market capacity. Communities need to consider the interplay of ALFs and NHs in planning for long-term care services and supports. Policies supporting ALFs may enable care needs to be met in a lower cost setting than the NH.

  19. A multi-centre dosimetry audit on advanced radiotherapy in lung as part of the Isotoxic IMRT study

    Directory of Open Access Journals (Sweden)

    Yat Tsang

    2017-10-01

    Conclusion: This multi-centre dosimetry audit of complex IMRT/VMAT delivery provides confidence in the accuracy of modern planning and delivery systems in inhomogeneous tissues. The findings from this study can be used as a reference for future dosimetry audits.

  20. Clockwise: A Mixed-Media File System

    NARCIS (Netherlands)

    Bosch, H.G.P.; Jansen, P.G.; Mullender, Sape J.

    This (short) paper presents the Clockwise, a mixed-media file system. The primary goal of the Clockwise is to provide a storage architecture that supports the storage and retrieval of best-effort and real-time file system data. Clockwise provides an abstraction called a dynamic partition that groups

  1. Four-wave mixing and six-wave mixing in a four-level confined atomic system

    International Nuclear Information System (INIS)

    Chang-Biao, Li; Yan-Peng, Zhang; Zhi-Qiang, Nie; Huai-Bin, Zheng; Mei-Zhen, Shi; Dong-Ning, Liu; Jian-Ping, Song; Ke-Qing, Lu

    2009-01-01

    We have investigated coexisting four-wave mixing and six-wave mixing (SWM) in ultra-thin, micrometre and long vapour cells. There exists competition between Dicke-narrowing features and polarization interference in the micrometre cell. The oscillation behaviour of SWM signal intensities and linewidths results from destructive interference. With a larger destructive interference, the SWM signal in ultra-thin cells shows a narrow spectrum, in contrast to the long cell case. Due to the Dicke-narrowing features, a narrow spectrum can be obtained, and such spectra can be used for high precision measurements and metrological standards. (classical areas of phenomenology)

  2. Competition between Dispersion and Absorption of Doubly-Dressed Four-Wave Mixing and Dressed Six-Wave Mixing

    International Nuclear Information System (INIS)

    Lei-Jian, Shen; Chuang-She, Li; Yi-Gang, Du; Cui-Cui, Zuo; Zhi-Qiang, Nie; Yan-Peng, Zhang; Yuan-Yuan, Li; Chen-Li, Gan; Ke-Qing, Lu

    2008-01-01

    We study the competition between dispersion and absorption of doubly-dressed four-wave mixing (DDFWM) and dressed six-wave mixing. In the case of weak coupling fields limit, we find DDFWM signal is affected by destructive interference between four-wave mixing(FWM) and six-wave mixing as well as constructive interference between FWM and eight-wave mixing. By analysing the difference between two kinds of doubly dressing mechanisms (parallel cascade and nested cascade) in this opening five-level system, we can further understand the generated high-order nonlinear optical signal dressed by multi-fields

  3. Association between Health Information Technology and Case Mix Index.

    Science.gov (United States)

    Park, Young-Taek; Lee, Junsang; Lee, Jinhyung

    2017-10-01

    Health information technology (IT) can assist healthcare providers in ordering medication and adhering to guidelines while improving communication among providers and the quality of care. However, the relationship between health IT and Case Mix Index (CMI) has not been thoroughly investigated; therefore, this study aimed to clarify this relationship. To examine the effect of health IT on CMI, a generalized estimation equation (GEE) was applied to two years of California hospital data. We found that IT was positively associated with CMI, indicating that increased IT adoption could lead to a higher CMI or billing though DRG up-coding. This implies that hospitals' revenue could increase around $40,000 by increasing IT investment by 10%. The positive association between IT and CMI implies that IT adoption itself could lead to higher patient billings. Generally, a higher CMI in a hospital indicates that the hospital provides expensive services with higher coding and therefore receives more money from patients. Therefore, measures to prevent upcoding through IT systems should be implemented.

  4. Multicentre structural and functional MRI

    OpenAIRE

    Gountouna, Viktoria-Eleni

    2014-01-01

    Neuroimaging techniques are likely to continue to improve our understanding of the brain in health and disease, but studies tend to be small, based in one imaging centre and of uncertain generalisability. Multicentre imaging studies therefore have great appeal but it is not yet clear under which circumstances data from different scanners can be combined. The successful harmonisation of multiple Magnetic Resonance Imaging (MRI) machines will increase study power, flexibility and...

  5. 10 best resources on ... mixed methods research in health systems.

    Science.gov (United States)

    Ozawa, Sachiko; Pongpirul, Krit

    2014-05-01

    Mixed methods research has become increasingly popular in health systems. Qualitative approaches are often used to explain quantitative results and help to develop interventions or survey instruments. Mixed methods research is especially important in low- and middle-income country (LMIC) settings, where understanding social, economic and cultural contexts are essential to assess health systems performance. To provide researchers and programme managers with a guide to mixed methods research in health systems, we review the best resources with a focus on LMICs. We selected 10 best resources (eight peer-reviewed articles and two textbooks) based on their importance and frequency of use (number of citations), comprehensiveness of content, usefulness to readers and relevance to health systems research in resource-limited contexts. We start with an overview on mixed methods research and discuss resources that are useful for a better understanding of the design and conduct of mixed methods research. To illustrate its practical applications, we provide examples from various countries (China, Vietnam, Kenya, Tanzania, Zambia and India) across different health topics (tuberculosis, malaria, HIV testing and healthcare costs). We conclude with some toolkits which suggest what to do when mixed methods findings conflict and provide guidelines for evaluating the quality of mixed methods research.

  6. Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

    Science.gov (United States)

    Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L; Roland, Martin

    2012-08-01

    Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.

  7. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

    2015-01-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for th...

  8. Inter-provider comparison of patient-reported outcomes: developing an adjustment to account for differences in patient case mix.

    Science.gov (United States)

    Nuttall, David; Parkin, David; Devlin, Nancy

    2015-01-01

    This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed. © 2013 Crown copyright.

  9. Usefulness of a centralized system of data collection for the development of an international multicentre registry of spondyloarthritis

    Science.gov (United States)

    Schiotis, Ruxandra; Font, Pilar; Zarco, Pedro; Almodovar, Raquel; Gratacós, Jordi; Mulero, Juan; Juanola, Xavier; Montilla, Carlos; Moreno, Estefanía; Ariza Ariza, Rafael; Collantes-Estevez, Eduardo

    2011-01-01

    Objective. To present the usefulness of a centralized system of data collection for the development of an international multicentre registry of SpA. Method. The originality of this registry consists in the creation of a virtual network of researchers in a computerized Internet database. From its conception, the registry was meant to be a dynamic acquiring system. Results. REGISPONSER has two developing phases (Conception and Universalization) and gathers several evolving secondary projects (REGISPONSER-EARLY, REGISPONSER-AS, ESPERANZA and RESPONDIA). Each sub-project answered the necessity of having more specific and complete data of the patients even from the onset of the disease so, in the end, obtaining a well-defined picture of SpAs spectrum in the Spanish population. Conclusion. REGISPONSER is the first dynamic SpA database composed of cohorts with a significant number of patients distributed by specific diagnosis, which provides basic specific information of the sub-cohorts useful for patients’ evaluation in rheumatology ambulatory consulting. PMID:20823095

  10. Productivity growth in outpatient child and adolescent mental health services: the impact of case-mix adjustment.

    Science.gov (United States)

    Halsteinli, Vidar; Kittelsen, Sverre A; Magnussen, Jon

    2010-02-01

    The performance of health service providers may be monitored by measuring productivity. However, the policy value of such measures may depend crucially on the accuracy of input and output measures. In particular, an important question is how to adjust adequately for case-mix in the production of health care. In this study, we assess productivity growth in Norwegian outpatient child and adolescent mental health service units (CAMHS) over a period characterized by governmental utilization of simple productivity indices, a substantial increase in capacity and a concurrent change in case-mix. We analyze the sensitivity of the productivity growth estimates using different specifications of output to adjust for case-mix differences. Case-mix adjustment is achieved by distributing patients into eight groups depending on reason for referral, age and gender, as well as correcting for the number of consultations. We utilize the nonparametric Data Envelopment Analysis (DEA) method to implicitly calculate weights that maximize each unit's efficiency. Malmquist indices of technical productivity growth are estimated and bootstrap procedures are performed to calculate confidence intervals and to test alternative specifications of outputs. The dataset consist of an unbalanced panel of 48-60 CAMHS in the period 1998-2006. The mean productivity growth estimate from a simple unadjusted patient model (one single output) is 35%; adjusting for case-mix (eight outputs) reduces the growth estimate to 15%. Adding consultations increases the estimate to 28%. The latter reflects an increase in number of consultations per patient. We find that the governmental productivity indices strongly tend to overestimate productivity growth. Case-mix adjustment is of major importance and governmental utilization of performance indicators necessitates careful considerations of output specifications. Copyright 2009 Elsevier Ltd. All rights reserved.

  11. Geometric Phases for Mixed States in Trapped Ions

    International Nuclear Information System (INIS)

    Lu Hongxia

    2006-01-01

    The generalization of geometric phase from the pure states to the mixed states may have potential applications in constructing geometric quantum gates. We here investigate the mixed state geometric phases and visibilities of the trapped ion system in both non-degenerate and degenerate cases. In the proposed quantum system, the geometric phases are determined by the evolution time, the initial states of trapped ions, and the initial states of photons. Moreover, special periods are gained under which the geometric phases do not change with the initial states changing of photon parts in both non-degenerate and degenerate cases. The high detection efficiency in the ion trap system implies that the mixed state geometric phases proposed here can be easily tested.

  12. A system dynamics model to determine products mix

    Directory of Open Access Journals (Sweden)

    Mahtab Hajghasem

    2014-02-01

    Full Text Available This paper presents an implementation of system dynamics model to determine appropriate product mix by considering various factors such as labor, materials, overhead, etc. for an Iranian producer of cosmetic and sanitary products. The proposed model of this paper considers three hypotheses including the relationship between product mix and profitability, optimum production capacity and having minimum amount of storage to take advantage of low cost production. The implementation of system dynamics on VENSIM software package has confirmed all three hypotheses of the survey and suggested that in order to reach better mix product, it is necessary to reach optimum production planning, take advantage of all available production capacities and use inventory management techniques.

  13. Benign mixed tumor of the lacrimal sac

    Directory of Open Access Journals (Sweden)

    Jong-Suk Lee

    2015-01-01

    Full Text Available Neoplasms of the lacrimal drainage system are uncommon, but potentially life-threatening and are often difficult to diagnose. Among primary lacrimal sac tumors, benign mixed tumors are extremely rare. Histologically, benign mixed tumors have been classified as a type of benign epithelial tumor. Here we report a case of benign mixed tumor of the lacrimal sac.

  14. Improved mixing and sampling systems for vitrification melter feeds

    International Nuclear Information System (INIS)

    Ebadian, M.A.

    1998-01-01

    This report summarizes the methods used and results obtained during the progress of the study of waste slurry mixing and sampling systems during fiscal year 1977 (FY97) at the Hemispheric Center for Environmental Technology (HCET) at Florida International University (FIU). The objective of this work is to determine optimal mixing configurations and operating conditions as well as improved sampling technology for defense waste processing facility (DWPF) waste melter feeds at US Department of Energy (DOE) sites. Most of the research on this project was performed experimentally by using a tank mixing configuration with different rotating impellers. The slurry simulants for the experiments were prepared in-house based on the properties of the DOE sites' typical waste slurries. A sampling system was designed to withdraw slurry from the mixing tank. To obtain insight into the waste mixing process, the slurry flow in the mixing tank was also simulated numerically by applying computational fluid dynamics (CFD) methods. The major parameters investigated in both the experimental and numerical studies included power consumption of mixer, mixing time to reach slurry uniformity, slurry type, solids concentration, impeller type, impeller size, impeller rotating speed, sampling tube size, and sampling velocities. Application of the results to the DWPF melter feed preparation process will enhance and modify the technical base for designing slurry transportation equipment and pipeline systems. These results will also serve as an important reference for improving waste slurry mixing performance and melter operating conditions. These factors will contribute to an increase in the capability of the vitrification process and the quality of the waste glass

  15. Successful treatment with tacrolimus in TAFRO syndrome: two case reports and literature review.

    Science.gov (United States)

    Shirai, Taiichiro; Onishi, Akira; Waki, Daisuke; Saegusa, Jun; Morinobu, Akio

    2018-06-01

    TAFRO syndrome is a systemic inflammatory disorder characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly. In contrast to that in multicentric Castleman disease, interleukin-6 targeting strategies seem ineffective in some TAFRO syndrome cases; however, the optimal treatment remains unclear. Here, we report 2 cases of TAFRO syndrome, where 1 with cardiomyopathy, successfully treated with tacrolimus. This is the first case report of successful treatment with tacrolimus in TAFRO syndrome. Both patients (cases 1 and 2) developed fever, anasarca, thrombocytopenia, renal dysfunction, and mild hepatosplenomegaly. In both patients, lymph node pathology revealed mixed type Castleman disease-like features, and bone marrow showed reticulin myelofibrosis. TAFRO syndrome was diagnosed based on the patients' laboratory, clinical, and pathologic findings. In case 2, we observed a rare complication of cardiomyopathy with no evidence of takotsubo cardiomyopathy or viral myocarditis. In case 1, tocilizumab combined with glucocorticoids was ineffective and caused septic shock; additionally, cyclosporine A was discontinued because of hepatotoxicity. However, tacrolimus was effective in resolving TAFRO syndrome without any adverse events. In case 2, tacrolimus completely reversed TAFRO syndrome and was also effective in cardiomyopathy. This report suggests that tacrolimus is potentially effective and safe as an initial treatment and a glucocorticoid-sparing agent. Our literature review shows that calcineurin inhibitors, including tacrolimus, may be effective in TAFRO syndrome. Since previous studies indicate a role of Th1 inflammation in TAFRO syndrome pathogenesis, tacrolimus may, therefore, be effective in treating TAFRO syndrome.

  16. Nodules on the Hair: A Rare Case of Mixed Piedra

    OpenAIRE

    Khatu, Swapna S; Poojary, Shital Amin; Nagpur, Niranjan G

    2013-01-01

    Piedra is a superficial fungal infection of the hair shaft characterized by nodules along the hair shaft. Black piedra affects the scalp hair more frequently than white piedra. Occurrence of both types of piedra simultaneously in a patient is extremely rare. We describe here a rare case of mixed piedra of scalp hair.

  17. Nodules on the hair: a rare case of mixed piedra.

    Science.gov (United States)

    Khatu, Swapna S; Poojary, Shital Amin; Nagpur, Niranjan G

    2013-10-01

    Piedra is a superficial fungal infection of the hair shaft characterized by nodules along the hair shaft. Black piedra affects the scalp hair more frequently than white piedra. Occurrence of both types of piedra simultaneously in a patient is extremely rare. We describe here a rare case of mixed piedra of scalp hair.

  18. Ion-beam-mixing in metal-metal systems and metal-silicon systems

    International Nuclear Information System (INIS)

    Hung, L.

    1984-01-01

    The influence of energetic ion bombardment on the composition and structure of thin film materials and utilization of ion-beam-mixing techniques to modify interfacial reactions are reported in this thesis. The phase formation in metals by using ion mixing techniques has been studied. Upon ion irradiation of Al/Pt, Al/Pd and Al/Ni thin films, only the simplest intermetallic compounds of PdAl and NiAl were formed in crystalline structure, while the amorphous phase has been observed over a large range of composition. Ion mixing of Au/Cu bilayers resulted in the formation of substitutional solid solutions with no trace of ordered compounds. The formation of the ordered compound CuAu was achieved either by irradiation of bilayers with Ar ions at elevated substrate temperature or by irradiation of the mixed layers with He ions at relatively low temperature. In the Au/Al system several crystal compounds existed in the as-deposited samples. These phases remained crystalline or transformed into other equilibrium compounds upon ion irradiation. The results suggest that the phase formation by ion mixing is dependent on the high quench rate in the collision cascade region and the atomic mobility at the irradiation temperature. The argument can be applied to silicide forming systems. With near-noble metals, the mixed atoms are mobile and form metallurgically distinct phases. With refractory metals, amorphous phases are formed due to lack of atomic mobility

  19. Authorship issues in multi-centre clinical trials

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian

    2015-01-01

    to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference...... to the original source....

  20. Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.

    Science.gov (United States)

    Mesterton, Johan; Lindgren, Peter; Ekenberg Abreu, Anna; Ladfors, Lars; Lilja, Monica; Saltvedt, Sissel; Amer-Wåhlin, Isis

    2016-05-31

    Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for

  1. Multi-Objective Sensitivity Analyses for Power Generation Mix: Malaysia Case Study

    OpenAIRE

    Siti Mariam Mohd Shokri; Nofri Yenita Dahlan; Hasmaini Mohamad

    2017-01-01

    This paper presents an optimization framework to determine long-term optimal generation mix for Malaysia Power Sector using Dynamic Programming (DP) technique. Several new candidate units with a pre-defined MW capacity were included in the model for generation expansion planning from coal, natural gas, hydro and renewable energy (RE). Four objective cases were considered, 1) economic cost, 2) environmental, 3) reliability and 4) multi-objectives that combining the three cases. Results show th...

  2. Directional nonlinear guided wave mixing: Case study of counter-propagating shear horizontal waves

    Science.gov (United States)

    Hasanian, Mostafa; Lissenden, Cliff J.

    2018-04-01

    While much nonlinear ultrasonics research has been conducted on higher harmonic generation, wave mixing provides the potential for sensitive measurements of incipient damage unencumbered by instrumentation nonlinearity. Studies of nonlinear ultrasonic wave mixing, both collinear and noncollinear, for bulk waves have shown the robust capability of wave mixing for early damage detection. One merit of bulk wave mixing lies in their non-dispersive nature, but guided waves enable inspection of otherwise inaccessible material and a variety of mixing options. Co-directional guided wave mixing was studied previously, but arbitrary direction guided wave mixing has not been addressed until recently. Wave vector analysis is applied to study variable mixing angles to find wave mode triplets (two primary waves and a secondary wave) resulting in the phase matching condition. As a case study, counter-propagating Shear Horizontal (SH) guided wave mixing is analyzed. SH wave interactions generate a secondary Lamb wave mode that is readily receivable. Reception of the secondary Lamb wave mode is compared for an angle beam transducer, an air coupled transducer, and a laser Doppler vibrometer (LDV). Results from the angle beam and air coupled transducers are quite consistent, while the LDV measurement is plagued by variability issues.

  3. TRAFFIC SIMULATION FOR MIXED TRAFFIC SYSTEMS

    African Journals Online (AJOL)

    EGETE

    2012-05-04

    May 4, 2012 ... Traffic problem is classified into single and mixed, especially in most developing countries, where motorbikes are ..... The traffic light control system presented by its location on ... multi-destination dynamic routing and real-time.

  4. Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients

    DEFF Research Database (Denmark)

    Johansen, J D; Rastogi, Suresh Chandra; Menné, T

    1996-01-01

    . In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha......The aim of the present study was to assess exposure to constituents of the fragrance mix from cosmetic products used by fragrance-mix-positive eczema patients. 23 products, which had either given a positive patch and/or use test in a total of 11 fragrance-mix-positive patients, were analyzed....... It is concluded that exposure to constituents of the fragrance mix is common in fragrance-allergic patients with cosmetic eczema, and that the fragrance mix is a good reflection of actual exposure....

  5. CFD and system analysis code investigations of the multidimensional flow mixing phenomena in the reactor pressure vessel

    International Nuclear Information System (INIS)

    Ceuca, S.C.; Herb, J.; Schoeffel, P.J.; Hollands, T.; Austregesilo, H.; Hristov, H.V.

    2017-01-01

    The realistic numerical prediction of transient fluid-dynamic scenarios including the complex, three-dimensional flow mixing phenomena occurring in the reactor pressure vessel (RPV) both in normal or abnormal operation are an important issue in today's reactor safety assessment studies. Both Computational Fluid Dynamics (CFD) tools as well as fluid-dynamic system analysis codes, each with its advantages and drawbacks, are commonly used to model such transients. Simulation results obtained with the open-source CFD tool-box OpenFOAM and the German thermal-hydraulic system code ATHLET (Analysis of THermal-hydraulics of LEaks and Transients), the later developed by Gesellschaft für Anlagen- und Reaktorsicherheit (GRS) for the analysis of the whole spectrum of operational transients, design-basis accidents and beyond design basis accidents anticipated for nuclear energy facilities, are compared against experimental data from the ROssendorf Coolant Mixing (ROCOM) test facility. In the case of the OpenFOAM CFD simulations the influence of various turbulence models and numerical schemes has been assessed while in the case of the system analysis code ATHLET a multidimensional nodalization recommended for real power plant applications has been employed. The simulation results show a good agreement with the experimental data, indicating that both OpenFOAM and ATHLET can capture the key flow features of the mixing processes in the Reactor Pressure Vessel (RPV). (author)

  6. Mixed thermal convection: fundamental issues and analysis of the planar case

    Directory of Open Access Journals (Sweden)

    JACQUES PADET

    2015-09-01

    Full Text Available This paper aims to renew interest on mixed thermal convection research and to emphasize three issues that arise from the present analysis: (i a clear definition of the reference temperature in the Boussinesq approximation; (ii a practical delimitation of the three convective modes, which are the forced convection (FC, mixed convection (MC and natural (or free convection (NC; (iii and, finally, a uniform description of the set FC/MC/NC in the similarity framework. The planar case, for which analytical solutions are available, allows a detailed illustration of the answers here advanced to the above issues.

  7. Malignant mixed mullerian tumor arising from the uterine cervix: A case report

    International Nuclear Information System (INIS)

    Shim, Jong Joon; Shim, Jae Chan; Lee, Kyoung Eun; Lee, Ghi Jai; Kim, Ho Kyun; Suh, Jung Ho; Lee, Hye Kyung

    2012-01-01

    Malignant mixed mullerian tumors (MMMTs) are a rare uterine tumor and contribute to approximately 1-3% of all corpus malignant tumors. MMMTs are usually in the uterine corpus, but can also arise from the uterine cervix, vagina, ovaries and fallofian tubes. MMMTs of the uterine cervix are extremely rare. MMMTs are highly malignant and tend to maintain a rapid growth and exhibit a high rate of recurrence. Therefore, the prognosis of patients diagnosed with these types of tumors is extremely poor. We report a rare case of a malignant mixed mullerian tumor arising from the uterine cervix and introduce CT and MRI findings. CT and magnetic resonance findings of the uterine cervical MMMT in our case show highly aggressive features, such as parametrial involvement, pelvic and paraaortic lymphadenopathy, and distant metastasis and high enhancement

  8. Risk adjustment for case mix and the effect of surgeon volume on morbidity.

    Science.gov (United States)

    Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

    2013-06-01

    Retrospective studies of large administrative databases have shown higher mortality for procedures performed by low-volume surgeons, but the adequacy of risk adjustment in those studies is in doubt. To determine whether the relationship between surgeon volume and outcomes is an artifact of case mix using a prospective sample of carotid endarterectomy cases. Observational cohort study from January 1, 2008, through December 31, 2010, with preoperative, immediate postoperative, and 30-day postoperative assessments acquired by independent monitors. Urban, tertiary academic medical center. All 841 patients who underwent carotid endarterectomy performed by a vascular surgeon or cerebrovascular neurosurgeon at the institution. Carotid endarterectomy without another concurrent surgery. Stroke, death, and other surgical complications occurring within 30 days of surgery along with other case data. A low-volume surgeon performed 40 or fewer cases per year. Variables used in a comparison administrative database study, as well as variables identified by our univariate analysis, were used for adjusted analyses to assess for an association between low-volume surgeons and the rate of stroke and death as well as other complications. RESULTS The rate of stroke and death was 6.9% for low-volume surgeons and 2.0% for high-volume surgeons (P = .001). Complications were similarly higher (13.4% vs 7.2%, P = .008). Low-volume surgeons performed more nonelective cases. Low-volume surgeons were significantly associated with stroke and death in the unadjusted analysis as well as after adjustment with variables used in the administrative database study (odds ratio, 3.61; 95% CI, 1.70-7.67, and odds ratio, 3.68; 95% CI, 1.72-7.89, respectively). However, adjusting for the significant disparity of American Society of Anesthesiologists Physical Status classification in case mix eliminated the effect of surgeon volume on the rate of stroke and death (odds ratio, 1.65; 95% CI, 0.59-4.64) and other

  9. A Real-Time Semiautonomous Audio Panning System for Music Mixing

    Directory of Open Access Journals (Sweden)

    Perez_Gonzalez Enrique

    2010-01-01

    Full Text Available A real-time semiautonomous stereo panning system for music mixing has been implemented. The system uses spectral decomposition, constraint rules, and cross-adaptive algorithms to perform real-time placement of sources in a stereo mix. A subjective evaluation test was devised to evaluate its quality against human panning. It was shown that the automatic panning technique performed better than a nonexpert and showed no significant statistical difference to the performance of a professional mixing engineer.

  10. Dry and mixed air cooling systems

    International Nuclear Information System (INIS)

    Gutner, Gidali.

    1975-01-01

    The various dry air cooling systems now in use or being developed are classified. The main dimensioning parameters are specified and the main systems already built are given with their characteristics. The available data allow dry air cooling to be situated against the other cooling modes and so specify the aim of the research or currently developed works. Some systems at development stages are briefly described. The interest in mixed cooling (assisted draft) and the principal available systems is analyzed. A program of research is outlined [fr

  11. Numerical Simulation on the Performance of a Mixed-Flow Pump under Various Casing Structures

    Directory of Open Access Journals (Sweden)

    Wu Dazhuan

    2013-01-01

    Full Text Available With regard to the reactor coolant pump and high flow-rate circulating pump, the requirements on the compactness of the structure, safety, and hydraulic performance are particularly important. Thus, the mixed-flow pump with cylindrical casing is adopted in some occasions. Due to the different characteristics between the special cylindrical casing and the common pump casing, the influence of the special casing on a mixed-flow pump characteristics was numerically investigated to obtain better performance and flow structure in the casing. The results show that the models with cylindrical casing have much worse head and efficiency characteristics than the experimental model, and this is caused by the flow in the pump casing. By moving the guide vanes half inside the pump casing, the efficiency gets improved while the low pressure zone at the corner of outlet pipe and pump casing disappeared. When the length of pump casing increases from the size equal to the diameter of outlet pipe to that larger than it, the efficiency drops obviously and the flow field in the outlet pipe improved without curved flow. In addition, the length of the pump casing has greater impacts on the pump performance than the radius of it.

  12. The European I-MOVE Multicentre 2013-2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2).

    LENUS (Irish Health Repository)

    Valenciano, Marta

    2015-06-04

    In the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013-2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013-2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.

  13. Multicentre prospective evaluation of implant-assisted mandibular removable partial dentures: surgical and prosthodontic outcomes.

    Science.gov (United States)

    Payne, Alan G T; Tawse-Smith, Andrew; Wismeijer, Daniel; De Silva, Rohana K; Ma, Sunyoung

    2017-01-01

    To determine implant survival and prosthodontic maintenance of implant-assisted mandibular removable partial dentures in a multicentre prospective study up to 10 years. Forty-eight participants with mandibular distal extension partial dentures were selected. A control group of 12 New Zealand participants had new conventional mandibular partial dentures made. Three test groups of 36 participants in New Zealand (n = 12), the Netherlands (n = 12) and Colombia (n = 12) had bilateral distal implants placed. Surgical and prosthodontic outcomes were documented with only healing caps placed (Stage 1) and with an attachment system (Stage 2). No implants failed after 3 years. Four late implant failures in three participants occurred in New Zealand (two unilateral implant failures after 5 and 8 years and two bilateral implant failures in the same participant after 6 and 10 years); two unilateral late implant failures occurred in the Netherlands and no late failures in Colombia. Implant survival rate was 92% by 10 years. Resonance frequency measurements were taken at surgery implant stability quotient (ISQ) 62.44 ± 7.46; range 40 - 79), baseline (ISQ 63.22 ± 6.17; range 50 - 74) and after 3 years (ISQ 66.38 ± 6.77; range 55 - 83). In New Zealand and Colombia, measured crestal bone levels were 2.03 ± 0.71 mm and 2.20 ± 0.81 mm, respectively, at baseline and 3 years. For Stage I, principal prosthodontic maintenance issues were loose healing caps among 10 New Zealand participants, four Colombian participants and one Netherlands participant. For Stage 2, matrix activation and overdenture puncture fractures resulted in 41 events (25 participants) in New Zealand over 10 years, whilst over 3 years, there were 14 events in nine Colombian participants and six events in five Netherlands participants. This clinical multicentre research complements previous case reports, case series, retrospective and prospective studies on the notion of implant

  14. The prevalence of lymphogranuloma venereum infection in men who have sex with men: results of a multicentre case finding study

    Science.gov (United States)

    Ward, H; Alexander, S; Carder, C; Dean, G; French, P; Ivens, D; Ling, C; Paul, J; Tong, W; White, J; Ison, C A

    2009-01-01

    Objective: To determine the prevalence of lymphogranuloma venereum (LGV) and non-LGV associated serovars of urethral and rectal Chlamydia trachomatis (CT) infection in men who have sex with men (MSM). Design: Multicentre cross-sectional survey. Setting: Four genitourinary medicine clinics in the United Kingdom from 2006–7. Subjects: 4825 urethral and 6778 rectal samples from consecutive MSM attending for sexual health screening. Methods: Urethral swabs or urine and rectal swabs were tested for CT using standard nucleic acid amplification tests. Chlamydia-positive specimens were sent to the reference laboratory for serovar determination. Main outcome: Positivity for both LGV and non-LGV associated CT serovars; proportion of cases that were symptomatic. Results: The positivity (with 95% confidence intervals) in rectal samples was 6.06% (5.51% to 6.66%) for non-LGV CT and 0.90% (0.69% to 1.16%) for LGV; for urethral samples 3.21% (2.74% to 3.76%) for non-LGV CT and 0.04% (0.01% to 0.16%) for LGV. The majority of LGV was symptomatic (95% of rectal, one of two urethral cases); non-LGV chlamydia was mostly symptomatic in the urethra (68%) but not in the rectum (16%). Conclusions: Chlamydial infections are common in MSM attending for sexual health screening, and the majority are non-LGV associated serovars. We did not identify a large reservoir of asymptomatic LGV in the rectum or urethra. Testing for chlamydia from the rectum and urethra should be included for MSM requesting a sexual health screen, but serovar-typing is not indicated in the absence of symptoms. We have yet to identify the source of most cases of LGV in the UK. PMID:19221105

  15. CORMIX2: An expert system for hydrodynamic mixing zone analysis of conventional and toxic multiport diffuser discharges

    International Nuclear Information System (INIS)

    Akar, P.J.; Jirka, G.H.

    1991-12-01

    One of the most important tasks in the management of water quality is the ability to achieve pollutant concentrations within regulated standards. The Cornell Mixing Zone Expert System (CORMIX) is a series of software systems for the analysis, prediction, and design of aqueous toxic or conventional pollutant discharges into watercourses, with emphasis on the geometry and dilution characteristics of the initial mixing zone. The present development, subsystem CORMIX2 is concerned with submerged multiport discharges into flowing water environments, such as rivers, lakes, estuaries, and coastal waters. It includes effects of ambient stratification, dynamic attachment of the plume to the bottom of the receiving water, and the limiting case of stagnant conditions

  16. Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

    Science.gov (United States)

    2017-11-07

    This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

  17. PREVAIL TRANSAPICAL: multicentre trial of transcatheter aortic valve implantation using the newly designed bioprosthesis (SAPIEN-XT) and delivery system (ASCENDRA-II).

    Science.gov (United States)

    Walther, Thomas; Thielmann, Matthias; Kempfert, Joerg; Schroefel, Holger; Wimmer-Greinecker, Gerhard; Treede, Hendrik; Wahlers, Thorsten; Wendler, Olaf

    2012-08-01

    Transapical (TA) aortic valve implantation (AVI) has evolved as an alternative procedure for high-risk patients. We evaluated the second-generation SAPIEN XT™ prosthesis in a prospective multicentre clinical trial. A total of 150 patients (age: 81.6 ± 5.8 years; 40.7% female) were included. Prosthetic valves (diameter: 23 mm (n = 36), 26 mm (n = 57) and 29 mm (n = 57)) were implanted. The ASCENDRA-II™ modified delivery system was used in the smaller sizes. Mean logistic EuroSCORE was 24.3 ± 7.0%, and mean STS score 7.5 ± 4.4%. All patients gave written informed consent. Off-pump AVI was performed using femoral arterial and venous access wires as a safety net. All but two patients received TA-AVI, as planned. The 29-mm valve showed similar function as the values of two other diameters did. Three patients (2%) required temporary cardiopulmonary bypass support. Postoperative complications included renal failure requiring long-term dialysis in four, bleeding requiring rethoracotomy in four, respiratory complication requiring reintubation in eight and sepsis in four patients, respectively. Thirty-day mortality was 13 (8.7%) for the total cohort and 2/57 (3.5%) for patients receiving the 29-mm valve, respectively. Echocardiography at discharge showed none or trivial aortic incompetence (AI) in 71% and mild-AI in 22% of the patients. Post-implantation AI was predominantly paravalvular and ≥ 2+ in 7% of patients. One patient required reoperation for AI within 30 days. The PREVAIL TA multicentre trial demonstrates good functionality and good outcomes for TA-AVI, using the SAPIEN XT™ prosthesis and its second-generation ASCENDRA-II™ delivery system, as well successful introduction of the 29-mm SAPIEN XT™ valve for the benefit of high-risk elderly patients.

  18. CFD simulation for thermal mixing of a SMART flow mixing header assembly

    International Nuclear Information System (INIS)

    Kim, Young In; Bae, Youngmin; Chung, Young Jong; Kim, Keung Koo

    2015-01-01

    Highlights: • Thermal mixing performance of a FMHA installed in SMART is investigated numerically. • Effects of operating condition and discharge hole configuration are examined. • FMHA performance satisfies the design requirements under various abnormal conditions. - Abstract: A flow mixing header assembly (FMHA) is installed in a system-integrated modular advanced reactor (SMART) to enhance the thermal mixing capability and create a uniform core flow distribution under both normal operation and accident conditions. In this study, the thermal mixing characteristics of the FMHA are investigated for various steam generator conditions using a commercial CFD code. Simulations include investigations for the effects of FMHA discharge flow rate differences, turbulence models, and steam generator conditions. The results of the analysis show that the FMHA works effectively for thermal mixing in various conditions and makes the temperature difference at the core inlet decrease noticeably. We verified that the mixing capability of the FMHA is excellent and satisfies the design requirement in all simulation cases tested here

  19. Are mixed electoral systems the best choice for central and Eastern Europe or the reason for defective party systems?

    DEFF Research Database (Denmark)

    Bochsler, Daniel

    2009-01-01

    incentives of mixed electoral systems might hamper the stabilization and institutionalization of party systems in young democracies. Empirical results from 19 democracies in Central and Eastern Europe suggest that the learning and stabilization effect that is exerted through simple electoral systems fails...... under mixed systems. Using a variance model analysis, this study rejects the common belief that mixed systems lead to more moderate party systems with regards to party system fractionalization. Rather, outcomes under mixed systems vary much more widely than under proportional representation...

  20. Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection

    Directory of Open Access Journals (Sweden)

    Rachid Mahdoufi

    2017-07-01

    Full Text Available Introduction: Pyolaryngocele is a very rare and serious complication of laryngocele. It can present as deep neck space infection and mislead the diagnosis. Our aim is to bring this unusual entity to the attention of surgeons and describe its clinical features. Case Report: We report a case of a 45-year-old male patient with a five-week history of neck swelling, dysphonia, dyspnea and odynophagia. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of a high dose antibiotic and an excision of the residual laryngocele via an external approach. Conclusion: A pyolaryngocele is an unusual complication of laryngocele, which becomes secondarily infected, causing many symptoms. Removing the laryngocele is still the best treatment option to prevent this complication and recurrence.

  1. Thrombotic Thrombocytopenic Purpura Associated with Mixed Connective Tissue Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    João Tadeu Damian Souto Filho

    2011-01-01

    Full Text Available Thrombotic thrombocytopenic purpura (TTP is a multisystemic disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia, which may be accompanied by fever, renal, or neurologic abnormalities. Cases are divided into acute idiopathic TTP and secondary TTP. Autoimmune diseases, especially systemic lupus erythematosus, in association with TTP have been described so far in many patients. In contrast, TTP occurring in a patient with mixed connected tissue disease (MCTD is extremely rare and has only been described in nine patients. We describe the case of a 42-year-old female with MCTD who developed thrombocytopenia, microangiopathic hemolytic anemia, fever, and neurological symptoms. The patient had a good clinical evolution with infusion of high volume of fresh frozen plasma, steroid therapy, and support in an intensive care unit. Although the occurrence of TTP is rare in MCTD patients, it is important to recognize TTP as a cause of thrombocytopenia and hemolytic anemia in any patient with autoimmune diseases. Prompt institution of treatment remains the cornerstone of treatment of TTP even if plasma exchange is not available like what frequently happens in developing countries.

  2. Cohesive and mixed sediment in the Regional Ocean Modeling System (ROMS v3.6 implemented in the Coupled Ocean–Atmosphere–Wave–Sediment Transport Modeling System (COAWST r1234

    Directory of Open Access Journals (Sweden)

    C. R. Sherwood

    2018-05-01

    Full Text Available We describe and demonstrate algorithms for treating cohesive and mixed sediment that have been added to the Regional Ocean Modeling System (ROMS version 3.6, as implemented in the Coupled Ocean–Atmosphere–Wave–Sediment Transport Modeling System (COAWST Subversion repository revision 1234. These include the following: floc dynamics (aggregation and disaggregation in the water column; changes in floc characteristics in the seabed; erosion and deposition of cohesive and mixed (combination of cohesive and non-cohesive sediment; and biodiffusive mixing of bed sediment. These routines supplement existing non-cohesive sediment modules, thereby increasing our ability to model fine-grained and mixed-sediment environments. Additionally, we describe changes to the sediment bed layering scheme that improve the fidelity of the modeled stratigraphic record. Finally, we provide examples of these modules implemented in idealized test cases and a realistic application.

  3. Prospective evaluation of the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Response Criteria (INRC) in a multicentre setting.

    Science.gov (United States)

    Castel, V; García-Miguel, P; Cañete, A; Melero, C; Navajas, A; Ruíz-Jiménez, J I; Navarro, S; Badal, M D

    1999-04-01

    The aim of this study was to classify prospectively a series of neuroblastoma tumours according to the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Response Criteria (INRC) and to evaluate the difficulties and pitfalls involved in a multicentre setting. Each hospital provided their data for central review. The surgical procedures and their complications were reported. Kaplan-Meier estimates of survival and event-free survival were calculated according to stage and response to therapy. From June 1992 to December 1996, 194 patients were included in the study, with a mean age of 2 years. Initial studies were performed according to INSS recommendations without major problems. INSS stage was correctly applied to all patients except for 9 (95%). Post-operative complications were observed in 15 patients (8.3%). Response to therapy (INRC) was studied in 63 stage 4 patients, 11 of whom were not classified correctly (17%). Differences in survival according to stage (INSS) and group of response to therapy (INRC) were statistically significant (P INSS was easy to use and separated different prognostic groups. Surgical complications and mortality did not increase in this series because of using the INSS. The feasibility of INRC was evaluated in a small series of stage 4 patients and the designation of response was problematic in a relatively high proportion of cases. The prognostic value of the different responses was highly significant, but less informative than had been hoped for.

  4. The Engineering of Mixed Reality Systems

    Science.gov (United States)

    Dubois, Emmanuel; Gray, Philip; Nigay, Laurence

    Human-Computer Interaction (HCI) is no longer restricted to interaction between users and computers via keyboard and screen: Currently one of the most challenging aspects of interactive systems is the integration of the physical and digital aspects of interaction in a smooth and usable way. The design challenge of such mixed reality (MR) systems lies in the fluid and harmonious fusion of the physical and digital worlds. Examples of MR systems include tangible user interfaces, augmented reality, augmented virtuality and embodied interfaces. The diversity of terms highlights the ever growing interest in MR systems and the very dynamic and challenging domain they define.

  5. Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

    Science.gov (United States)

    Lee, Alexander D; Yu, Alexander; Young, Shayne B; Battaglia, Patrick J; Ho, C John

    2015-01-01

    Omohyoid muscle syndrome is a rare cause of an X-shaped bulging lateral neck mass that occurs on swallowing. This is a diagnostic case report of a 22-year-old mixed martial arts athlete who acquired this condition. © 2014 The Author(s).

  6. Revisiting the Robustness of PET-Based Textural Features in the Context of Multi-Centric Trials.

    Science.gov (United States)

    Bailly, Clément; Bodet-Milin, Caroline; Couespel, Solène; Necib, Hatem; Kraeber-Bodéré, Françoise; Ansquer, Catherine; Carlier, Thomas

    2016-01-01

    This study aimed to investigate the variability of textural features (TF) as a function of acquisition and reconstruction parameters within the context of multi-centric trials. The robustness of 15 selected TFs were studied as a function of the number of iterations, the post-filtering level, input data noise, the reconstruction algorithm and the matrix size. A combination of several reconstruction and acquisition settings was devised to mimic multi-centric conditions. We retrospectively studied data from 26 patients enrolled in a diagnostic study that aimed to evaluate the performance of PET/CT 68Ga-DOTANOC in gastro-entero-pancreatic neuroendocrine tumors. Forty-one tumors were extracted and served as the database. The coefficient of variation (COV) or the absolute deviation (for the noise study) was derived and compared statistically with SUVmax and SUVmean results. The majority of investigated TFs can be used in a multi-centric context when each parameter is considered individually. The impact of voxel size and noise in the input data were predominant as only 4 TFs presented a high/intermediate robustness against SUV-based metrics (Entropy, Homogeneity, RP and ZP). When combining several reconstruction settings to mimic multi-centric conditions, most of the investigated TFs were robust enough against SUVmax except Correlation, Contrast, LGRE, LGZE and LZLGE. Considering previously published results on either reproducibility or sensitivity against delineation approach and our findings, it is feasible to consider Homogeneity, Entropy, Dissimilarity, HGRE, HGZE and ZP as relevant for being used in multi-centric trials.

  7. Incineration systems for low level and mixed wastes

    International Nuclear Information System (INIS)

    Vavruska, J.

    1986-01-01

    A variety of technologies has emerged for incineration of combustible radioactive, hazardous, and mixed wastes. Evaluation and selection of an incineration system for a particular application from such a large field of options are often confusing. This paper presents several current incineration technologies applicable to Low Level Waste (LLW), hazardous waste, and mixed waste combustion treatment. The major technologies reviewed include controlled-air, rotary kiln, fluidized bed, and liquid injection. Coupled with any incineration technique is the need to select a compatible offgas effluent cleaning system. This paper also reviews the various methods of treating offgas emissions for acid vapor, particulates, organics, and radioactivity. Such effluent control systems include the two general types - wet and dry scrubbing with a closer look at quenching, inertial systems, fabric filtration, gas absorption, adsorption, and various other filtration techniques. Selection criteria for overall waste incineration systems are discussed as they relate to waste characterization

  8. Nonideal mixing in multicomponent lipid/detergent systems

    International Nuclear Information System (INIS)

    Tsamaloukas, Alekos; Szadkowska, Halina; Heerklotz, Heiko

    2006-01-01

    A detailed understanding of the mixing properties of membranes to which detergents are added is mandatory for improving the application and interpretation of detergent based protein or lipid extraction assays. For Triton X-100 (TX-100), a nonionic detergent frequently used in the process of solubilizing and purifying membrane proteins and lipids, we present here a detailed study of the mixing properties of binary and ternary lipid mixtures by means of high-sensitivity isothermal titration calorimetry (ITC). To this end the partitioning thermodynamics of TX-100 molecules from the aqueous phase to lipid bilayers composed of various mixtures of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC), egg-sphingomyelin (SM), and cholesterol (cho) are characterized. Composition-dependent partition coefficients K are analysed within the frame of a thermodynamic model developed to describe nonideal mixing in multicomponent lipid/detergent systems. The results imply that POPC, fluid SM, and TX-100 mix almost ideally (nonideality parameters ρ α/β SM/cho ≤-6RT) and unfavourable PC/cho interactions (ρ PC/cho = 2RT) may under certain conditions cause POPC/TX-100-enriched domains to segregate from SM/cho-enriched ones. TX-100/cho contacts are unfavourable (ρ cho/TX = 4RT), so the system tends to avoid them. That means, addition of TX-100 promotes the separation of SM/cho-rich from PC/TX-100-rich domains. It appears that cho/detergent interactions are crucial governing the abundance and composition of detergent-resistant membrane patches

  9. [Home health resource utilization measures using a case-mix adjustor model].

    Science.gov (United States)

    You, Sun-Ju; Chang, Hyun-Sook

    2005-08-01

    The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.

  10. A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews.

    Science.gov (United States)

    Pluye, Pierre; Gagnon, Marie-Pierre; Griffiths, Frances; Johnson-Lafleur, Janique

    2009-04-01

    A new form of literature review has emerged, Mixed Studies Review (MSR). These reviews include qualitative, quantitative and mixed methods studies. In the present paper, we examine MSRs in health sciences, and provide guidance on processes that should be included and reported. However, there are no valid and usable criteria for concomitantly appraising the methodological quality of the qualitative, quantitative and mixed methods studies. To propose criteria for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies or study components. A three-step critical review was conducted. 2322 references were identified in MEDLINE, and their titles and abstracts were screened; 149 potentially relevant references were selected and the full-text papers were examined; 59 MSRs were retained and scrutinized using a deductive-inductive qualitative thematic data analysis. This revealed three types of MSR: convenience, reproducible, and systematic. Guided by a proposal, we conducted a qualitative thematic data analysis of the quality appraisal procedures used in the 17 systematic MSRs (SMSRs). Of 17 SMSRs, 12 showed clear quality appraisal procedures with explicit criteria but no SMSR used valid checklists to concomitantly appraise qualitative, quantitative and mixed methods studies. In two SMSRs, criteria were developed following a specific procedure. Checklists usually contained more criteria than needed. In four SMSRs, a reliability assessment was described or mentioned. While criteria for quality appraisal were usually based on descriptors that require specific methodological expertise (e.g., appropriateness), no SMSR described the fit between reviewers' expertise and appraised studies. Quality appraisal usually resulted in studies being ranked by methodological quality. A scoring system is proposed for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies for SMSRs. This

  11. Ethical dilemmas of a large national multi-centre study in Australia: time for some consistency.

    Science.gov (United States)

    Driscoll, Andrea; Currey, Judy; Worrall-Carter, Linda; Stewart, Simon

    2008-08-01

    To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits

  12. [Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)].

    Science.gov (United States)

    Rodríguez-Hernández, M Jesús; Ruiz-Pérez de Pipaon, Maite; Márquez-Solero, Manuel; Martín-Rico, Patricia; Castón-Osorio, Juan José; Guerrero-Sánchez, Francisca M; Vidal-Verdú, Elisa; García-Figueras, Carolina; Del Arco-Jiménez, Alfonso; Rodríguez-Baño, Jesús; Martín-Mazuelos, Estrella; Cisneros-Herreros, José Miguel

    2011-05-01

    Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  13. Development of a fully automated online mixing system for SAXS protein structure analysis

    DEFF Research Database (Denmark)

    Nielsen, Søren Skou; Arleth, Lise

    2010-01-01

    This thesis presents the development of an automated high-throughput mixing and exposure system for Small-Angle Scattering analysis on a synchrotron using polymer microfluidics. Software and hardware for both automated mixing, exposure control on a beamline and automated data reduction...... and preliminary analysis is presented. Three mixing systems that have been the corner stones of the development process are presented including a fully functioning high-throughput microfluidic system that is able to produce and expose 36 mixed samples per hour using 30 μL of sample volume. The system is tested...

  14. Case-mix adjustment approach to benchmarking prevalence rates of nosocomial infection in hospitals in Cyprus and Greece.

    Science.gov (United States)

    Kritsotakis, Evangelos I; Dimitriadis, Ioannis; Roumbelaki, Maria; Vounou, Emelia; Kontou, Maria; Papakyriakou, Panikos; Koliou-Mazeri, Maria; Varthalitis, Ioannis; Vrouchos, George; Troulakis, George; Gikas, Achilleas

    2008-08-01

    To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection. Cross-sectional survey. Eleven hospitals located in Cyprus and in the region of Crete in Greece. The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe-Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.Results. The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%-8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%-9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1-6.1]). The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.

  15. Rural and Urban Differences in Vocational Rehabilitation Case Mix, Delivery Practices, and Employment Outcomes

    Science.gov (United States)

    Ipsen, Catherine; Swicegood, Grant

    2015-01-01

    Purpose: To examine rural and urban differences in Vocational Rehabilitation (VR) case mix, delivery practices, and employment outcomes. Methods: Rehabilitation Services Administration 911 (RSA-911) case data do not include location indicators that allow for rural analyses. We compiled RSA-911 data with county and ZIP code information from 47 VR…

  16. Case studies of corrosion of mixed waste and transuranic waste drums

    International Nuclear Information System (INIS)

    Kosiewicz, S.T.

    1993-01-01

    This paper presents three case studies of corrosion of waste drums at the Los Alamos National Laboratory (LANL). Corrosion was not anticipated by the waste generators, but occurred because of subtle chemical or physical mechanisms. In one case, drums of a cemented transuranic (TRU) sludge experienced general and pitting corrosion. In the second instance, a chemical from a commercial paint stripper migrated from its primary containment drums to chemically attack overpack drums made of mild carbon steel. In the third case, drums of mixed low level waste (MLLW) soil corroded drum packaging even though the waste appeared to be dry when it was placed in the drums. These case studies are jointly discussed as ''lessons learned'' to enhance awareness of subtle mechanisms that can contribute to the corrosion of radioactive waste drums during interim storage

  17. [A case of mixed adenoneuroendocrine carcinoma of the transverse colon].

    Science.gov (United States)

    Kusakabe, Jiro; Miki, Akira; Kobayashi, Hiroyuki; Uryuhara, Kenji; Hashida, Hiroki; Mizumoto, Masaki; Kaihara, Satoshi; Hosotani, Ryo; Yamashita, Daisuke

    2014-11-01

    A 7 1-year-old man presented to our hospital with constipation and abdominal pain. Computed tomography of the abdomen and colonoscopy revealed advanced cancer of the transverse colon. The biopsy specimen indicated a highly differentiated adenocarcinoma. The patient underwent extended right hemicolectomy with regional lymph node dissection. Pathological examination showed a neuroendocrine carcinoma (NEC) with concurrent adenocarcinoma of the transverse colon and regional lymph node metastases of the NEC and adenocarcinoma. The histopathological examination confirmed a diagnosis of mixed adenoneuroendocrine carcinoma (MANEC) in accordance with the 2010 WHO Classification of Tumors of the Digestive System. Liver and lung metastases were identified 8 months after the surgery. We administered chemotherapy including 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX) plus bevacizumab, with limited therapeutic effect, as the disease progressed despite treatment. The patient chose best supportive care 13 months after the surgery. Several studies have reported that most patients with adenoendocrine cell carcinoma, including MANEC, experience relapse within 1 year after surgery, and few patients remain disease-free for long periods after surgery. The optimal strategy for the management of MANEC is variable owing to its rarity; only 2 cases of MANEC in the colon, including the present case, have been reported in Japan. It is thus important to gather more evidence on this disease and its management.

  18. The "Nursing Home Compare" measure of urinary/fecal incontinence: cross-sectional variation, stability over time, and the impact of case mix.

    Science.gov (United States)

    Li, Yue; Schnelle, John; Spector, William D; Glance, Laurent G; Mukamel, Dana B

    2010-02-01

    To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R(2) were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R(2)case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.

  19. A comparison of functional outcome in patients sustaining major trauma: a multicentre, prospective, international study.

    Directory of Open Access Journals (Sweden)

    Timothy H Rainer

    Full Text Available OBJECTIVES: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. SUMMARY BACKGROUND DATA: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR. METHODS: Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE functional outcome and risk-adjusted Short-Form 12 (SF-12 health status at 6 and 12 months after injury. RESULTS: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17, and at 12 months was 0.83 (95% CI: 0.60, 1.12. Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6 and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4 compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8 or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5. CONCLUSION: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

  20. A Comparison of Functional Outcome in Patients Sustaining Major Trauma: A Multicentre, Prospective, International Study

    Science.gov (United States)

    Rainer, Timothy H.; Yeung, Hiu Hung; Gabbe, Belinda J.; Yuen, Kai Y.; Ho, Hiu F.; Kam, Chak W.; Chang, Annice; Poon, Wai S.; Cameron, Peter A.; Graham, Colin A.

    2014-01-01

    Objectives To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. Summary Background Data Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). Methods Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. Results 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: −1.2, 3.6) and 12-months (adjusted mean difference: −0.4, 95% CI: −3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: −2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: −0.8, 4.5). Conclusion The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions. PMID:25157522

  1. Purists need not apply: the case for pragmatism in mixed methods research.

    Science.gov (United States)

    Florczak, Kristine L

    2014-10-01

    The purpose of this column is to describe several different ways of conducting mixed method research. The paradigms that underpin both qualitative and quantitative research are also considered along with a cursory review of classical pragmatism as it relates conducting mixed methods studies. Finally, the idea of loosely coupled systems as a means to support mixed methods studies is proposed along with several caveats to researchers who desire to use this new way of obtaining knowledge. © The Author(s) 2014.

  2. Transportable Vitrification System: Operational experience gained during vitrification of simulated mixed waste

    International Nuclear Information System (INIS)

    Whitehouse, J.C.; Burket, P.R.; Crowley, D.A.; Hansen, E.K.; Jantzen, C.M.; Smith, M.E.; Singer, R.P.; Young, S.R.; Zamecnik, J.R.; Overcamp, T.J.; Pence, I.W. Jr.

    1996-01-01

    The Transportable Vitrification System (TVS) is a large-scale, fully-integrated, transportable, vitrification system for the treatment of low-level nuclear and mixed wastes in the form of sludges, soils, incinerator ash, and similar waste streams. The TVS was built to demonstrate the vitrification of actual mixed waste at U. S. Department of Energy (DOE) sites. Currently, Westinghouse Savannah River Company (WSRC) is working with Lockheed Martin Energy Systems (LMES) to apply field scale vitrification to actual mixed waste at Oak Ridge Reservation's (ORR) K-25 Site. Prior to the application of the TVS to actual mixed waste it was tested on simulated K-25 B and C Pond waste at Clemson University. This paper describes the results of that testing and preparations for the demonstration on actual mixed waste

  3. Modal and Mixed Specifications: Key Decision Problems and their Complexities

    DEFF Research Database (Denmark)

    Antonik, Adam; Huth, Michael; Larsen, Kim Guldstrand

    2010-01-01

    , and whether all implementations of one specification are implementations of another one. For each of these decision problems we investigate the worst-case computational complexity for the modal and mixed case. We show that the first decision problem is EXPTIME-complete for modal as well as for mixed......Modal and mixed transition systems are specification formalisms that allow mixing of over- and under-approximation. We discuss three fundamental decision problems for such specifications: whether a set of specifications has a common implementation, whether a sole specification has an implementation...... specifications. We prove that the second decision problem is EXPTIME-complete for mixed specifications (while it is known to be trivial for modal ones). The third decision problem is furthermore demonstrated to be EXPTIME-complete for mixed specifications....

  4. Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

    Science.gov (United States)

    Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H

    2008-12-01

    To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

  5. Measuring performance in health care: case-mix adjustment by boosted decision trees.

    Science.gov (United States)

    Neumann, Anke; Holstein, Josiane; Le Gall, Jean-Roger; Lepage, Eric

    2004-10-01

    The purpose of this paper is to investigate the suitability of boosted decision trees for the case-mix adjustment involved in comparing the performance of various health care entities. First, we present logistic regression, decision trees, and boosted decision trees in a unified framework. Second, we study in detail their application for two common performance indicators, the mortality rate in intensive care and the rate of potentially avoidable hospital readmissions. For both examples the technique of boosting decision trees outperformed standard prognostic models, in particular linear logistic regression models, with regard to predictive power. On the other hand, boosting decision trees was computationally demanding and the resulting models were rather complex and needed additional tools for interpretation. Boosting decision trees represents a powerful tool for case-mix adjustment in health care performance measurement. Depending on the specific priorities set in each context, the gain in predictive power might compensate for the inconvenience in the use of boosted decision trees.

  6. Memory controllers for mixed-time-criticality systems architectures, methodologies and trade-offs

    CERN Document Server

    Goossens, Sven; Akesson, Benny; Goossens, Kees

    2016-01-01

    This book discusses the design and performance analysis of SDRAM controllers that cater to both real-time and best-effort applications, i.e. mixed-time-criticality memory controllers. The authors describe the state of the art, and then focus on an architecture template for reconfigurable memory controllers that addresses effectively the quickly evolving set of SDRAM standards, in terms of worst-case timing and power analysis, as well as implementation. A prototype implementation of the controller in SystemC and synthesizable VHDL for an FPGA development board are used as a proof of concept of the architecture template.

  7. Revisiting the Robustness of PET-Based Textural Features in the Context of Multi-Centric Trials.

    Directory of Open Access Journals (Sweden)

    Clément Bailly

    Full Text Available This study aimed to investigate the variability of textural features (TF as a function of acquisition and reconstruction parameters within the context of multi-centric trials.The robustness of 15 selected TFs were studied as a function of the number of iterations, the post-filtering level, input data noise, the reconstruction algorithm and the matrix size. A combination of several reconstruction and acquisition settings was devised to mimic multi-centric conditions. We retrospectively studied data from 26 patients enrolled in a diagnostic study that aimed to evaluate the performance of PET/CT 68Ga-DOTANOC in gastro-entero-pancreatic neuroendocrine tumors. Forty-one tumors were extracted and served as the database. The coefficient of variation (COV or the absolute deviation (for the noise study was derived and compared statistically with SUVmax and SUVmean results.The majority of investigated TFs can be used in a multi-centric context when each parameter is considered individually. The impact of voxel size and noise in the input data were predominant as only 4 TFs presented a high/intermediate robustness against SUV-based metrics (Entropy, Homogeneity, RP and ZP. When combining several reconstruction settings to mimic multi-centric conditions, most of the investigated TFs were robust enough against SUVmax except Correlation, Contrast, LGRE, LGZE and LZLGE.Considering previously published results on either reproducibility or sensitivity against delineation approach and our findings, it is feasible to consider Homogeneity, Entropy, Dissimilarity, HGRE, HGZE and ZP as relevant for being used in multi-centric trials.

  8. Conundrums in mixed woody-herbaceous plant systems

    CSIR Research Space (South Africa)

    House, JI

    2003-11-01

    Full Text Available -form communities, the novel, complex, nonlinear behaviour of mixed tree-grass systems cannot be accounted for by simply studying or modelling woody and herbaceous components independently. A more robust understanding requires addressing three fundamental conundrums...

  9. Evaluating acute medical admissions through emergency departments in Hong Kong: can one adjust for case-mix variation?

    Science.gov (United States)

    Rainer, T H; Sollich, P; Piotrowski, T; Coolen, A C C; Cheng, B; Graham, C A

    2012-12-01

    Healthcare systems are under pressure to efficiently and safely reduce acute care admissions to hospital. There is a need to develop a standardised system for assessing emergency department performance which takes into account case-mix variation. The objective of this study was to derive and validate a standardised tool for assessing variations in medical admissions through emergency departments in Hong Kong. Retrospective study of patients attending emergency departments of 14 acute hospitals in Hong Kong. Data were retrieved from a centralised administrative database. Of 2,531,225 patients who attended emergency departments between 1 January 2001 and 31 December 2003, 780,444 (30.8%) were admitted to medical wards. A model derived from 2001 data shows well-calibrated admission probabilities, with an area under the receiver operating characteristic curve for probability of admission of 90.3 (95% CI ±0.11). The areas under the receiver operating characteristic curves for 2002 and 2003 validation sets were 89.9 (95% CI ±0.11) and 89.0 (95% CI ±0.12), respectively. With an averaged benchmark, reductions in medical admissions of up to 19% could be achieved, while under the most optimistic assumption, reductions of up 36% could be achieved. A tool for benchmarking hospital medical admissions and minimising case-mix variation has been derived and validated in Hong Kong, but it requires further validation in other healthcare systems given the wide variations in admission thresholds internationally. This may be used as one potential method to evaluate the performance of emergency departments against a common standard.

  10. Cover and liner system designs for mixed-waste disposal

    International Nuclear Information System (INIS)

    MacGregor, A.

    1994-01-01

    Land disposal of mixed waste is subject to a variety of regulations and requirements. Landfills will continue to be a part of waste management plans at virtually all facilities. New landfills are planned to serve the ongoing needs of the national laboratories and US Department of Energy (DOE) facilities, and environmental restoration wastes will ultimately need to be disposed in these landfills. This paper reviews the basic objectives of mixed-waste disposal and summarizes key constraints facing planners and designers of these facilities. Possible objectives of cover systems include infiltration reduction; maximization of evapotranspiration; use of capillary barriers or low-permeability layers (or combinations of all these); lateral drainage transmission; plant, animal, and/or human intrusion control; vapor/gas control; and wind and water erosion control. Liner system objectives will be presented, and will be compared to the US Environmental Protection Agency-US Nuclear Regulatory Commission guidance for mixed-waste landfills. The measures to accomplish each objective will be reviewed. Then, the design of several existing or planned mixed-waste facilities (DOE and commercial) will be reviewed to illustrate the application of the various functional objectives. Key issues will include design life and performance period as compared/contrasted to postclosure care periods, the use (or avoidance) of geosynthetics or clays, intermediate or interim cover systems, and soil erosion protection in contrast to vegetative enhancement. Possible monitoring approaches to cover systems and landfill installations will be summarized as well

  11. Diet and Pre-eclampsia: A Prospective Multicentre Case-Control Study in Ethiopia.

    Science.gov (United States)

    Endeshaw, Mulualem; Abebe, Fantu; Bedimo, Melkamu; Asart, Anemaw

    2015-06-01

    Pre-eclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20-80% of maternal mortality in developing countries, including Ethiopia. For many years, diet has been suggested to play a role in pre-eclampsia. However, the hypotheses have been diverse with inconsistent results across studies, and this has not been studied in Ethiopia. The objective of this study was to determine the effect of dietary habits on the incidence of pre-eclampsia in Bahir Dar, Ethiopia A prospective multicentre unmatched case-control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City from June to September 2014. The interviewer conducted a face-to-face interview, measured the mid-upper arm circumference (MUAC) and collected the mid-pregnancy haemoglobin level from clinical notes using a standardized and pretested questionnaire. Epi Info 3.5.3 was used for data entry and cleaning, while IBM SPSS Statistics 20 was used for data analysis. Backward stepwise unconditional logistic regression analysis was employed to determine the strength of association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P-value ≤0.05 was considered statistically significant. For every 1-cm increase of MUAC, there was an increase in the incidence rate of pre-eclampsia by a factor of 1.35 (adjusted odds ratio (AOR)=1.35, 95% confidence interval (CI): 1.21, 1.51). A higher incidence of pre-eclampsia was found in women who reported to have consumed coffee daily during pregnancy (AOR=1.78, 95% CI: 1.20, 3.05). Similarly, for women who had anaemia during the first trimester, the incidence of pre-eclampsia was 2.5 times higher than their counterparts (AOR=2.47, 95% CI: 1.12, 7.61). This study also revealed consumption of fruit or vegetables at least three times a week during pregnancy to be protective

  12. Mixed grazing systems benefit both upland biodiversity and livestock production.

    Directory of Open Access Journals (Sweden)

    Mariecia D Fraser

    Full Text Available With world food demand expected to double by 2050, identifying farming systems that benefit both agricultural production and biodiversity is a fundamentally important challenge for the 21(st century, but this has to be achieved in a sustainable way. Livestock grazing management directly influences both economic outputs and biodiversity on upland farms while contributing to potentially damaging greenhouse gas emissions, yet no study has attempted to address these impacts simultaneously.Using a replicated, landscape-scale field experiment consisting of five management 'systems' we tested the effects of progressively altering elements within an upland farming system, viz i incorporating cattle grazing into an upland sheep system, ii integrating grazing of semi-natural rough grazing into a mixed grazing system based on improved pasture, iii altering the stocking ratio within a mixed grazing system, and iv replacing modern crossbred cattle with a traditional breed. We quantified the impacts on livestock productivity and numbers of birds and butterflies over four years.We found that management systems incorporating mixed grazing with cattle improve livestock productivity and reduce methane emissions relative to sheep only systems. Systems that also included semi-natural rough grazing consistently supported more species of birds and butterflies, and it was possible to incorporate bouts of summer grazing of these pastures by cattle to meet habitat management prescriptions without compromising cattle performance overall. We found no evidence that the system incorporating a cattle breed popular as a conservation grazer was any better for bird and butterfly species richness than those based on a mainstream breed, yet methane emissions from such a system were predicted to be higher. We have demonstrated that mixed upland grazing systems not only improve livestock production, but also benefit biodiversity, suggesting a 'win-win' solution for farmers and

  13. Data collection using open access technology in multicentre operational research involving patient interviews.

    Science.gov (United States)

    Shewade, H D; Chadha, S S; Gupta, V; Tripathy, J P; Satyanarayana, S; Sagili, K; Mohanty, S; Bera, O P; Pandey, P; Rajeswaran, P; Jayaraman, G; Santhappan, A; Bajpai, U N; Mamatha, A M; Maiser, R; Naqvi, A J; Pandurangan, S; Nath, S; Ghule, V H; Das, A; Prasad, B M; Biswas, M; Singh, G; Mallick, G; Jeyakumar Jaisingh, A J; Rao, R; Kumar, A M V

    2017-03-21

    Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

  14. Property-Based Monitoring of Analog and Mixed-Signal Systems

    Science.gov (United States)

    Havlicek, John; Little, Scott; Maler, Oded; Nickovic, Dejan

    In the recent past, there has been a steady growth of the market for consumer embedded devices such as cell phones, GPS and portable multimedia systems. In embedded systems, digital, analog and software components are combined on a single chip, resulting in increasingly complex designs that introduce richer functionality on smaller devices. As a consequence, the potential insertion of errors into a design becomes higher, yielding an increasing need for automated analog and mixed-signal validation tools. In the purely digital setting, formal verification based on properties expressed in industrial specification languages such as PSL and SVA is nowadays successfully integrated in the design flow. On the other hand, the validation of analog and mixed-signal systems still largely depends on simulation-based, ad-hoc methods. In this tutorial, we consider some ingredients of the standard verification methodology that can be successfully exported from digital to analog and mixed-signal setting, in particular property-based monitoring techniques. Property-based monitoring is a lighter approach to the formal verification, where the system is seen as a "black-box" that generates sets of traces, whose correctness is checked against a property, that is its high-level specification. Although incomplete, monitoring is effectively used to catch faults in systems, without guaranteeing their full correctness.

  15. Fuel injection and mixing systems having piezoelectric elements and methods of using the same

    Science.gov (United States)

    Mao, Chien-Pei [Clive, IA; Short, John [Norwalk, IA; Klemm, Jim [Des Moines, IA; Abbott, Royce [Des Moines, IA; Overman, Nick [West Des Moines, IA; Pack, Spencer [Urbandale, IA; Winebrenner, Audra [Des Moines, IA

    2011-12-13

    A fuel injection and mixing system is provided that is suitable for use with various types of fuel reformers. Preferably, the system includes a piezoelectric injector for delivering atomized fuel, a gas swirler, such as a steam swirler and/or an air swirler, a mixing chamber and a flow mixing device. The system utilizes ultrasonic vibrations to achieve fuel atomization. The fuel injection and mixing system can be used with a variety of fuel reformers and fuel cells, such as SOFC fuel cells.

  16. Mixed Reality Systems

    OpenAIRE

    Dieter Müller

    2009-01-01

    Currently one of the most challenging aspects of human computer interaction design is the integration of physical and digital worlds in a single environment. This fusion involves the development of "Mixed Reality Systems”, including various technologies from the domains of augmented and virtual reality. In this paper I will present related concepts and discuss lessons learned from our own research and prototype development. Our recent work involves the use of mixed reality (as opposed to ‘pur...

  17. RSW-MCFP: A Resource-Oriented Solid Waste Management System for a Mixed Rural-Urban Area through Monte Carlo Simulation-Based Fuzzy Programming

    Directory of Open Access Journals (Sweden)

    P. Li

    2013-01-01

    Full Text Available The growth of global population and economy continually increases the waste volumes and consequently creates challenges to handle and dispose solid wastes. It becomes more challenging in mixed rural-urban areas (i.e., areas of mixed land use for rural and urban purposes where both agricultural waste (e.g., manure and municipal solid waste are generated. The efficiency and confidence of decisions in current management practices significantly rely on the accurate information and subjective judgments, which are usually compromised by uncertainties. This study proposed a resource-oriented solid waste management system for mixed rural-urban areas. The system is featured by a novel Monte Carlo simulation-based fuzzy programming approach. The developed system was tested by a real-world case with consideration of various resource-oriented treatment technologies and the associated uncertainties. The modeling results indicated that the community-based bio-coal and household-based CH4 facilities were necessary and would become predominant in the waste management system. The 95% confidence intervals of waste loadings to the CH4 and bio-coal facilities were 387, 450 and 178, 215 tonne/day (mixed flow, respectively. In general, the developed system has high capability in supporting solid waste management for mixed rural-urban areas in a cost-efficient and sustainable manner under uncertainty.

  18. Spoofing cyber attack detection in probe-based traffic monitoring systems using mixed integer linear programming

    KAUST Repository

    Canepa, Edward S.

    2013-01-01

    Traffic sensing systems rely more and more on user generated (insecure) data, which can pose a security risk whenever the data is used for traffic flow control. In this article, we propose a new formulation for detecting malicious data injection in traffic flow monitoring systems by using the underlying traffic flow model. The state of traffic is modeled by the Lighthill-Whitham- Richards traffic flow model, which is a first order scalar conservation law with concave flux function. Given a set of traffic flow data, we show that the constraints resulting from this partial differential equation are mixed integer linear inequalities for some decision variable. We use this fact to pose the problem of detecting spoofing cyber-attacks in probe-based traffic flow information systems as mixed integer linear feasibility problem. The resulting framework can be used to detect spoofing attacks in real time, or to evaluate the worst-case effects of an attack offline. A numerical implementation is performed on a cyber-attack scenario involving experimental data from the Mobile Century experiment and the Mobile Millennium system currently operational in Northern California. © 2013 IEEE.

  19. Spoofing cyber attack detection in probe-based traffic monitoring systems using mixed integer linear programming

    KAUST Repository

    Canepa, Edward S.

    2013-09-01

    Traffic sensing systems rely more and more on user generated (insecure) data, which can pose a security risk whenever the data is used for traffic flow control. In this article, we propose a new formulation for detecting malicious data injection in traffic flow monitoring systems by using the underlying traffic flow model. The state of traffic is modeled by the Lighthill- Whitham-Richards traffic flow model, which is a first order scalar conservation law with concave flux function. Given a set of traffic flow data generated by multiple sensors of different types, we show that the constraints resulting from this partial differential equation are mixed integer linear inequalities for a specific decision variable. We use this fact to pose the problem of detecting spoofing cyber attacks in probe-based traffic flow information systems as mixed integer linear feasibility problem. The resulting framework can be used to detect spoofing attacks in real time, or to evaluate the worst-case effects of an attack offliine. A numerical implementation is performed on a cyber attack scenario involving experimental data from the Mobile Century experiment and the Mobile Millennium system currently operational in Northern California. © American Institute of Mathematical Sciences.

  20. Optimizing the strategic patient mix

    NARCIS (Netherlands)

    Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.

    In this paper we address the decision of choosing a patient mix for a hospital that leads to the most beneficial treatment case mix. We illustrate how capacity, case mix and patient mix decisions are interrelated and how understanding this complex relationship is crucial for achieving the maximum

  1. Mixed vascular nevus syndrome: a report of four new cases and a literature review.

    Science.gov (United States)

    Ruggieri, Martino; Polizzi, Agata; Strano, Serena; Schepis, Carmelo; Morano, Massimiliano; Belfiore, Giuseppe; Palmucci, Stefano; Foti, Pietro Valerio; Pirrone, Concetta; Sofia, Vito; David, Emanuele; Salpietro, Vincenzo; Mankad, Kshitij; Milone, Pietro

    2016-10-01

    Mixed vascular nevus (or nevus vascularis mixtus) represents an admixture of cutaneous vascular malformations of the telangiectatic type and angiospastic spots of nevus anemicus. It can occur as an purely cutaneous trait or as a hallmark of a neurocutaneous phenotype (mixed vascular nevus syndrome) characterised by the combination of: (I) paired vascular (telangiectatic and anemic) twin nevi and brain abnormalities of the Dyke-Davidoff-Masson type (i.e., crossed cerebral/cerebellar hemiatrophy with hypoplasia of the ipsilateral cerebral vessels and homolateral hypertrophy of the skull and sinuses (hyperpneumatisation) with contralateral hemispheric hypertrophy); or (II) paired vascular twin nevi and brain malformations of the Dyke-Davidoff-Masson type in association with systemic abnormalities consisting in facial asymmetry, skeletal anomalies (i.e., Legg-Calvé-Perthes-like disease) and disorders of autoimmunity (i.e., diabetes, thyroiditis). In 2014, Happle proposed to name the syndrome with the eponym Ruggieri-Leech syndrome. Review of the existing literature on nevus vascularis mixtus and information on our personal experience on new cases and follow-up of previously reported cases by some of us. The existing literature revealed 4 previous studies including 33 cases with an inferred purely cutaneous trait and 3 cases with a combination of paired vascular twin nevi and brain malformation of the Dyke-Davidoff-Masson type. Our personal experience includes 4 unpublished patients (1 female and 3 males; currently aged 2 to 34 years) seen and followed-up at our Institutions in Italy who had: paired vascular nevi involving either the face (n=2) or the face and parts of the body (n=2); facial asymmetry (n=4); mild to moderate facial dysmorphic features (n=2); developmental delay (n=3); seizures/stroke-like episodes and associated hemiplegia (n=4); muscular hypotrophy (n=2); mild to moderate hemispheric atrophy (n=4); skull osseous hypertrophy (n=4); hyperpneumatisation

  2. RKKY interaction in mixed valence system and heavy fermion superconductivity

    International Nuclear Information System (INIS)

    Fusui Liu; Gao Lin; Lin Zonghan

    1985-11-01

    The 1-D RKKY interaction of mixed valence system is given by using the thermodynamic perturbation theory. The numerical comparisons of 1-D and 3-D RKKY interaction between systems with localized magnetic moments of mixed valence and non-mixed valence show that the former is much stronger than the latter. From some analyses we propose that the heavy Fermion superconductivity comes from the RKKY interaction between two local f electrons which hop off the impurity site to become two continuum electrons. The source of the two impurity electrons hopping is the Coulomb interaction. It is also emphasized that the RKKY interaction does not disappear for the Kondo lattice, when the temperature is less than the Kondo temperature. (author)

  3. Classification of polynomial integrable systems of mixed scalar and vector evolution equations: I

    International Nuclear Information System (INIS)

    Tsuchida, Takayuki; Wolf, Thomas

    2005-01-01

    We perform a classification of integrable systems of mixed scalar and vector evolution equations with respect to higher symmetries. We consider polynomial systems that are homogeneous under a suitable weighting of variables. This paper deals with the KdV weighting, the Burgers (or potential KdV or modified KdV) weighting, the Ibragimov-Shabat weighting and two unfamiliar weightings. The case of other weightings will be studied in a subsequent paper. Making an ansatz for undetermined coefficients and using a computer package for solving bilinear algebraic systems, we give the complete lists of second-order systems with a third-order or a fourth-order symmetry and third-order systems with a fifth-order symmetry. For all but a few systems in the lists, we show that the system (or, at least a subsystem of it) admits either a Lax representation or a linearizing transformation. A thorough comparison with recent work of Foursov and Olver is made

  4. Classification of polynomial integrable systems of mixed scalar and vector evolution equations: I

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchida, Takayuki [Department of Physics, Kwansei Gakuin University, 2-1 Gakuen, Sanda 669-1337 (Japan); Wolf, Thomas [Department of Mathematics, Brock University, St Catharines, ON L2S 3A1 (Canada)

    2005-09-02

    We perform a classification of integrable systems of mixed scalar and vector evolution equations with respect to higher symmetries. We consider polynomial systems that are homogeneous under a suitable weighting of variables. This paper deals with the KdV weighting, the Burgers (or potential KdV or modified KdV) weighting, the Ibragimov-Shabat weighting and two unfamiliar weightings. The case of other weightings will be studied in a subsequent paper. Making an ansatz for undetermined coefficients and using a computer package for solving bilinear algebraic systems, we give the complete lists of second-order systems with a third-order or a fourth-order symmetry and third-order systems with a fifth-order symmetry. For all but a few systems in the lists, we show that the system (or, at least a subsystem of it) admits either a Lax representation or a linearizing transformation. A thorough comparison with recent work of Foursov and Olver is made.

  5. Mixed cryoglobulinemia-associated Sjögren's syndrome leading to spontaneous rupture of the kidney: a case report

    Directory of Open Access Journals (Sweden)

    Haddiya I

    2016-03-01

    Full Text Available Intissar Haddiya,1 Hakim Hamzaoui,1 Zitouna Alhamany,2 Fatime-zohra Berkchi,1 Hakima Rhou,1 Loubna Benamar,1 Naima Ouzeddoun,1 Rabea Bayahia1 1Department of Nephrology-Dialysis-Renal Transplantation, Ibn Sina University Hospital, Rabat, Morocco; 2Department of Pathology, Rabat Children's Hospital, Ibn Sina University Hospital, Rabat, Morocco Background: Spontaneous rupture of the kidney is uncommon and is mainly caused by renal tumors. Only a few cases are caused by vasculitis. We report here the first case of spontaneous rupture of kidney resulting from mixed cryoglobulinemia. Case presentation: A 44-year-old man presented with sudden onset of fever, acute pulmonary edema, left flank abdominal pain unassociated with trauma, and rapidly progressive renal failure requiring dialysis. Computed tomography of the abdomen revealed a large perirenal hematoma of the left kidney. During conservative surgery, the patient underwent renal biopsy that showed renal vasculitis and membranoproliferative glomerulonephritis with intracapillary microthrombi. Tests were positive for mixed cryoglobulinemia caused by Sjögren's syndrome. The patient was better after immunosuppressive therapy, with the disappearance of clinical symptoms and the recovery of baseline renal function. Conclusion: We report on this case and discuss a possible link between spontaneous rupture of kidney and mixed cryoglobulinemia-associated Sjögren's syndrome. Keywords: mixed cryoglobulinemia, Sjögren's syndrome, spontaneous rupture of kidney, renal hematoma, Wünderlich syndrome

  6. Achieving Integration in Mixed Methods Designs—Principles and Practices

    OpenAIRE

    Fetters, Michael D; Curry, Leslie A; Creswell, John W

    2013-01-01

    Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs—exploratory sequential, explanatory sequential, and convergent—and through four advanced frameworks—multistage, intervention, case study, and participato...

  7. Advanced exergoeconomic analysis of the multistage mixed refrigerant systems

    International Nuclear Information System (INIS)

    Mehrpooya, Mehdi; Ansarinasab, Hojat

    2015-01-01

    Highlights: • Advanced exergoeconomic analysis is performed for mixed refrigerant systems. • Cost of investment is divided into avoidable/unavoidable and endogenous/exogenous. • Results show that interactions between the components is not considerable. - Abstract: Advanced exergoeconomic analysis is applied on three multi stage mixed refrigerant liquefaction processes. They are propane precooled mixed refrigerant, dual mixed refrigerant and mixed fluid cascade. Cost of investment and exergy destruction for the components with high inefficiencies are divided into avoidable/unavoidable and endogenous/exogenous parts. According to the avoidable exergy destruction cost in propane precooled mixed refrigerant process, C-2 compressor with 455.5 ($/h), in dual mixed refrigerant process, C-1 compressor with 510.8 ($/h) and in mixed fluid cascade process, C-2/1 compressor with 338.8 ($/h) should be considered first. A comparison between the conventional and advanced exergoeconomic analysis is done by three important parameters: Exergy efficiency, exergoeconomic factor and total costs. Results show that interactions between the process components are not considerable because cost of investment and exergy destruction in most of them are endogenous. Exergy destruction cost of the compressors is avoidable while heat exchangers and air coolers destruction cost are unavoidable. Investment cost of heat exchangers and air coolers are avoidable while compressor’s are unavoidable

  8. QuaDoSta - a freely configurable system which facilitates multi-centric data collection for healthcare and medical research

    Directory of Open Access Journals (Sweden)

    Albrecht, Ulrike

    2007-07-01

    Full Text Available This article describes QuaDoSta (quality assurance, documentation and statistics, a flexible documentation system as well as a data collection and networking platform for medical facilities. The user can freely define the required documentation masks which are easily expandable and can be adapted to individual requirements without the need for additional programming. To avoid duplication, data transfer interfaces can be configured flexibly to external sources such as patient management systems used in surgeries or hospital information systems. The projects EvaMed (Evaluation Anthroposophical Medicine and the Network Oncology are two scientific research projects which have been successfully established as nationally active networks on the basis of QuaDoSta. The EvaMed-Network serves as a modern pharmacovigilance project for the documentation of adverse drug events. All prescription data are electronically recorded to assess the relative risk of drugs. The Network Oncology was set up as a documentation system in four hospitals and seven specialist oncology practices where a complete record of all oncological therapies is being carried out to uniform standards on the basis of the ‘basic documentation for tumour patients’ (BDT developed by the German Cancer Society. The QuaDoSta solution system made it possible to cater for the specific requirements of the presented projects. The following features of the system proved to be highly advantageous: flexible setup of catalogues and user friendly customisation and extensions, complete dissociation of system setup and documentation content, multi-centre networkability, and configurable data transfer interfaces.

  9. System architecture of a mixed reality framework

    OpenAIRE

    Seibert, Helmut; Dähne, Patrick

    2006-01-01

    In this paper the software architecture of a framework which simplifies the development of applications in the area of Virtual and Augmented Reality is presented. It is based on VRML/X3D to enable rendering of audio-visual information. We extended our VRML rendering system by a device management system that is based on the concept of a data-flow graph. The aim of the system is to create Mixed Reality (MR) applications simply by plugging together small prefabricated software components, instea...

  10. Authoring Immersive Mixed Reality Experiences

    Science.gov (United States)

    Misker, Jan M. V.; van der Ster, Jelle

    Creating a mixed reality experience is a complicated endeavour. From our practice as a media lab in the artistic domain we found that engineering is “only” a first step in creating a mixed reality experience. Designing the appearance and directing the user experience are equally important for creating an engaging, immersive experience. We found that mixed reality artworks provide a very good test bed for studying these topics. This chapter details three steps required for authoring mixed reality experiences: engineering, designing and directing. We will describe a platform (VGE) for creating mixed reality environments that incorporates these steps. A case study (EI4) is presented in which this platform was used to not only engineer the system, but in which an artist was given the freedom to explore the artistic merits of mixed reality as an artistic medium, which involved areas such as the look and feel, multimodal experience and interaction, immersion as a subjective emotion and game play scenarios.

  11. Economic impact of a head and neck oncologic surgeon: the case mix index.

    Science.gov (United States)

    Jalisi, Scharukh; Sanan, Akshay; Mcdonough, Katie; Hussein, Khalil; Platt, Michael; Truong, Minh Tam; Couch, Marion; Burkey, Brian B

    2014-10-01

    Head and neck oncologic surgery is a time-consuming specialty that requires extensive resources and manpower. Case mix index (CMI) is used in evaluating the complexity and economic impact of surgeons. Head and neck oncologic surgeons generate significant revenue for hospitals, yet compensation is relatively low. Retrospective review of a tertiary hospital's case mix data for 605 otolaryngology admissions from 2009 to 2011 was performed. CMI comparison for head and neck oncologic surgeons versus general otolaryngology was performed. In an otolaryngology department of 9 surgeons; there was a significant difference (p 1) favoring head and neck oncologic surgeons. Head and neck oncologic surgeons increase the CMI for hospitals and ultimately influence the hospital's reimbursement. There is a need for increased collaboration between hospitals and departments in fostering and furthering their head and neck surgical oncology programs by taking CMI into consideration. © 2013 Wiley Periodicals, Inc.

  12. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  13. A Mixed WLS Power System State Estimation Method Integrating a Wide-Area Measurement System and SCADA Technology

    Directory of Open Access Journals (Sweden)

    Tao Jin

    2018-02-01

    Full Text Available To address the issue that the phasor measurement units (PMUs of wide area measurement system (WAMS are not sufficient for static state estimation in most existing power systems, this paper proposes a mixed power system weighted least squares (WLS state estimation method integrating a wide-area measurement system and supervisory control and data acquisition (SCADA technology. The hybrid calculation model is established by incorporating phasor measurements (including the node voltage phasors and branch current phasors and the results of the traditional state estimator in a post-processing estimator. The performance assessment is discussed through setting up mathematical models of the distribution network. Based on PMU placement optimization and bias analysis, the effectiveness of the proposed method was proved to be accurate and reliable by simulations of different cases. Furthermore, emulating calculation shows this method greatly improves the accuracy and stability of the state estimation solution, compared with the traditional WLS state estimation.

  14. Presence of mixed modes in red giants in binary systems

    Directory of Open Access Journals (Sweden)

    Themeßl Nathalie

    2017-01-01

    Full Text Available The frequencies of oscillation modes in stars contain valueable information about the stellar properties. In red giants the frequency spectrum also contains mixed modes, with both pressure (p and gravity (g as restoring force, which are key to understanding the physical conditions in the stellar core. We observe a high fraction of red giants in binary systems, for which g-dominated mixed modes are not pronounced. This trend leads us to investigate whether this is specific for binary systems or a more general feature. We do so by comparing the fraction of stars with only p-dominated mixed modes in binaries and in a larger set of stars from the APOKASC sample. We find only p-dominated mixed modes in about 50% of red giants in detached eclipsing binaries compared to about 4% in the large sample. This could indicate that this phenomenon is tightly related to binarity and that the binary fraction in the APOKASC sample is about 8%.

  15. [Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up].

    Science.gov (United States)

    Blanco Saiz, I; López Carballo, M T; Martínez Fernández, J; Carrión Maldonado, J; Cabrera Pereira, A; Moral Alvarez, S; Santamaría Girón, L; Cantero Cerquella, F; López Secades, A; Díaz González, D; Llaneza Folgueras, A; Aira Delgado, F J

    2014-01-01

    Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  16. Research on ration selection of mixed absorbent solution for membrane air-conditioning system

    International Nuclear Information System (INIS)

    Li, Xiu-Wei; Zhang, Xiao-Song; Wang, Fang; Zhao, Xiao; Zhang, Zhuo

    2015-01-01

    Highlights: • We derive models of the membrane air-conditioning system with mixed absorbents. • We make analysis on system COP, cost-effectiveness and economy. • The paper provides a new method for ideal absorbent selection. • The solutes concentration of 50% achieves the best cost-effectiveness and the economy. - Abstract: Absorption air-conditioning system is a good alternative to vapor compression system for developing low carbon society. To improve the performance of the traditional absorption system, the membrane air-conditioning system is configured and its COP can reach as high as 6. Mixed absorbents are potential for cost reduction of the membrane system while maintaining a high COP. On the purpose of finding ideal mixed absorbent groups, this paper makes analysis on COP, cost-effectiveness and economy of the membrane system with mixed LiBr–CaCl 2 absorbent solution. The models of the system have been developed for the analysis. The results show the COP is higher for the absorbent groups with lower concentration of the total solute and higher concentration ratio of LiBr. It also reveals when the total solutes concentration is about 50%, it achieves the best cost-effectiveness and the economy. The process of the analysis provides a useful method for mixed absorbents selection

  17. A multi-centre evaluation of oral cancer in Southern and Western Nigeria: an African oral pathology research consortium initiative.

    Science.gov (United States)

    Omitola, Olufemi Gbenga; Soyele, Olujide Oladele; Sigbeku, Opeyemi; Okoh, Dickson; Akinshipo, Abdulwarith Olaitan; Butali, Azeez; Adeola, Henry Ademola

    2017-01-01

    Oral cancer is a leading cause of cancer deaths among African populations. Lack of standard cancer registries and under-reporting has inaccurately depicted its magnitude in Nigeria. Development of multi-centre collaborative oral pathology networks such as the African Oral Pathology Research Consortium (AOPRC) facilitates skill and expertise exchange and fosters a robust and systematic investigation of oral diseases across Africa. In this descriptive cross-sectional study, we have leveraged the auspices of the AOPRC to examine the burden of oral cancer in Nigeria, using a multi-centre approach. Data from 4 major tertiary health institutions in Western and Southern Nigeria was generated using a standardized data extraction format and analysed using the SPSS data analysis software (version 20.0; SPSS Inc. Chicago, IL). Of the 162 cases examined across the 4 centres, we observed that oral squamous cell carcinomas (OSCC) occurred mostly in the 6 th and 7 th decades of life and maxillary were more frequent than mandibular OSCC lesions. Regional variations were observed both for location, age group and gender distribution. Significant regional differences was found between poorly, moderately and well differentiated OSCC (p value = 0.0071). A multi-centre collaborative oral pathology research approach is an effective way to achieve better insight into the patterns and distribution of various oral diseases in men of African descent. The wider outlook for AOPRC is to employ similar approaches to drive intensive oral pathology research targeted at addressing the current morbidity and mortality of various oral diseases across Africa.

  18. Modulation of aerosol radiative forcing due to mixing state in clear and cloudy-sky: A case study from Delhi National Capital Region, India

    Science.gov (United States)

    Srivastava, Parul; Dey, Sagnik; Srivastava, Atul K.; Singh, Sachchidanand; Tiwari, Suresh; Agarwal, Poornima

    2016-04-01

    Aerosol properties change with the change in mixing state of aerosols and therefore it is a source of uncertainty in estimated aerosol radiative forcing (ARF) from observations or by models assuming a specific mixing state. The problem is important in the Indo-Gangetic Basin, Northern India, where various aerosol types mix and show strong seasonal variations. Quantifying the modulation of ARF by mixing state is hindered by lack of knowledge about proper aerosol composition. Hence, first a detailed chemical composition analysis of aerosols for Delhi National capital region (NCR) is carried out. Aerosol composition is arranged quantitatively into five major aerosol types - accumulation dust, coarse dust, water soluble (WS), water insoluble (WINS), and black carbon (BC) (directly measured by Athelometer). Eight different mixing cases - external mixing, internal mixing, and six combinations of core- shell mixing (BC over dust, WS over dust, WS over BC, BC over WS, WS over WINS, and BC over WINS; each of the combinations externally mixed with other species) have been considered. The spectral aerosol optical properties - extinction coefficient, single scattering albedo (SSA) and asymmetry parameter (g) for each of the mixing cases are calculated and finally 'clear-sky' and 'cloudy-sky' ARF at the top-of-the-atmosphere (TOA) and surface are estimated using a radiative transfer model. Comparison of surface-reaching flux for each of the cases with MERRA downward shortwave surface flux reveals the most likely mixing state. 'BC-WINS+WS+Dust' show least deviation relative to MERRA during the pre-monsoon (MAMJ) and monsoon (JAS) seasons and hence is the most probable mixing states. During the winter season (DJF), 'BC-Dust+WS+WINS' case shows the closest match with MERRA, while external mixing is the most probable mixing state in the post-monsoon season (ON). Lowest values for both TOA and surface 'clear-sky' ARF is observed for 'BC-WINS+WS+ Dust' mixing case. TOA ARF is 0.28±2

  19. Mixed Reality Systems

    Directory of Open Access Journals (Sweden)

    Dieter Müller

    2009-11-01

    Full Text Available Currently one of the most challenging aspects of human computer interaction design is the integration of physical and digital worlds in a single environment. This fusion involves the development of "Mixed Reality Systems”, including various technologies from the domains of augmented and virtual reality. In this paper I will present related concepts and discuss lessons learned from our own research and prototype development. Our recent work involves the use of mixed reality (as opposed to ‘pure’ virtual reality techniques to support seamless collaborative work between remote and hands-on laboratories.

  20. Magnetic particle mixing with magnetic micro-convection for microfluidics

    International Nuclear Information System (INIS)

    Kitenbergs, Guntars; Erglis, Kaspars; Perzynski, Régine; Cēbers, Andrejs

    2015-01-01

    In this paper we discuss the magnetic micro-convection phenomenon as a tool for mixing enhancement in microfluidics systems in cases when one of the miscible fluids is a magnetic particle colloid. A system of a water-based magnetic fluid and water is investigated experimentally under homogeneous magnetic field in a Hele–Shaw cell. Subsequent image analysis both qualitatively and quantitatively reveals the high enhancement of mixing efficiency provided by this method. The mixing efficiency dependence on the magnetic field and the physical limits is discussed. A suitable model for a continuous-flow microfluidics setup for mixing with magnetic micro-convection is also proposed and justified with an experiment. In addition, possible applications in improving the speed of ferrohydrodynamic sorting and magnetic label or selected tracer mixing in lab on a chip systems are noted. - Highlights: • We study the magnetic micro-convection as a mixing method in microfluidics. • We show that the method enhances mixing with magnetic field squared dependency. • We propose a flow cell setup for mixing and justify it with a sample experiment. • The mixing method can be easily implemented in an existing microfluidics setup

  1. Individual chaos implies collective chaos for weakly mixing discrete dynamical systems

    International Nuclear Information System (INIS)

    Liao Gongfu; Ma Xianfeng; Wang Lidong

    2007-01-01

    Let X be a metric space (X,f) a discrete dynamical system, where f:X->X is a continuous function. Let f-bar denote the natural extension of f to the space of all non-empty compact subsets of X endowed with Hausdorff metric induced by d. In this paper we investigate some dynamical properties of f and f-bar . It is proved that f is weakly mixing (mixing) if and only if f-bar is weakly mixing (mixing, respectively). From this, we deduce that weak-mixing of f implies transitivity of f-bar , further, if f is mixing or weakly mixing, then chaoticity of f (individual chaos) implies chaoticity of f-bar (collective chaos) and if X is a closed interval then f-bar is chaotic (in the sense of Devaney) if and only if f is weakly mixing

  2. Development of a model for case-mix adjustment of pressure ulcer prevalence rates.

    NARCIS (Netherlands)

    Bours, G.J.J.W.; Halfens, J.; Berger, M.P.; Abu-Saad, H.H.; Grol, R.P.T.M.

    2003-01-01

    BACKGROUND: Acute care hospitals participating in the Dutch national pressure ulcer prevalence survey use the results of this survey to compare their outcomes and assess their quality of care regarding pressure ulcer prevention. The development of a model for case-mix adjustment is essential for the

  3. Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

    NARCIS (Netherlands)

    Vos, L.; Dückers, M.L.A.; Wagner, C.; Merode, G.G. van

    2010-01-01

    Objectives: Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix

  4. Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

    NARCIS (Netherlands)

    Kolfschoten, N. E.; Marang van de Mheen, P. J.; Gooiker, G. A.; Eddes, E. H.; Kievit, J.; Tollenaar, R. A. E. M.; Wouters, M. W. J. M.; Bemelman, W. A.; Busch, O. R. C.; van Dam, R. M.; van der Harst, E.; Jansen-Landheer, M. L. E. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Kuijpers, W. G. T.; Lemmens, V. E.; Manusama, E. R.; Meijerink, W. J. H. J.; Rutten, H. J. T.; Wiggers, T.; van de Velde, C. J. H.

    2011-01-01

    The purpose of this study was to determine how expected mortality based on case-mix varies between colorectal cancer patients treated in non-teaching, teaching and university hospitals, or high, intermediate and low-volume hospitals in the Netherlands. We used the database of the Dutch Surgical

  5. Rheological evaluation of the irradiated pectin/gelatin mixed systems

    International Nuclear Information System (INIS)

    Inamura, Patricia Y.; Mastro, Nelida L. del

    2011-01-01

    The main biopolymers used in the edible films production are polysaccharides and proteins. Pectin is a heterosaccharidic polymer derived from the vegetal cell wall. Gelatin is a heterogeneous mixture of water-soluble proteins of high average molecular mass derived by hydrolytic action from animal collagen. The aim of this research was to evaluate the effect of ionizing radiation on either the biopolymers alone or on the mixed systems prepared with high-and low-methoxyl pectin and gelatin in solution and mixed gel. The results showed that gelatin viscosity remained almost unaffected by the irradiation with doses from 1 to 15 kGy, with a slight increase at 3 kGy. On the other hand, there was a sharp decrease of viscosity values of all pectin solutions upon irradiation, being this behavior predominant when both polysaccharides and proteins were present in a mixed system. The gel hardness and gel brittleness of the gelatin were affected by the increase of radiation dose. (author)

  6. A multicentre ‘end to end’ dosimetry audit for cervix HDR brachytherapy treatment

    International Nuclear Information System (INIS)

    Palmer, Antony L.; Diez, Patricia; Gandon, Laura; Wynn-Jones, Andrea; Bownes, Peter; Lee, Chris; Aird, Edwin; Bidmead, Margaret; Lowe, Gerry; Bradley, David; Nisbet, Andrew

    2015-01-01

    Purpose: To undertake the first multicentre fully ‘end to end’ dosimetry audit for HDR cervix brachytherapy, comparing planned and delivered dose distributions around clinical treatment applicators, with review of local procedures. Materials and methods: A film-dosimetry audit was performed at 46 centres, including imaging, applicator reconstruction, treatment planning and delivery. Film dose maps were calculated using triple-channel dosimetry and compared to RTDose data from treatment planning systems. Deviations between plan and measurement were quantified at prescription Point A and using gamma analysis. Local procedures were also discussed. Results: The mean difference between planned and measured dose at Point A was −0.6% for plastic applicators and −3.0% for metal applicators, at standard uncertainty 3.0% (k = 1). Isodose distributions agreed within 1 mm over a dose range 2–16 Gy. Mean gamma passing rates exceeded 97% for plastic and metal applicators at 3% (local) 2 mm criteria. Two errors were found: one dose normalisation error and one applicator library misaligned with the imaged applicator. Suggestions for quality improvement were also made. Conclusions: The concept of ‘end to end’ dosimetry audit for HDR brachytherapy has been successfully implemented in a multicentre environment, providing evidence that a high level of accuracy in brachytherapy dosimetry can be achieved

  7. Authorship issues in multi-centre clinical trials: the importance of making an authorship contract.

    Science.gov (United States)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian; Vinther, Siri

    2015-02-01

    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

  8. Dosimetry audit for a multi-centre IMRT head and neck trial

    International Nuclear Information System (INIS)

    Clark, Catharine H.; Hansen, Vibeke Nordmark; Chantler, Hannah; Edwards, Craig; James, Hayley V.; Webster, Gareth; Miles, Elizabeth A.; Guerrero Urbano, M. Teresa; Bhide, Shree A.; Bidmead, A. Margaret; Nutting, Christoper M.

    2009-01-01

    Background and purpose: PARSPORT was a multi-centre randomised trial in the UK which compared Intensity-Modulated Radiotherapy (IMRT) and conventional radiotherapy (CRT) for patients with head and neck cancer. The dosimetry audit goals were to verify the plan delivery in participating centres, ascertain what tolerances were suitable for head and neck IMRT trials and develop an IMRT credentialing program. Materials and methods: Centres enrolling patients underwent rigorous quality assurance before joining the trial. Following this each centre was visited for a dosimetry audit, which consisted of treatment planning system tests, fluence verification films, combined field films and dose point measurements. Results: Mean dose point measurements were made at six centres. For the primary planning target volume (PTV) the differences with the planned values for the IMRT and CRT arms were -0.6% (1.8% to -2.4%) and 0.7% (2.0% to -0.9%), respectively. Ninety-four percent of the IMRT fluence films for individual fields passed gamma criterion of 3%/3 mm and 75% of the films for combined fields passed gamma criterion 4%/3 mm (no significant difference between dynamic delivery and step and shoot delivery). Conclusions: This audit suggests that a 3% tolerance could be applied for PTV point doses. For dose distributions tolerances of 3%/3 mm on individual fields and 4%/3 mm for combined fields are proposed for multi-centre head and neck IMRT trials.

  9. Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Leigh R. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-09-01

    This document was prepared to meet FCR&D level 3 milestone M3FT-14IN0304022, “Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems.” This work was carried out under the auspices of the Thermodynamics and Kinetics FCR&D work package. This document reports preliminary work in support of determining the thermodynamic parameters for the ALSEP process. The ALSEP process is a mixed extractant system comprised of a cation exchanger 2-ethylhexyl-phosphonic acid mono-2-ethylhexyl ester (HEH[EHP]) and a neutral solvating extractant N,N,N’,N’-tetraoctyldiglycolamide (TODGA). The extractant combination produces complex organic phase chemistry that is challenging for traditional measurement techniques. To neutralize the complexity, temperature dependent solvent extraction experiments were conducted with neat TODGA and scaled down concentrations of the ALSEP formulation to determine the enthalpies of extraction for the two conditions. A full set of thermodynamic data for Eu, Am, and Cm extraction by TODGA from 3.0 M HNO3 is reported. These data are compared to previous extraction results from a 1.0 M HNO3 aqueous medium, and a short discussion of the mixed HEH[EHP]/TODGA system results is offered.

  10. Battery-Aware Scheduling of Mixed Criticality Systems

    DEFF Research Database (Denmark)

    Wognsen, Erik Ramsgaard; Hansen, Rene Rydhof; Larsen, Kim Guldstrand

    2014-01-01

    . Mixed criticality and soft real-time systems may accept deadline violations and therefore enable trade-offs and evaluation of performance by criteria such as the number of tasks that can be completed with a given battery. We model a task set in combination with the kinetic battery model as a stochastic...

  11. Mixed-mode distribution systems for high average power electron cyclotron heating

    International Nuclear Information System (INIS)

    White, T.L.; Kimrey, H.D.; Bigelow, T.S.

    1984-01-01

    The ELMO Bumpy Torus-Scale (EBT-S) experiment consists of 24 simple magnetic mirrors joined end-to-end to form a torus of closed magnetic field lines. In this paper, we first describe an 80% efficient mixed-mode unpolarized heating system which couples 28-GHz microwave power to the midplane of the 24 EBT-S cavities. The system consists of two radiused bends feeding a quasi-optical mixed-mode toroidal distribution manifold. Balancing power to the 24 cavities is determined by detailed computer ray tracing. A second 28-GHz electron cyclotron heating (ECH) system using a polarized grid high field launcher is described. The launcher penetrates the fundamental ECH resonant surface without a vacuum window with no observable breakdown up to 1 kW/cm 2 (source limited) with 24 kW delivered to the plasma. This system uses the same mixed-mode output as the first system but polarizes the launched power by using a grid of WR42 apertures. The efficiency of this system is 32%, but can be improved by feeding multiple launchers from a separate distribution manifold

  12. Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010.

    Science.gov (United States)

    Brown, Katherine L; Crowe, Sonya; Franklin, Rodney; McLean, Andrew; Cunningham, David; Barron, David; Tsang, Victor; Pagel, Christina; Utley, Martin

    2015-01-01

    To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix. Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations. 30-day mortality for an episode of surgical management. Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (pcase mix became more complex in terms of the percentage of patients case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects.

  13. Harmonization process and reliability assessment of anthropometric measurements in the elderly EXERNET multi-centre study.

    Directory of Open Access Journals (Sweden)

    Alba Gómez-Cabello

    Full Text Available BACKGROUND: The elderly EXERNET multi-centre study aims to collect normative anthropometric data for old functionally independent adults living in Spain. PURPOSE: To describe the standardization process and reliability of the anthropometric measurements carried out in the pilot study and during the final workshop, examining both intra- and inter-rater errors for measurements. MATERIALS AND METHODS: A total of 98 elderly from five different regions participated in the intra-rater error assessment, and 10 different seniors living in the city of Toledo (Spain participated in the inter-rater assessment. We examined both intra- and inter-rater errors for heights and circumferences. RESULTS: For height, intra-rater technical errors of measurement (TEMs were smaller than 0.25 cm. For circumferences and knee height, TEMs were smaller than 1 cm, except for waist circumference in the city of Cáceres. Reliability for heights and circumferences was greater than 98% in all cases. Inter-rater TEMs were 0.61 cm for height, 0.75 cm for knee-height and ranged between 2.70 and 3.09 cm for the circumferences measured. Inter-rater reliabilities for anthropometric measurements were always higher than 90%. CONCLUSION: The harmonization process, including the workshop and pilot study, guarantee the quality of the anthropometric measurements in the elderly EXERNET multi-centre study. High reliability and low TEM may be expected when assessing anthropometry in elderly population.

  14. Abdominal localization of unicentric form of Castleman disease: A case report

    Directory of Open Access Journals (Sweden)

    Milev Boško

    2017-01-01

    Full Text Available Introduction. Castleman disease is a rare disease of the unknown etiology, occuring in two clinical forms: unicentric or multicentric. It is characterized by the hyperplasia of lymph glands. In literature the four pathohistological forms were described: hyaline vascular type, plasma cell type, mixed type and a recently recognized plasmablastic type. The most frequent changes are localized in the mediastinum, while the abdominal localization is with significatly rare occurrence, and that was the motive for presentation of this case. Case report. In a 41-year old male magnetic resonance (MR enterography showed a change in the ileocecal area without the presence of subjective symptoms of digestive tract and without loss of body mass. Due to the suspicion of stromal tumor, surgical intervention was indicated. Pathohistological findings showed Castleman lymphadenopathia reactiva mesenterii (plasma cell type which was in the unicentric form. There were present only anaemia and the increased value of sedimentation from the laboratory analyses. Conclusion. Abdominal localization of unicentric plasma cell form occurs rarely and the surgical method of treatment presents the golden standard as it was shown in the presented case.

  15. Evaluation of mixing downstream of tees in duct systems with respect to single point representative air sampling.

    Science.gov (United States)

    Kim, Taehong; O'Neal, Dennis L; Ortiz, Carlos

    2006-09-01

    Air duct systems in nuclear facilities must be monitored with continuous sampling in case of an accidental release of airborne radionuclides. The purpose of this work is to identify the air sampling locations where the velocity and contaminant concentrations fall below the 20% coefficient of variation required by the American National Standards Institute/Health Physics Society N13.1-1999. Experiments of velocity and tracer gas concentration were conducted on a generic "T" mixing system which included combinations of three sub ducts, one main duct, and air velocities from 0.5 to 2 m s (100 to 400 fpm). The experimental results suggest that turbulent mixing provides the accepted velocity coefficients of variation after 6 hydraulic diameters downstream of the T-junction. About 95% of the cases achieved coefficients of variation below 10% by 6 hydraulic diameters. However, above a velocity ratio (velocity in the sub duct/velocity in the main duct) of 2, velocity profiles were uniform in a shorter distance downstream of the T-junction as the velocity ratio went up. For the tracer gas concentration, the distance needed for the coefficients of variation to drop 20% decreased with increasing velocity ratio due to the sub duct airflow momentum. The results may apply to other duct systems with similar geometries and, ultimately, be a basis for selecting a proper sampling location under the requirements of single point representative sampling.

  16. Design of a mixing system for simulated high-level nuclear waste melter feed slurries

    International Nuclear Information System (INIS)

    Peterson, M.E.; McCarthy, D.; Muhlstein, K.D.

    1986-03-01

    The Nuclear Waste Treatment Program development program consists of coordinated nonradioactive and radioactive testing combined with numerical modeling of the process to provide a complete basis for design and operation of a vitrification facility. The radioactive demonstration tests of equipment and processes are conducted before incorporation in radioactive pilot-scale melter systems for final demonstration. The mixing system evaluation described in this report was conducted as part of the nonradioactive testing. The format of this report follows the sequence in which the design of a large-scale mixing system is determined. The initial program activity was concerned with gaining an understanding of the theoretical foundation of non-Newtonian mixing systems. Section 3 of this report describes the classical rheological models that are used to describe non-Newtonian mixing systems. Since the results obtained here are only valid for the slurries utilized, Section 4, Preparation of Simulated Hanford and West Valley Slurries, describes how the slurries were prepared. The laboratory-scale viscometric and physical property information is summarized in Section 5, Laboratory Rheological Evaluations. The bench-scale mixing evaluations conducted to define the effects of the independent variables described above on the degree of mixing achieved with each slurry are described in Section 6. Bench-scale results are scaled-up to establish engineering design requirements for the full-scale mixing system in Section 7. 24 refs., 37 figs., 44 tabs

  17. Policy Mixes to Achieve Absolute Decoupling: A Case Study of Municipal Waste Management

    Directory of Open Access Journals (Sweden)

    Francesca Montevecchi

    2016-05-01

    Full Text Available Studying the effectiveness of environmental policies is of primary importance to address the unsustainable use of resources that threatens the entire society. Thus, the aim of this paper is to investigate on the effectiveness of environmental policy instruments to decouple waste generation and landfilling from economic growth. In order to do so, the paper analyzes the case study of the Slovakian municipality of Palarikovo, which has drastically improved its waste management system between 2000 and 2012, through the utilization of differentiated waste taxes and awareness-raising and education campaigns, as well as targeting increased recycling and municipal composting. We find evidence of absolute decoupling for landfilled waste and waste generation, the latter being more limited in time and magnitude. These policy instruments could therefore play an important role in municipalities that are still lagging behind in waste management. More specifically, this policy mix was effective in moving away from landfilling, initiating recycling systems, and to some extent decreasing waste generation. Yet, a more explicit focus on waste prevention will be needed to address the entirety of the problem effectively.

  18. Analysis of a PDF model in a mixing layer case

    International Nuclear Information System (INIS)

    Minier, J.P.; Pozorski, J.

    1996-04-01

    A recent turbulence model put forward by Pope (1991) in the context of PDF modeling has been applied to a mixing layer case. This model solves the one-point joint velocity-dissipation pdf equation by simulating the instantaneous behaviour of a large number of Lagrangian fluid particles. Closure of the evolution equations of these Lagrangian particles is based on diffusion stochastic processes. The paper reports numerical results and tries to analyse the physical meaning of some variables, in particular the dissipation-weighted kinetic energy and its relation with external intermittency. (authors). 14 refs., 7 figs

  19. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)--a case series multicentric study.

    Science.gov (United States)

    Fatton, B; Amblard, J; Debodinance, P; Cosson, M; Jacquetin, B

    2007-07-01

    Our goal was to report the preliminary results of a transvaginal mesh repair of genital prolapse using the Prolift system. This retrospective multicentric study includes 110 patients. All patients had a stage 3 (at the hymen) or stage 4 (beyond the hymen) prolapse. Total mesh was used in 59 patients (53.6%), an isolated anterior mesh in 22 patients (20%) and an isolated posterior mesh in 29 patients (26.4%). We report one bladder injury sutured at surgery and two haematomas requiring secondary surgical management. At 3 months, 106 patients were available for follow-up. Mesh exposure occurred in five patients (4.7%), two of them requiring a surgical management. Granuloma without exposure occurred in three patients (2.8%). Failure rate (recurrent prolapse even asymptomatic or low grade symptomatic prolapse) was 4.7%. According to the perioperative and immediate post-operative results, Prolift repair seems to be a safe technique to correct pelvic organ prolapse. Anatomical and functional results must be assessed with a long-term follow-up to confirm the effectiveness and safety of the procedure.

  20. Mixed Connective Tissue Disease and Papillary Thyroid Cancer: A Case Report.

    Science.gov (United States)

    Thongpooswan, Supat; Tushabe, Rachel; Song, Jeffrey; Kim, Paul; Abrudescu, Adriana

    2015-08-06

    Mixed connective tissue disease (MCTD) is a connective tissue disorder characterized by high titers of distinct antibodies: U1 ribonucleoprotein with clinical features seen in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM), polymyositis, and scleroderma. The association of SLE and DM with various cancers of the thyroid has been reported in the literature. However, there have been no reports associating MCTD with thyroid cancer. We present a 58-year-old woman diagnosed with MCTD with co-morbid interstitial lung disease that has remained stable for 10 years, who developed papillary thyroid carcinoma (PTC) 10 years after initial diagnosis. We theorize that: 1) MCTD may have been a primary diagnosis complicated by PTC, or 2) MCTD may have been an initial presentation of paraneoplastic syndrome of silent PTC, because her symptoms of MCTD significantly improved after total thyroidectomy. To the best of our knowledge, this is the first case report to associate MCTD with PTC. It highlights the importance of maintaining a high index of suspicion for thyroid malignancy in MCTD patients.

  1. The adaptive capacity of smallholder mixed-farming systems to the impact of climate change: The case of KwaZulu-Natal in South Africa

    Directory of Open Access Journals (Sweden)

    Nonhlanzeko N. Mthembu

    2017-11-01

    Full Text Available Climate change poses a serious threat to efforts by developing countries to ensure food security and poverty reduction. The National Development goals of South Africa envisage the agricultural sector as a key driver for job creation and economic growth. This article seeks to investigate the adaptive capacity of the Ncunjane farming community in Msinga, KwaZuluNatal in response to drought spells of 2010 and 2014. This article draws on data collected using both qualitative and quantitative methods in 2011 and later in 2015 with the data analysed through the Statistical Package for Social Science to determine significant correlations between variables. Analysis of the vulnerability and adaptive capacity is performed using conceptual framework. This study found that both smallholder farmers who engaged in livestock and crop production have experienced high cattle mortalities and stagnant crop productivity, which in turn put pressure on already constrained disposable household income because of increased food costs and agricultural input costs, particularly supplementary animal feed. Cattle owners were more vulnerable to drought because of poor risk management and thus became highly dependent on government to provide drought relief. Application for government drought relief was found not to be effective in cases of large herds of cattle. Variability of rainfall and prolonged heat spells has a significant impact on the sustainability of smallholder mixed-farming systems, leaving agriculture as a highly questionable form of livelihood for rural farming communities such as Msinga. The article recommends strengthened institutional mechanisms so that stakeholders should play a more meaningful role within provincial and local agriculture in leveraging government support but places emphasis on the adoption of innovative strategies that can potentially yield significantly resilient smallholder mixed-farming systems in the wake of climate variability.

  2. Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases (UICC stage IV): SYNCHRONOUS - a randomised controlled multicentre trial (ISRCTN30964555)

    International Nuclear Information System (INIS)

    Rahbari, Nuh N; Koch, Moritz; Büchler, Markus W; Kieser, Meinhard; Weitz, Jürgen; Lordick, Florian; Fink, Christine; Bork, Ulrich; Stange, Annika; Jäger, Dirk; Luntz, Steffen P; Englert, Stefan; Rossion, Inga

    2012-01-01

    Currently, it remains unclear, if patients with colon cancer and synchronous unresectable metastases who present without severe symptoms should undergo resection of the primary tumour prior to systemic chemotherapy. Resection of the primary tumour may be associated with significant morbidity and delays the beginning of chemotherapy. However, it may prevent local symptoms and may, moreover, prolong survival as has been demonstrated in patients with metastatic renal cell carcinoma. It is the aim of the present randomised controlled trial to evaluate the efficacy of primary tumour resection prior to systemic chemotherapy to prolong survival in patients with newly diagnosed colon cancer who are not amenable to curative therapy. The SYNCHRONOUS trial is a multicentre, randomised, controlled, superiority trial with a two-group parallel design. Colon cancer patients with synchronous unresectable metastases are eligible for inclusion. Exclusion criteria are primary tumour-related symptoms, inability to tolerate surgery and/or systemic chemotherapy and history of another primary cancer. Resection of the primary tumour as well as systemic chemotherapy is provided according to the standards of the participating institution. The primary endpoint is overall survival that is assessed with a minimum follow-up of 36 months. Furthermore, it is the objective of the trial to assess the safety of both treatment strategies as well as quality of life. The SYNCHRONOUS trial is a multicentre, randomised, controlled trial to assess the efficacy and safety of primary tumour resection before beginning of systemic chemotherapy in patients with metastatic colon cancer not amenable to curative therapy. http://www.controlled-trials.com/ISRCTN30964555

  3. All-order renormalization of propagator matrix for fermionic system with flavor mixing

    Energy Technology Data Exchange (ETDEWEB)

    Kniehl, Bernd A. [California Univ., Santa Barbara, CA (United States). Kavli Inst. for Theoretical Physics

    2013-08-15

    We consider a mixed system of Dirac fermions in a general parity-nonconserving theory and renormalize the propagator matrix to all orders in the pole scheme, in which the squares of the renormalized masses are identified with the complex pole positions and the wave-function renormalization (WFR) matrices are adjusted in compliance with the Lehmann-Symanzik-Zimmermann reduction formalism. We present closed analytic all-order expressions for the renormalization constants in terms of the scalar, pseudoscalar, vector, and pseudovector parts of the unrenormalized self-energy matrix, which is computable from the one-particle-irreducible Feynman diagrams of the flavor transitions. We identify residual degrees of freedom in the WFR matrices and propose an additional renormalization condition to exhaust them. We then explain how our results may be generalized to the case of unstable fermions, in which we encounter the phenomenon of WFR bifurcation. In the special case of a solitary unstable fermion, the all-order-renormalized propagator is presented in a particularly compact form.

  4. Mixed-μ magnetic levitation for advanced ground transport system

    International Nuclear Information System (INIS)

    Russell, F.M.

    1977-12-01

    The possibility of applying the mixed-μ principle for magnetic levitation to ground transport systems is examined. The system is developed specifically for suspension and useful lift to passive weight ratios exceeding 8:1 have been calculated. Application to a hybrid system where conventional wheel drive is used in conjunction with magnetic levitation is explained for urban transport. (author)

  5. Magnetic particle mixing with magnetic micro-convection for microfluidics

    OpenAIRE

    Kitenbergs , Guntars; Erglis , Kaspars; Perzynski , Régine; Cēbers , Andrejs

    2015-01-01

    International audience; In this paper we discuss the magnetic micro-convection phenomenon as a tool for mixing enhancement in microfluidics systems in cases when one of the mis-cible fluids is a magnetic particle colloid. A system of a water-based magnetic fluid and water is investigated experimentally under homogeneous magnetic field in a Hele-Shaw cell. Subsequent image analysis both qualitatively and quan-titatively reveals the high enhancement of mixing efficiency provided by this method....

  6. Synthesis of Communication Schedules for TTEthernet-Based Mixed-Criticality Systems

    DEFF Research Database (Denmark)

    Tamas-Selicean, Domitian; Pop, Paul; Steiner, Wilfried

    2012-01-01

    In this paper we are interested in safety-critical distributed systems, composed of heterogeneous processing elements interconnected using the TTEthernet protocol. We address hard real-time mixed-criticality applications, which may have different criticality levels, and we focus on the optimization...... be integrated onto the same architecture only if there is enough spatial and temporal separation among them. TTEthernet offers spatial separation for mixed-criticality messages through the concept of virtual links, and temporal separation, enforced through schedule tables for TT messages and bandwidth...... allocation for RC messages. Given the set of mixed-criticality messages in the system and the topology of the virtual links on which the messages are transmitted, we are interested to synthesize offline the static schedules for the TT messages, such that the deadlines for the TT and RC messages are satisfied...

  7. On mixing property in set-valued discrete systems

    International Nuclear Information System (INIS)

    Gu Rongbao; Guo Wenjing

    2006-01-01

    Let (X,d) be a compact metric space and f:X->X be a continuous map. Let (K(X),H) be the space of all non-empty compact subsets of X endowed with the Hausdorff metric induced by d and f-bar :K(X)->K(X) be the map defined by f-bar (A):{f(a):a-bar A}. In this paper we investigate the relationships between the mixing property of (K(X),f-bar ) and the mixing property of (X,f). In addition, we discuss specification for the set-valued discrete dynamical system (K(X),f-bar )

  8. Quantum Darwinism in a Mixed Environment

    Science.gov (United States)

    Zwolak, Michael; Quan, H. T.; Zurek, Wojciech H.

    2009-09-01

    Quantum Darwinism recognizes that we—the observers—acquire our information about the “systems of interest” indirectly from their imprints on the environment. Here, we show that information about a system can be acquired from a mixed-state, or hazy, environment, but the storage capacity of an environment fragment is suppressed by its initial entropy. In the case of good decoherence, the mutual information between the system and the fragment is given solely by the fragment’s entropy increase. For fairly mixed environments, this means a reduction by a factor 1-h, where h is the haziness of the environment, i.e., the initial entropy of an environment qubit. Thus, even such hazy environments eventually reveal the state of the system, although now the intercepted environment fragment must be larger by ˜(1-h)-1 to gain the same information about the system.

  9. A case report: mixed thrombus formation in a previously sutured right atrium.

    Science.gov (United States)

    Yunfei, Ling; Dongxu, Li; Shuhua, Luo; Yabo, Wang; San, Deep; Changping, Gan; Ke, Lin; Qi, An

    2014-08-01

    We describe the case of a 19-year-old Chinese woman who nine months prior underwent repair of an atrial septal defect and came to our hospital with a right atrial mass attached to the anterior wall of the right atrium on transthoracic echocardiography. Pathologic examination revealed the mass was a mixed-type thrombosis with some unusual organization, which previously was not described in literature.

  10. Loss to follow-up in an international, multicentre observational study

    DEFF Research Database (Denmark)

    Mocroft, A; Kirk, O; Aldins, P

    2008-01-01

    OBJECTIVE: The aim of this work was to assess loss to follow-up (LTFU) in EuroSIDA, an international multicentre observational cohort study. METHODS: LTFU was defined as no follow-up visit, CD4 cell count measurement or viral load measurement after 1 January 2006. Poisson regression was used...

  11. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    DEFF Research Database (Denmark)

    Kurshumliu, Fisnik; Rung-Hansen, Helle; Skovlund, Vibeke Ravn

    2011-01-01

    Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower...

  12. Mixed Methods Case Study of Generational Patterns in Responses to Shame and Guilt

    Science.gov (United States)

    Ng, Tony

    2013-01-01

    Moral socialization and moral learning are antecedents of moral motivation. As many as 4 generations interact in workplace and education settings; hence, a deeper understanding of the moral motivation of members of those generations is needed. The purpose of this convergent mixed methods case study was to understand the moral motivation of 5…

  13. Unilateral pallidotomy in Parkinson's disease : a randomised, single-blind, multicentre trial

    NARCIS (Netherlands)

    de Bie, RMA; de Haan, RJ; Nijssen, PCG; Rutgers, AWF; Beute, GN; Haaxma, R; Schmand, B; Staal, MJ; Speelman, J.D.

    1999-01-01

    Background The results of several cohort studies suggest that patients with advanced Parkinson's disease would benefit from unilateral pallidotomy. We have assessed the efficacy of unilateral pallidotomy in a randomised, single-blind, multicentre trial. Methods We enrolled 37 patients with advanced

  14. Managing Atypical and Typical herpetic central nervous system infections

    DEFF Research Database (Denmark)

    Cag, Yasemin; Erdem, Hakan; Leib, Stephen

    2016-01-01

    There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. O...... the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection....

  15. Study on system dynamics of evolutionary mix-game models

    Science.gov (United States)

    Gou, Chengling; Guo, Xiaoqian; Chen, Fang

    2008-11-01

    Mix-game model is ameliorated from an agent-based MG model, which is used to simulate the real financial market. Different from MG, there are two groups of agents in Mix-game: Group 1 plays a majority game and Group 2 plays a minority game. These two groups of agents have different bounded abilities to deal with historical information and to count their own performance. In this paper, we modify Mix-game model by assigning the evolution abilities to agents: if the winning rates of agents are smaller than a threshold, they will copy the best strategies the other agent has; and agents will repeat such evolution at certain time intervals. Through simulations this paper finds: (1) the average winning rates of agents in Group 1 and the mean volatilities increase with the increases of the thresholds of Group 1; (2) the average winning rates of both groups decrease but the mean volatilities of system increase with the increase of the thresholds of Group 2; (3) the thresholds of Group 2 have greater impact on system dynamics than the thresholds of Group 1; (4) the characteristics of system dynamics under different time intervals of strategy change are similar to each other qualitatively, but they are different quantitatively; (5) As the time interval of strategy change increases from 1 to 20, the system behaves more and more stable and the performances of agents in both groups become better also.

  16. Spectral Mixing in Nervous Systems: Experimental Evidenceand Biologically Plausible Circuits

    Science.gov (United States)

    Kleinfeld, D.; Mehta, S. B.

    The ability to compute the difference frequency for two periodic signals depends on a nonlinear operation that mixes those signals. Behavioral and psychophysical evidence suggest that such mixing is likely to occur in the vertebrate nervous system as a means to compare rhythmic sensory signals, such as occurs in human audition, and as a means to lock an intrinsic rhythm to a sensory input. Electrophysiological data from electroreceptors in the immobilized electric fish and somatosensory cortex in the anesthetized rat yield direct evidence for such mixing, providing a neurological substrate for the modulation and demodulation of rhythmic neuronal signals. We consider an analytical model of spectral mixing that makes use of the threshold characteristics of neuronal firing and which has features consistent with the experimental observations. This model serves as a guide for constructing circuits that isolate given mixture components. In particular, such circuits can generate nearly pure difference tones from sinusoidal inputs without the use of band-pass filters, in analogy to an image-reject mixer in communications engineering. We speculate that such computations may play a role in coding of sensory input and feedback stabilization of motor output in nervous systems.

  17. Bright-Dark Mixed N-Soliton Solutions of the Multi-Component Mel'nikov System

    Science.gov (United States)

    Han, Zhong; Chen, Yong; Chen, Junchao

    2017-10-01

    By virtue of the Kadomtsev-Petviashvili (KP) hierarchy reduction technique, we construct the general bright-dark mixed N-soliton solution to the multi-component Mel'nikov system. This multi-component system comprised of multiple (say M) short-wave components and one long-wave component with all possible combinations of nonlinearities including all-positive, all-negative and mixed types. Firstly, the two-bright-one-dark (2-b-1-d) and one-bright-two-dark (1-b-2-d) mixed N-soliton solutions in short-wave components of the three-component Mel'nikov system are derived in detail. Then we extend our analysis to the M-component Mel'nikov system to obtain its general mixed N-soliton solution. The formula obtained unifies the all-bright, all-dark and bright-dark mixed N-soliton solutions. For the collision of two solitons, an asymptotic analysis shows that for an M-component Mel'nikov system with M ≥ 3, inelastic collision takes place, resulting in energy exchange among the short-wave components supporting bright solitons only if the bright solitons appear in at least two short-wave components. In contrast, the dark solitons in the short-wave components and the bright solitons in the long-wave component always undergo elastic collision which is only accompanied by a position shift.

  18. Continuous mixing of solids

    NARCIS (Netherlands)

    Raouf, M.S.

    1963-01-01

    The most important literature on theoretical aspects of mixing solids was reviewed.

    Only when the mixed materials showed no segregation it was possible to analyse the mixing process quantitatively. In this case the mixture could be described by the 'χ' Square test. Longitudinal mixing could be

  19. Cognitive Performance Assessment in Mixed and Virtual Environment Systems

    National Research Council Canada - National Science Library

    Pair, Jarrell; Rizzo, Albert

    2006-01-01

    The U.S. Army is currently interested in developing state-of-the-art training methods that leverage technology based on established and emerging immersive mixed and virtual environment systems employing...

  20. Human Herpesvirus-8 Infection Associated with Kaposi Sarcoma, Multicentric Castleman's Disease, and Plasmablastic Microlymphoma in a Man with AIDS: A Case Report with Review of Pathophysiologic Processes

    Directory of Open Access Journals (Sweden)

    Christian Eaton

    2011-01-01

    Full Text Available Kaposi sarcoma (KS, multicentric Castleman's disease (MCD, and plasmablastic microlymphoma, are all linked to human herpesvirus-8 (HHV-8 infection and HIV-induced immunodeficiency. Herein, we describe the case of a Kenyan man diagnosed with HIV in 2000. He deferred highly active antiretroviral therapy (HAART and remained in good health until his CD4+ count declined in 2006. He was hospitalized with bacterial pneumonia in 2008, after which he agreed to take HAART but did so sporadically. In 2010, he was hospitalized with fever, lymphadenopathy, pancytopenia, and an elevated HHV-8 viral load. A lymph node biopsy showed findings consistent with KS, MCD, and plasmablastic microlymphoma. Eight months after starting liposomal doxorubicin, Rituximab, and a new HAART regimen, he has improved clinically, and his HIV and HHV-8 viral loads are suppressed. These three conditions, found in the same lymph node, underscore the inflammatory and malignant potential of HHV-8, particularly in the milieu of HIV-induced immunodeficiency.

  1. Controlling Actinide Hydration in Mixed Solvent Systems: Towards Tunable Solvent Systems to Close the Fuel Cycle

    International Nuclear Information System (INIS)

    Clark, Sue B.

    2016-01-01

    The goal of this project has been to define the extent of hydration the f-elements and other cations in mixed solvent electrolyte systems. Methanol-water and other mixed solvent systems have been studied, where the solvent dielectric constant was varied systematically. Thermodynamic and spectroscopic studies provide details concerning the energetics of complexation and other reactions of these cations. This information has also been used to advance new understanding of the behavior of these cations in a variety of systems, ranging from environmental studies, chromatographic approaches, and ionization processes for mass spectrometry.

  2. Controlling Actinide Hydration in Mixed Solvent Systems: Towards Tunable Solvent Systems to Close the Fuel Cycle

    Energy Technology Data Exchange (ETDEWEB)

    Clark, Sue B. [Washington State Univ., Pullman, WA (United States). Dept. of Chemistry

    2016-10-31

    The goal of this project has been to define the extent of hydration the f-elements and other cations in mixed solvent electrolyte systems. Methanol-water and other mixed solvent systems have been studied, where the solvent dielectric constant was varied systematically. Thermodynamic and spectroscopic studies provide details concerning the energetics of complexation and other reactions of these cations. This information has also been used to advance new understanding of the behavior of these cations in a variety of systems, ranging from environmental studies, chromatographic approaches, and ionization processes for mass spectrometry.

  3. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    DEFF Research Database (Denmark)

    Kurshumliu, Fisnik; Rung-Hansen, Helle; Skovlund, Vibeke Ravn

    2011-01-01

    Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower...... abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed...... and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion....

  4. Games policy makers and providers play: introducing case-mix-based payment to hospital chronic care units in Japan.

    Science.gov (United States)

    Ikegami, Naoki

    2009-06-01

    Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

  5. Impairment of Heat Transfer in the Passive Cooling System due to Mixed Convection

    Energy Technology Data Exchange (ETDEWEB)

    Chae Myeong Seon; Chung, Bum Jin [Kyunghee University, Yongin (Korea, Republic of); Kim, Jong Hwan [KAERI, Daejeon (Korea, Republic of)

    2016-05-15

    In the passive cooling devices, the buoyant flows are induced. However the local Nusselt number of natural convective flow can be partly impaired due to the development of the mixed convective flows. This paper discusses impairment of heat transfer in the passive cooling system in relation to the development of mixed convection. The present work describes the preliminary plan to explore the phenomena experimentally. This paper is to discuss and make the plan to experiment the impairment of heat transfer in the passive cooling system due to mixed convection. In the sufficiently high passive cooling devices, the natural convection flow behavior can be mixed convection. The local Nusselt number distribution exhibits the non-monotonic behavior as axial position, since the buoyancy-aided with mixed convection was appeared. This is the part of the experimental work.

  6. Managing urban energy system: A case of Suzhou in China

    International Nuclear Information System (INIS)

    Liang Sai; Zhang Tianzhu

    2011-01-01

    Managing urban energy system is vital for energy conservation and CO 2 reduction. Integrating energy input-output model with carbon emission pinch analysis, we propose a framework for managing urban energy system. This framework could analyze current energy demands and CO 2 emissions, predict their future possibilities and optimize energy mix of key sectors under CO 2 emission constraints. Key sectors are identified by the energy input-output table from both direct and accumulative perspectives. Moreover, taking Suzhou, a typical manufacturing center and export-oriented city in China, as a case example, energy metabolism of Suzhou in 2020 is predicted using energy input-output model. And three sectors named Coking, Smelting and pressing of metals and Production and supply of electric power are identified to have big effects on CO 2 emissions. Subsequently, energy mix of three identified key sectors is optimized under CO 2 emission constraints by the carbon emission pinch analysis. According to the results, clean energy sources will occupy a great position in Suzhou's future energy demands. And the reuse of wastes as energy sources should be limited to achieve CO 2 mitigation targets. Finally, policy implications of results and future work are discussed. - Research highlights: → We construct a framework for sustainable energy system management. → We apply the framework in a typical manufacturing center named Suzhou in China. → Key sectors for CO 2 emissions are identified, and energy mix is optimized. → Policy implications of results and future work are discussed.

  7. The diagnostic value of lymph node biopsy to detect Castleman’s disease

    Directory of Open Access Journals (Sweden)

    Prashilla Soma

    2014-09-01

    Full Text Available HIV is not indicated in the aetiology of Castleman’s disease. However, it impacts on the prevalence and natural history of this disease and significantly on the disease progression. Castleman’s disease is a uni- or multicentric disease of the lymph node with or without polyclonal proliferation of B-cells. It is a morphologically distinct form of lymph node hyperplasia and is characterised by significant architectural changes in all lymphatic compartments. Histopathologically, the disease is classified into two major subtypes: the hyaline-vascular type and the plasma-cell type. A mixed type is also identified, as there are frequent transitions between the types. The diagnosis of Castleman’s disease needs to be made histologically. Treatment modalities include surgery, which is curative for unicentric disease, and systemic therapy, which is needed for multicentric disease. This case highlights the diagnostic value of lymph node excision biopsy in HIV-infected patients.

  8. The use of the BDA Case Mix Model to assess the need for referral of patients to specialist dental services.

    Science.gov (United States)

    AlKindi, N A; Nunn, J

    2016-04-22

    Access to health services is a right for every individual. However, there is evidence that people with disabilities face barriers in accessing dental health. One of the reasons associated with this is the unclear referral pathway existing in the Irish dental health service. The appropriate assignment of patients to relevant services is an important issue to ensure better access to healthcare. This is all the more pertinent because there are only a few trained dental practitioners to provide dental treatment for people with disabilities, as well as even fewer qualified specialists in special care dentistry. The aim of this part of the study was to assess the use of the BDA Case Mix Model to determine the need for referral of patients to specialist dental services, and to determine any association between patient complexity and the need for adjunct measures, such as sedation and general anaesthesia for the management of people with disabilities and complex needs. A retrospective analysis of dental records using the BDA Case Mix Model.Results The results showed that patients with different levels of complexities were being referred to the special care dentistry clinic at the Dublin Dental University Hospital. The results also showed that the need for supportive adjunct measures such as sedation and general anaesthesia was not necessarily the main reason for referring patients to specialist services. The assessment with the BDA Case Mix Model was comprehensive as it looked at many factors contributing to the cases' complexity. Not all categories in the Case Mix Model had significant association with the need for an adjunct.Conclusion The BDA Case Mix Model can be used to measure the need for supportive adjunct measures, such as sedation and general anaesthesia.

  9. Ferroelectric-antiferroelectric mixed systems. Equation of state, thermodynamic functions

    Directory of Open Access Journals (Sweden)

    N.A.Korynevskii

    2006-01-01

    Full Text Available The problem of equation of state for ferroelectric-antiferroelectric mixed systems in the whole region of a concentration change (0≤n≤1 is discussed. The main peculiarity of the presented model turns out to be the possibility for the site dipole momentum to be oriented ferroelectrically in z-direction and antiferroelectrically in x-direction. Such a situation takes place in mixed compounds of KDP type. The different phases (ferro-, antiferro-, paraelectric, dipole glass and some combinations of them have been found and analyzed.

  10. Castleman’s disease – a case report

    Directory of Open Access Journals (Sweden)

    Maciej Wilczak

    2011-03-01

    Full Text Available Angiofollicular lymphoid hyperplasia (Castleman’s disease is a very rare disease of lymphatic tissue, manifested by overgrowth of B lymphocytes and plasma cells in lymph nodes. The aetiology of this lymphocyte hyperplasia has not been conclusively explained and its pathogenesis is still not known. There are three types of the disease based on histological criteria: plasma-cell, hyaline-vascular and transitional. Clinically it is classified into two forms, localized and multicentric (disseminated/generalized. Castleman’s disease may develop not only in lymph nodes, but also in other organs and tissues, e.g. larynx, pancreas, meninges, etc. In patients with localized Castleman’s disease the most important therapy is radical surgery of the tumour, which creates conditions leading to complete recovery. In the case of multicentric diagnosis the prognosis is unsure.The paper describes an atypical case of Castleman’s disease, diagnosed as localized form in the patient’s pelvis minor with accompanying cystic changes in the mesocolon.

  11. Toxoplasma gondii Infection and Mixed Anxiety and Depressive Disorder: A Case-Control Seroprevalence Study in Durango, Mexico.

    Science.gov (United States)

    Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Berumen-Segovia, Luis Omar; Torres-Prieto, Yazmin Elizabeth; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ortiz-Jurado, Maria Nalleli; Molotla-de-Leon, Gabriel; Beristain Garcia, Isabel; Rabago-Sanchez, Elizabeth; Liesenfeld, Oliver

    2016-07-01

    The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed.

  12. Book review: A study of mixed legal systems: endangered, entrenched, or blended / edited by S. Farran, E. Örücü, and S.P. Donlan, Farnham and Burlington - ISBN 978-1-4724-4177-5

    NARCIS (Netherlands)

    Simon Thomas, Marc|info:eu-repo/dai/nl/325784760

    2015-01-01

    This edited volume offers a number of detailed and fascinating case studies of mixed legal systems (i.e., mixed systems of common law and civil law) from across the globe: Cyprus, Guyana, Jersey, Mauritius, the Philippines, Quebec, Saint Lucia, Scotland, and Seychelles. It explores the question of

  13. Intercomparison of model simulations of mixed-phase clouds observed during the ARM Mixed-Phase Arctic Cloud Experiment. Part II: Multi-layered cloud

    Energy Technology Data Exchange (ETDEWEB)

    Morrison, H; McCoy, R B; Klein, S A; Xie, S; Luo, Y; Avramov, A; Chen, M; Cole, J; Falk, M; Foster, M; Genio, A D; Harrington, J; Hoose, C; Khairoutdinov, M; Larson, V; Liu, X; McFarquhar, G; Poellot, M; Shipway, B; Shupe, M; Sud, Y; Turner, D; Veron, D; Walker, G; Wang, Z; Wolf, A; Xu, K; Yang, F; Zhang, G

    2008-02-27

    Results are presented from an intercomparison of single-column and cloud-resolving model simulations of a deep, multi-layered, mixed-phase cloud system observed during the ARM Mixed-Phase Arctic Cloud Experiment. This cloud system was associated with strong surface turbulent sensible and latent heat fluxes as cold air flowed over the open Arctic Ocean, combined with a low pressure system that supplied moisture at mid-level. The simulations, performed by 13 single-column and 4 cloud-resolving models, generally overestimate the liquid water path and strongly underestimate the ice water path, although there is a large spread among the models. This finding is in contrast with results for the single-layer, low-level mixed-phase stratocumulus case in Part I of this study, as well as previous studies of shallow mixed-phase Arctic clouds, that showed an underprediction of liquid water path. The overestimate of liquid water path and underestimate of ice water path occur primarily when deeper mixed-phase clouds extending into the mid-troposphere were observed. These results suggest important differences in the ability of models to simulate Arctic mixed-phase clouds that are deep and multi-layered versus shallow and single-layered. In general, models with a more sophisticated, two-moment treatment of the cloud microphysics produce a somewhat smaller liquid water path that is closer to observations. The cloud-resolving models tend to produce a larger cloud fraction than the single-column models. The liquid water path and especially the cloud fraction have a large impact on the cloud radiative forcing at the surface, which is dominated by the longwave flux for this case.

  14. US Department of Energy Mixed Waste Integrated Program performance systems analysis

    International Nuclear Information System (INIS)

    Ferrada, J.J.; Berry, J.B.

    1994-01-01

    The primary goal of this project is to support decision making for the U.S. Department of Energy (DOE)/EM-50 Mixed Waste Integrated Program (MWIP) and the Mixed Low-Level Waste Program. A systems approach to the assessment of enhanced waste form(s) production will be employed including, coordination and configuration management of activities in specific technology development tasks. The purpose of this paper is to describe the development and application of a methodology for implementing a performance systems analysis on mixed waste treatment process technologies. The second section describes a conventional approach to process systems analysis followed by a methodology to estimate uncertainties when analyzing innovative technologies. Principles from these methodologies have been used to develop a performance systems analysis for MWIP. The third section describes the systems analysis tools. The fourth section explains how the performance systems analysis will be used to analyze MWIP process alternatives. The fifth and sixth sections summarize this paper and describe future work for this project. Baseline treatment process technologies (i.e., commercially available technologies) and waste management strategies are evaluated systematically using the ASPEN PLUS program applications developed by the DOE Mixed Waste Treatment Project (MWTP). Alternatives to the baseline (i.e., technologies developed by DOE's Office of Technology Development) are analyzed using FLOW, a user-friendly program developed at Oak Ridge National Laboratory (ORNL). Currently, this program is capable of calculating rough order-of-magnitude mass and energy balances to assess the performance of the alternative technologies as compared to the baseline process. In the future, FLOW will be capable of communicating information to the ASPEN PLUS program

  15. Mixing in the $D^0$ system Results from collider experiments

    CERN Document Server

    Grothe, Monika

    2003-01-01

    Mixing in the $D^0$ system may provide a sensitive probe for new physics beyond the Standard Model (SM) but has so far eluded experimental observation. The SM predictions are typically small ($< 10^{-3}$) for the mixing parameters $x$, $y$ which, in the absence of charge-parity ($CP$) symmetry violation, measure the mass ($x= Delta m/ Gamma$) and lifetime ($y= Delta Gamma / 2 Gamma$) difference of the $CP$ eigenstates in the $D^0$ system. The asymmetric $B$-factory experiments BABAR and Belle open up the opportunity of measuring $x$, $y$ with unprecedented statistical precision and sample purities. Results from BABAR and Belle, and from CLEO are reviewed.

  16. Appliance Call Center: A Successful Mixed-Initiative Case Study

    OpenAIRE

    Cheetham, William E.; Goebel, Kai

    2007-01-01

    Customer service is defined as the ability of a company to afford the service requestor with the expressed need. Due to the increasing importance of service offerings as a revenue source and increasing competition among service providers, it is important for companies to optimize both the customer experience as well as the associated cost of providing the service. For more complex interactions with higher value, mixed-initiative systems provide an avenue that gives a good balance between the ...

  17. TRACG-CFD analysis of ESBWR reactor water cleanup shutdown cooling system mixing coefficient

    International Nuclear Information System (INIS)

    Gallardo, J.; Marquino, W.; Mistreanu, A.; Yang, J.

    2015-09-01

    The ESBWR is a 1520 nominal [M We] Generation III+ natural circulation boiling water reactor designed to high levels of safety utilizing features that have been successfully used before in operating BWRs, as well as standard features common to A BWR. In September of 2014, the US NRC has certified the ESBWR design for use in the USA. The RWCU/Sdc is an auxiliary system for the ESBWR nuclear island. Basic functions it performs include purifying the reactor coolant during normal operation and shutdown and providing shutdown cooling and cooldown to cold shutdown conditions. The performance of the RWCU system during shutdown cooling is directly related to the temperature of the water removed through the outlets, which is coupled with the vessel and F W temperatures through a thermal mixing coefficient. The complex three-dimensional (3-D) geometry of the BWR downcomer and lower plenum has a great impact on the flow mixing. Only a fine mesh technique like CFD can predict the 3-D temperature distribution in the RPV during shutdown and provide the RWCU/Sdc system inlet temperature. Plant shutdown is an unsteady event by nature and was modeled as a succession of CFD steady-state simulations. It is required to establish the mixing coefficient (which is a function of the heat balance and the core flow) during the operation of the RWCU system in the multiple shutdown cooling modes, and therefore a range of core flows needs to be estimated using quasi steady states obtained with TRACG. The lower end of that range is obtained from a system with minimal power decay heat and core flow; while the higher end corresponds to the power at the beginning of RWCU/Sdc operation when the cooldown is transferred to the RWCU/Sdc after the initial depressurization via the turbine bypass valves. Because the ESBWR RWCU/Sdc return and suction designs provide good mixing, the uniform mixing energy balance was found to be an adequate alternative for deriving the mixing coefficient. The CFD mass flow

  18. TRACG-CFD analysis of ESBWR reactor water cleanup shutdown cooling system mixing coefficient

    Energy Technology Data Exchange (ETDEWEB)

    Gallardo, J. [UNAM, Facultad de Ingenieria, Ciudad Universitaria, 04510 Ciudad de Mexico (Mexico); Marquino, W.; Mistreanu, A.; Yang, J., E-mail: euqrop@hotmail.com [General Electric Hitachi Nuclear Energy, Wilmington, 28401 North Carolina (United States)

    2015-09-15

    The ESBWR is a 1520 nominal [M We] Generation III+ natural circulation boiling water reactor designed to high levels of safety utilizing features that have been successfully used before in operating BWRs, as well as standard features common to A BWR. In September of 2014, the US NRC has certified the ESBWR design for use in the USA. The RWCU/Sdc is an auxiliary system for the ESBWR nuclear island. Basic functions it performs include purifying the reactor coolant during normal operation and shutdown and providing shutdown cooling and cooldown to cold shutdown conditions. The performance of the RWCU system during shutdown cooling is directly related to the temperature of the water removed through the outlets, which is coupled with the vessel and F W temperatures through a thermal mixing coefficient. The complex three-dimensional (3-D) geometry of the BWR downcomer and lower plenum has a great impact on the flow mixing. Only a fine mesh technique like CFD can predict the 3-D temperature distribution in the RPV during shutdown and provide the RWCU/Sdc system inlet temperature. Plant shutdown is an unsteady event by nature and was modeled as a succession of CFD steady-state simulations. It is required to establish the mixing coefficient (which is a function of the heat balance and the core flow) during the operation of the RWCU system in the multiple shutdown cooling modes, and therefore a range of core flows needs to be estimated using quasi steady states obtained with TRACG. The lower end of that range is obtained from a system with minimal power decay heat and core flow; while the higher end corresponds to the power at the beginning of RWCU/Sdc operation when the cooldown is transferred to the RWCU/Sdc after the initial depressurization via the turbine bypass valves. Because the ESBWR RWCU/Sdc return and suction designs provide good mixing, the uniform mixing energy balance was found to be an adequate alternative for deriving the mixing coefficient. The CFD mass flow

  19. Mixing in three-phase systems: Implications for enhanced oil recovery and unconventional gas extraction

    Science.gov (United States)

    Jimenez-Martinez, J.; Porter, M. L.; Hyman, J.; Carey, J. W.; Viswanathan, H. S.

    2015-12-01

    Although the mixing of fluids within a porous media is a common process in natural and industrial systems, how the degree of mixing depends on the miscibility of multiple phases is poorly characterized. Often, the direct consequence of miscible mixing is the modification of the resident fluid (brine and hydrocarbons) rheological properties. We investigate supercritical (sc)CO2 displacement and mixing processes in a three-phase system (scCO2, oil, and H2O) using a microfluidics experimental system that accommodates the high pressures and temperatures encountered in fossil fuel extraction operations. The miscibility of scCO2 with the resident fluids, low with aqueous solutions and high with hydrocarbons, impacts the mixing processes that control sweep efficiency in enhanced oil recovery (EOR) and the unlocking of the system in unconventional oil and gas extraction. Using standard volume-averaging techniques we upscale the aqueous phase saturation to the field-scale (i.e., Darcy scale) and interpret the results as a simpler two-phase system. This process allows us to perform a statistical analysis to quantify i) the degree of heterogeneity in the system resulting from the immiscible H2O and ii) how that heterogeneity impacts mixing between scCO2 and oil and their displacement. Our results show that when scCO2 is used for miscible displacement, the presence of an aqueous solution, which is common in secondary and tertiary EOR and unconventional oil and gas extraction, strongly impacts the mixing of scCO2 with the hydrocarbons due to low scCO2-H2O miscibility. H2O, which must be displaced advectively by the injected scCO2, introduces spatio-temporal variability into the system that acts as a barrier between the two miscibile fluids. This coupled with the effect of viscosity contrast, i.e., viscous fingering, has an impact on the mixing of the more miscible pair.

  20. Ethics review as a component of institutional approval for a multicentre continuous quality improvement project: the investigator's perspective

    Directory of Open Access Journals (Sweden)

    von Dadelszen Peter

    2010-07-01

    Full Text Available Abstract Background For ethical approval of a multicentre study in Canada, investigators must apply separately to individual Research Ethics Boards (REBs. In principle, the protection of human research subjects is of utmost importance. However, in practice, the process of multicentre ethics review can be time consuming and costly, requiring duplication of effort for researchers and REBs. We used our experience with ethical review of The Canadian Perinatal Network (CPN, to gain insight into the Canadian system. Methods The applications forms of 16 different REBs were abstracted for a list of standardized items. The application process across sites was compared. Correspondence between the REB and the investigators was documented in order to construct a timeline to approval, identify the specific issues raised by each board, and describe how they were resolved. Results Each REB had a different application form. Most (n = 9 had a two or three step application process. Overall, it took a median of 31 days (range 2-174 days to receive an initial response from the REB. Approval took a median of 42 days (range 4-443 days. Privacy and consent were the two major issues raised. Several additional minor or administrative issues were raised which delayed approval. Conclusions For CPN, the Canadian REB process of ethical review proved challenging. REBs acted independently and without unified application forms or submission procedures. We call for a critical examination of the ethical, privacy and institutional review processes in Canada, to determine the best way to undertake multicentre review.

  1. Mixing ratio sensor of alcohol mixed fuel

    Energy Technology Data Exchange (ETDEWEB)

    Miyata, Shigeru; Matsubara, Yoshihiro

    1987-08-07

    In order to improve combustion efficiency of an internal combustion engine using gasoline-alcohol mixed fuel and to reduce harmful substance in its exhaust gas, it is necessary to control strictly the air-fuel ratio to be supplied and the ignition timing and change the condition of control depending upon the mixing ratio of the mixed fuel. In order to detect the mixing ratio of the mixed fuel, the above mixing ratio has so far been detected by casting a ray of light to the mixed fuel and utilizing a change of critical angle associated with the change of the composition of the fluid of the mixed fuel. However, in case when a light emitting diode is used for the light source above, two kinds of sensors are further needed. Concerning the two kinds of sensors above, this invention offers a mixing ratio sensor for the alcohol mixed fuel which can abolish a temperature sensor to detect the environmental temperature by making a single compensatory light receiving element deal with the compensation of the amount of light emission of the light emitting element due to the temperature change and the compensation of the critical angle caused by the temperature change. (6 figs)

  2. Implementation of a MIX Emulator: A Case Study of the Scala Programming Language Facilities

    Directory of Open Access Journals (Sweden)

    Batdalov Ruslan

    2017-12-01

    Full Text Available Implementation of an emulator of MIX, a mythical computer invented by Donald Knuth, is used as a case study of the features of the Scala programming language. The developed emulator provides rich opportunities for program debugging, such as tracking intermediate steps of program execution, an opportunity to run a program in the binary or the decimal mode of MIX, verification of correct synchronisation of input/output operations. Such Scala features as cross-compilation, family polymorphism and support for immutable data structures have proved to be useful for implementation of the emulator. The authors of the paper also propose some improvements to these features: flexible definition of family-polymorphic types, integration of family polymorphism with generics, establishing full equivalence between mutating operations on mutable data types and copy-and-modify operations on immutable data types. The emulator is free and open source software available at www.mix-emulator.org.

  3. Minimal modification to tribimaximal mixing

    International Nuclear Information System (INIS)

    He Xiaogang; Zee, A.

    2011-01-01

    We explore some ways of minimally modifying the neutrino mixing matrix from tribimaximal, characterized by introducing at most one mixing angle and a CP violating phase thus extending our earlier work. One minimal modification, motivated to some extent by group theoretic considerations, is a simple case with the elements V α2 of the second column in the mixing matrix equal to 1/√(3). Modifications by keeping one of the columns or one of the rows unchanged from tribimaximal mixing all belong to the class of minimal modification. Some of the cases have interesting experimentally testable consequences. In particular, the T2K and MINOS collaborations have recently reported indications of a nonzero θ 13 . For the cases we consider, the new data sharply constrain the CP violating phase angle δ, with δ close to 0 (in some cases) and π disfavored.

  4. Extramedullary hematopoiesis in a case of benign mixed mammary tumor in a female dog: cytological and histopathological assessment

    Directory of Open Access Journals (Sweden)

    Leão João

    2010-09-01

    Full Text Available Abstract Backgroud Extramedullary hematopoiesis (EMH is defined as the presence of hematopoietic stem cells such as erythroid and myeloid lineage plus megakaryocytes in extramedullary sites like liver, spleen and lymph nodes and is usually associated with either bone marrow or hematological disorders. Mammary EMH is a rare condition either in human and veterinary medicine and can be associated with benign mixed mammary tumors, similarly to that described in this case. Case presentation Hematopoietic stem cells were found in a benign mixed mammary tumor of a 7-year-old female mongrel dog that presents a nodule in the left inguinal mammary gland. The patient did not have any hematological abnormalities. Cytological evaluation demonstrated two distinct cell populations, composed of either epithelial or mesenchymal cells, sometimes associated with a fibrillar acidophilic matrix, apart from megakaryocytes, osteoclasts, metarubricytes, prorubricytes, rubricytes, rubriblasts, promyelocytes, myeloblasts. Histological examination confirmed the presence of an active hematopoietic bone marrow within the bone tissue of a benign mammary mixed tumor. Conclusions EMH is a rare condition described in veterinary medicine that can be associated with mammary mixed tumors. It's detection can be associated with several neoplastic and non-neoplastic mammary lesions, i.e. osteosarcomas, mixed tumors and bone metaplasia.

  5. Distributed mixed-integer fuzzy hierarchical programming for municipal solid waste management. Part I: System identification and methodology development.

    Science.gov (United States)

    Cheng, Guanhui; Huang, Guohe; Dong, Cong; Xu, Ye; Chen, Xiujuan; Chen, Jiapei

    2017-03-01

    Due to the existence of complexities of heterogeneities, hierarchy, discreteness, and interactions in municipal solid waste management (MSWM) systems such as Beijing, China, a series of socio-economic and eco-environmental problems may emerge or worsen and result in irredeemable damages in the following decades. Meanwhile, existing studies, especially ones focusing on MSWM in Beijing, could hardly reflect these complexities in system simulations and provide reliable decision support for management practices. Thus, a framework of distributed mixed-integer fuzzy hierarchical programming (DMIFHP) is developed in this study for MSWM under these complexities. Beijing is selected as a representative case. The Beijing MSWM system is comprehensively analyzed in many aspects such as socio-economic conditions, natural conditions, spatial heterogeneities, treatment facilities, and system complexities, building a solid foundation for system simulation and optimization. Correspondingly, the MSWM system in Beijing is discretized as 235 grids to reflect spatial heterogeneity. A DMIFHP model which is a nonlinear programming problem is constructed to parameterize the Beijing MSWM system. To enable scientific solving of it, a solution algorithm is proposed based on coupling of fuzzy programming and mixed-integer linear programming. Innovations and advantages of the DMIFHP framework are discussed. The optimal MSWM schemes and mechanism revelations will be discussed in another companion paper due to length limitation.

  6. Multicentre European study of thalamic stimulation in parkinsonian and essential tremor

    NARCIS (Netherlands)

    Limousin, P.; Speelman, J. D.; Gielen, F.; Janssens, M.

    1999-01-01

    Thalamic stimulation has been proposed to treat disabling tremor. The aims of this multicentre study were to evaluate the efficacy and the morbidity of thalamic stimulation in a large number of patients with parkinsonian or essential tremor. One hundred and eleven patients were included in the study

  7. Race, Identity and the Transference/Countertransference: A Mixed –Race Patient and a Mixed-Race Therapist- A Single Case Study

    OpenAIRE

    Millar, Tennyson

    2014-01-01

    This thesis is a single case-study of a child and adolescent psychotherapist working with a fourteen year old female adolescent patient of similar mixed ethnic background. The thesis presents the completed two year therapeutic work which included periods of intensive therapy (3-4 times-a-week work) following less intensive work.\\ud The patient’s early life was marked by witnessing parental domestic violence and parents who divorced. She subsequently struggled with maintaining relationships an...

  8. Thermal processing systems for TRU mixed waste

    International Nuclear Information System (INIS)

    Eddy, T.L.; Raivo, B.D.; Anderson, G.L.

    1992-01-01

    This paper presents preliminary ex situ thermal processing system concepts and related processing considerations for remediation of transuranic (TRU)-contaminated wastes (TRUW) buried at the Radioactive Waste Management Complex (RWMC) of the Idaho National Engineering Laboratory (INEL). Anticipated waste stream components and problems are considered. Thermal processing conditions required to obtain a high-integrity, low-leachability glass/ceramic final waste form are considered. Five practical thermal process system designs are compared. Thermal processing of mixed waste and soils with essentially no presorting and using incineration followed by high temperature melting is recommended. Applied research and development necessary for demonstration is also recommended

  9. Multipartite entangled states in particle mixing

    International Nuclear Information System (INIS)

    Blasone, M.; Dell'Anno, F.; De Siena, S.; Di Mauro, M.; Illuminati, F.

    2008-01-01

    In the physics of flavor mixing, the flavor states are given by superpositions of mass eigenstates. By using the occupation number to define a multiqubit space, the flavor states can be interpreted as multipartite mode-entangled states. By exploiting a suitable global measure of entanglement, based on the entropies related to all possible bipartitions of the system, we analyze the correlation properties of such states in the instances of three- and four-flavor mixing. Depending on the mixing parameters, and, in particular, on the values taken by the free phases, responsible for the CP-violation, entanglement concentrates in certain bipartitions. We quantify in detail the amount and the distribution of entanglement in the physically relevant cases of flavor mixing in quark and neutrino systems. By using the wave packet description for localized particles, we use the global measure of entanglement, suitably adapted for the instance of multipartite mixed states, to analyze the decoherence, induced by the free evolution dynamics, on the quantum correlations of stationary neutrino beams. We define a decoherence length as the distance associated with the vanishing of the coherent interference effects among massive neutrino states. We investigate the role of the CP-violating phase in the decoherence process.

  10. Real-time 3D human capture system for mixed-reality art and entertainment.

    Science.gov (United States)

    Nguyen, Ta Huynh Duy; Qui, Tran Cong Thien; Xu, Ke; Cheok, Adrian David; Teo, Sze Lee; Zhou, ZhiYing; Mallawaarachchi, Asitha; Lee, Shang Ping; Liu, Wei; Teo, Hui Siang; Thang, Le Nam; Li, Yu; Kato, Hirokazu

    2005-01-01

    A real-time system for capturing humans in 3D and placing them into a mixed reality environment is presented in this paper. The subject is captured by nine cameras surrounding her. Looking through a head-mounted-display with a camera in front pointing at a marker, the user can see the 3D image of this subject overlaid onto a mixed reality scene. The 3D images of the subject viewed from this viewpoint are constructed using a robust and fast shape-from-silhouette algorithm. The paper also presents several techniques to produce good quality and speed up the whole system. The frame rate of our system is around 25 fps using only standard Intel processor-based personal computers. Besides a remote live 3D conferencing and collaborating system, we also describe an application of the system in art and entertainment, named Magic Land, which is a mixed reality environment where captured avatars of human and 3D computer generated virtual animations can form an interactive story and play with each other. This system demonstrates many technologies in human computer interaction: mixed reality, tangible interaction, and 3D communication. The result of the user study not only emphasizes the benefits, but also addresses some issues of these technologies.

  11. Remotely controlled reagent feed system for mixed waste treatment Tank Farm

    International Nuclear Information System (INIS)

    Dennison, D.K.; Bowers, J.S.; Reed, R.K.

    1995-02-01

    LLNL has developed and installed a large-scale. remotely controlled, reagent feed system for use at its existing aqueous low-level radioactive and mixed waste treatment facility (Tank Farm). LLNL's Tank Farm is used to treat aqueous low-level and mixed wastes prior to vacuum filtration and to remove the hazardous and radioactive components before it is discharged to the City of Livermore Water Reclamation Plant (LWRP) via the sanitary sewer in accordance with established limits. This reagent feed system was installed to improve operational safety and process efficiency by eliminating the need for manual handling of various reagents used in the aqueous waste treatment processes. This was done by installing a delivery system that is controlled either remotely or locally via a programmable logic controller (PLC). The system consists of a pumping station, four sets of piping to each of six 6,800-L (1,800-gal) treatment tanks, air-actuated discharge valves at each tank, a pH/temperature probe at each tank, and the PLC-based control and monitoring system. During operation, the reagents are slowly added to the tanks in a preprogrammed and controlled manner while the pH, temperature, and liquid level are continuously monitored by the PLC. This paper presents the purpose of this reagent feed system, provides background related to LLNL's low-level/mixed waste treatment processes, describes the major system components, outlines system operation, and discusses current status and plans

  12. Dry low NOx combustion system with pre-mixed direct-injection secondary fuel nozzle

    Science.gov (United States)

    Zuo, Baifang; Johnson, Thomas; Ziminsky, Willy; Khan, Abdul

    2013-12-17

    A combustion system includes a first combustion chamber and a second combustion chamber. The second combustion chamber is positioned downstream of the first combustion chamber. The combustion system also includes a pre-mixed, direct-injection secondary fuel nozzle. The pre-mixed, direct-injection secondary fuel nozzle extends through the first combustion chamber into the second combustion chamber.

  13. Optimization of gas mixing system of premixed burner based on CFD analysis

    International Nuclear Information System (INIS)

    Zhang, Tian-Hu; Liu, Feng-Guo; You, Xue-Yi

    2014-01-01

    Highlights: • New multi-ejectors gas mixing system for premixed combustion burner is provided. • Two measures are proposed to improve the flow uniformity at the outlet of GMS. • Small improvement of uniformity induces significant decrease of pollutant emission. • Uniformity of velocity and fuel–gas mixing of ejector increases 234.2% and 2.9%. • Uniformity of flow rate and fuel–gas mixing of ejectors increases 1.9% and 2.2%. - Abstract: The optimization of gas mixing system (GMS) of premixed burner is presented by Computational Fluid Dynamics (CFD) and the uniformity at the outlet of GMS is proved experimentally to have strong influence on pollutant emission. To improve the uniformity at the outlet of GMS, the eleven distribution orifice plates and a diversion plate are introduced. The quantified analysis shows that the uniformity at the outlet of GMS is improved significantly. With applying the distribution orifice plates, the uniformity of velocity and fuel–gas mixing of single ejector is increased by 234.2% and 2.9%, respectively. With applying the diversion plate, the uniformity of flow rate and fuel–gas mixing of different ejectors is increased by 1.9% and 2.2%, respectively. The optimal measures and geometrical parameters provide an applicable guidance for the design of commercial premixed burner

  14. Performance of an Automated-Mixed-Traffic-Vehicle /AMTV/ System. [urban people mover

    Science.gov (United States)

    Peng, T. K. C.; Chon, K.

    1978-01-01

    This study analyzes the operation and evaluates the expected performance of a proposed automatic guideway transit system which uses low-speed Automated Mixed Traffic Vehicles (AMTV's). Vehicle scheduling and headway control policies are evaluated with a transit system simulation model. The effect of mixed-traffic interference on the average vehicle speed is examined with a vehicle-pedestrian interface model. Control parameters regulating vehicle speed are evaluated for safe stopping and passenger comfort.

  15. A multicentre cohort study assessing day of week effect and outcome from emergency appendicectomy.

    Science.gov (United States)

    Ferguson, Henry J M; Hall, Nigel J; Bhangu, Aneel

    2014-09-01

    There is evidence to suggest that patients undergoing treatment at weekends may be subject to different care processes and outcomes compared with weekdays. This study aimed to determine whether clinical outcomes from weekend appendicectomy are different from those performed on weekdays. Multicentre cohort study during May-June 2012 from 95 centres (89 within the UK). The primary outcome was the 30-day adverse event rate. Multilevel modelling was used to account for clustering within hospitals while adjusting for case mix to produce adjusted ORs and 95% CIs. When compared with Monday, there were no significant differences for other days of the week considering 30-day adverse events in adjusted models. On Sunday, rates of simple appendicitis were highest, and rates of normal (OR 0.62, 95% CI 0.42 to 0.90) and complex appendicitis (OR 0.65, 95% CI 0.46 to 0.93) lowest. This was accompanied by a 43% lower likelihood in use of laparoscopy on Sunday (OR 0.47, 95% CI 0.32 to 0.69), accompanied by the lowest level of consultant presence for the week. When pooling weekends and weekdays, laparoscopy use remained less likely at the weekend (OR 0.68, 95% CI 0.55 to 0.83), with no significant difference for 30-day adverse event rate (OR 1.01, 95% CI 0.80 to 1.29). This study found that weekend appendicectomy was not associated with increased 30-day adverse events. It cannot rule out smaller increases that may be shown by larger studies. It further illustrated that patients operated on at weekends were subject to different care processes, which may expose them to risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Case-mix and quality indicators in Chinese elder care homes: are there differences between government-owned and private-sector facilities?

    Science.gov (United States)

    Liu, Chang; Feng, Zhanlian; Mor, Vincent

    2014-02-01

    To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  17. Surface wind mixing in the Regional Ocean Modeling System (ROMS)

    Science.gov (United States)

    Robertson, Robin; Hartlipp, Paul

    2017-12-01

    Mixing at the ocean surface is key for atmosphere-ocean interactions and the distribution of heat, energy, and gases in the upper ocean. Winds are the primary force for surface mixing. To properly simulate upper ocean dynamics and the flux of these quantities within the upper ocean, models must reproduce mixing in the upper ocean. To evaluate the performance of the Regional Ocean Modeling System (ROMS) in replicating the surface mixing, the results of four different vertical mixing parameterizations were compared against observations, using the surface mixed layer depth, the temperature fields, and observed diffusivities for comparisons. The vertical mixing parameterizations investigated were Mellor- Yamada 2.5 level turbulent closure (MY), Large- McWilliams- Doney Kpp (LMD), Nakanishi- Niino (NN), and the generic length scale (GLS) schemes. This was done for one temperate site in deep water in the Eastern Pacific and three shallow water sites in the Baltic Sea. The model reproduced the surface mixed layer depth reasonably well for all sites; however, the temperature fields were reproduced well for the deep site, but not for the shallow Baltic Sea sites. In the Baltic Sea, the models overmixed the water column after a few days. Vertical temperature diffusivities were higher than those observed and did not show the temporal fluctuations present in the observations. The best performance was by NN and MY; however, MY became unstable in two of the shallow simulations with high winds. The performance of GLS nearly as good as NN and MY. LMD had the poorest performance as it generated temperature diffusivities that were too high and induced too much mixing. Further observational comparisons are needed to evaluate the effects of different stratification and wind conditions and the limitations on the vertical mixing parameterizations.

  18. The effectiveness of 2-implant overdentures: a pragmatic international multicentre study

    NARCIS (Netherlands)

    Rashid, F.; Awad, M.A.; Thomason, J.M.; Piovano, A.; Spielberg, G.P.; Scilingo, E.; Mojon, P.; Müller, F.; Spielberg, M.; Heydecke, G.; Stoker, G.; Wismeijer, D.; Allen, F.; Feine, J.S.

    2011-01-01

    The purpose of this multicentre observational study was to determine patient satisfaction with either conventional dentures or mandibular 2-implant overdentures in a 'real world' setting. Two hundred and three edentulous patients (mean age 68·8 ± 10·4 years) were recruited at eight centres located

  19. Improving of Mixing by Submerged Rotary Jet (SRJ) System in a Large Industrial Storage Tank by CFD Techniques

    Science.gov (United States)

    Barekatain, H.; Hashemabadi, S. H.

    2011-09-01

    This paper reports the result of a CFD (Computational Fluid Dynamics) study on the Submerged Rotary Jet (SRJ) mixing system in a large industrial crude oil storage tank (one million barrels). This system has been installed on the tank just for reduction of sludge, but improper installation causes more accumulation of sludge on one side of tank. The main question is: How can we improve the mixing operation in this tank? For the purpose, a three dimensional modeling is carried out using an in-house CFD code and RNG k-ɛ model for turbulence prediction. The results show that pump suction location and crude oil velocity in tank are most effective factors on the sludge amount. Then, different ways such as increasing of jet flow rate, increasing and decreasing of tank height and reducing of nozzle diameter have been investigated. Finally, in this case, the results show the sedimentation of sludge in whole tank can be removed by 20% increasing of jet flow rate.

  20. Recruitment and retention in a multicentre randomised controlled trial in Bell's palsy: A case study

    Directory of Open Access Journals (Sweden)

    Daly Fergus

    2007-03-01

    Full Text Available Abstract Background It is notoriously difficult to recruit patients to randomised controlled trials in primary care. This is particularly true when the disease process under investigation occurs relatively infrequently and must be investigated during a brief time window. Bell's palsy, an acute unilateral paralysis of the facial nerve is just such a relatively rare condition. In this case study we describe the organisational issues presented in setting up a large randomised controlled trial of the management of Bell's palsy across primary and secondary care in Scotland and how we managed to successfully recruit and retain patients presenting in the community. Methods Where possible we used existing evidence on recruitment strategies to maximise recruitment and retention. We consider that the key issues in the success of this study were; the fact that the research was seen as clinically important by the clinicians who had initial responsibility for recruitment; employing an experienced trial co-ordinator and dedicated researchers willing to recruit participants seven days per week and to visit them at home at a time convenient to them, hence reducing missed patients and ensuring they were retained in the study; national visibility and repeated publicity at a local level delivered by locally based principal investigators well known to their primary care community; encouraging recruitment by payment to practices and reducing the workload of the referring doctors by providing immediate access to specialist care; good collaboration between primary and secondary care and basing local investigators in the otolarnygology trial centres Results Although the recruitment rate did not meet our initial expectations, enhanced retention meant that we exceeded our planned target of recruiting 550 patients within the planned time-scale. Conclusion While difficult, recruitment to and retention within multi-centre trials from primary care can be successfully

  1. Equilibrium measures and Cramer asymptotics in a non-invertible dynamical system with power-law mixing

    International Nuclear Information System (INIS)

    Sarazhinskii, D S

    2004-01-01

    We consider a dynamical system generated by a shift in the space of finite-valued one-sided sequences. We study spectral properties of Perron-Frobenius operators associated with this system, whose potentials on the number of the term of the sequence have power-law dependence. Using these operators, we construct a family of equilibrium probability measures in the phase space having the property of power-law mixing. For these measures we prove a central limit theorem for functions in phase space and a Cramer-type theorem for the probabilities of large deviations. Similar results for the significantly simpler case of exponential decay in the dependence of the potentials on the number of the term of the sequence were previously obtained by the author.

  2. Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?

    Science.gov (United States)

    Goff, Iain; Wise, Elspeth Mary; Coady, David; Walker, David

    2016-02-01

    Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.

  3. Ionization and thermodynamic constants of 6-methylquinoline by potentiometry in aqueous and mixed organic-water solvent systems

    International Nuclear Information System (INIS)

    Hafiz, A; Indhar, B.; Khanzada, A.W.K.

    2000-01-01

    The ionization constant pKa and Gibbs's free energy DG of 6-methylquinoline are determined in aqueous solution at different temperatures and in three mixed organic-water solvent systems at 25 deg. C. It is observed that dissociation constant of 6-methylquinoline in aqueous system decreases with the increase of temperature. The curve is a parabolic. It is noted that pKa values of this compound are higher than those of quinoline and 8-methylquinoline. In case of mixed organic-water solvent systems, the influence of these solvents on the ionization equilibria of NH/sub 2/ group has been observed. The pK M/A and pK T/A values versus percent composition decrease gradually with increase in percent of organic solvents The curve of the pK/sub a/ versus percent composition is a distorted parabola. The data have been obtained potentiometrically by titrating 6-methylquinoline solutions with HCl. The values of dissociation constant were obtained from these data by a computer program written in GW-BASIC. From pKa values Gibbs's free energies DG for the respective pKa values have also been calculated. (author)

  4. Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer.

    Science.gov (United States)

    Morgan, J; Richards, P; Ward, S; Francis, M; Lawrence, G; Collins, K; Reed, M; Wyld, L

    2015-08-01

    Non-surgical management of older women with oestrogen receptor (ER)-positive operable breast cancer is common in the UK, with up to 40 per cent of women aged over 70 years receiving primary endocrine therapy. Although this may be appropriate for frailer patients, for some it may result in treatment failure, contributing to the poor outcomes seen in this age group. Wide variation in the rates of non-operative management of breast cancer in older women exists across the UK. Case mix may explain some of this variation in practice. Data from two UK regional cancer registries were analysed to determine whether variation in treatment observed between 2002 and 2010 at hospital and clinician level persisted after adjustment for case mix. Expected case mix-adjusted surgery rates were derived by logistic regression using the variables age, proxy Charlson co-morbidity score, deprivation quintile, method of cancer detection, tumour size, stage, grade and node status. Data on 17,129 women aged 70 years or more with ER-positive operable breast cancer were analysed. There was considerable variation in rates of surgery at both hospital and clinician level. Despite adjusting for case mix, this variation persisted at hospital level, although not at clinician level. This study demonstrates variation in selection criteria for older women for operative treatment of early breast cancer, indicating that some older women may be undertreated or overtreated, and may partly explain the inferior disease outcomes in this age group. It emphasizes the urgent need for evidence-based guidelines for treatment selection criteria in older women with breast cancer. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  5. Wave mixing spectroscopy

    International Nuclear Information System (INIS)

    Smith, R.W.

    1980-08-01

    Several new aspects of nonlinear or wave mixing spectroscopy were investigated utilizing the polarization properties of the nonlinear output field and the dependence of this field upon the occurrence of multiple resonances in the nonlinear susceptibility. First, it is shown theoretically that polarization-sensitive detection may be used to either eliminate or controllably reduce the nonresonant background in coherent anti-Stokes Raman spectroscopy, allowing weaker Raman resonances to be studied. The features of multi-resonant four-wave mixing are examined in the case of an inhomogeneously broadened medium. It is found that the linewidth of the nonlinear output narrows considerably (approaching the homogeneous width) when the quantum mechanical expressions for the doubly- and triply-resonant susceptibilities are averaged over a Doppler or strain broadened profile. Experimental studies of nonlinear processes in Pr +3 :LaF 3 verify this linewidth narrowing, but indicate that this strain broadened system cannot be treated with a single broadening parameter as in the case of Doppler broadening in a gas. Several susceptibilities are measured from which are deduced dipole matrix elements and Raman polarizabilities related to the 3 H 4 , 3 H 6 , and 3 P 0 levels of the praseodymium ions

  6. Age and case mix-standardised survival for all cancer patients in Europe 1999-2007: Results of EUROCARE-5, a population-based study.

    Science.gov (United States)

    Baili, Paolo; Di Salvo, Francesca; Marcos-Gragera, Rafael; Siesling, Sabine; Mallone, Sandra; Santaquilani, Mariano; Micheli, Andrea; Lillini, Roberto; Francisci, Silvia

    2015-10-01

    Overall survival after cancer is frequently used when assessing a health care service's performance as a whole. It is mainly used by the public, politicians and the media, and is often dismissed by clinicians because of the heterogeneous mix of different cancers, risk factors and treatment modalities. Here we give survival details for all cancers combined in Europe, correlating it with economic variables to suggest reasons for differences. We computed age and cancer site case-mix standardised relative survival for all cancers combined (ACRS) for 29 countries participating in the EUROCARE-5 project with data on more than 7.5million cancer cases from 87 population-based cancer registries, using complete and period approach. Denmark, United Kingdom (UK) and Eastern European countries had lower survival than neighbouring countries. Five-year ACRS has been increasing throughout Europe, and substantial increases, between 1999-2001 and 2005-2007, have been achieved in countries where survival was lower in the past. Five-year ACRS for men and women are positively correlated with macro-economic variables like the Gross Domestic Product (GDP) and Total National Expenditure on Health (TNEH) (R 2 about 70%). Countries with recent larger increases in GDP and TNEH had greater increases in cancer survival. ACRS serves to compare all cancer survival in Europe taking account of the geographical variability in case-mixes. The EUROCARE-5 data on ACRS confirm previous EUROCARE findings. Survival appears to correlate with macro-economic determinants, particularly with investments in the health care system. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Weak Thermocline Mixing in the North Pacific Low-Latitude Western Boundary Current System

    Science.gov (United States)

    Liu, Zhiyu; Lian, Qiang; Zhang, Fangtao; Wang, Lei; Li, Mingming; Bai, Xiaolin; Wang, Jianing; Wang, Fan

    2017-10-01

    Despite its potential importance in the global climate system, mixing properties of the North Pacific low-latitude western boundary current system (LLWBC) remained unsampled until very recently. We report here on the first measurements of turbulence microstructure associated with these currents, made in the western boundary region of the tropical North Pacific east of the Philippines. The results suggest that thermocline mixing in the North Pacific LLWBC is generally weak with the diapycnal diffusivity κρ˜O(10-6) m2 s-1. This is consistent with predictions from internal wave-wave interaction theory that mixing due to internal wave breaking is significantly reduced at low latitudes. Enhanced mixing is found to be associated with a permanent cyclonic eddy, the Mindanao Eddy, but mainly at its south and north flanks. There, κρ is elevated by an order of magnitude due to eddy-induced geostrophic shear. Mixing in the eddy core is at the background level with no indication of enhancement.

  8. Effects of solvation on partition and dimerization of benzoic acid in mixed solvent systems.

    Science.gov (United States)

    Yamada, H; Yajima, K; Wada, H; Nakagawa, G

    1995-06-01

    The partition of benzoic acid between 0.1M perchloric acid solution and two kinds of mixed solvents has been carried out at 25 degrees C. The partition and dimerization constants of benzoic acid have been determined in the 1-octanol-benzene and 2-octanone-benzene systems. In both the mixed solvent systems, with increasing content of 1-octanol and 2-octanone in each mixed solvent, the partition constant of benzoic acid has been found to increase, and the dimerization constant of benzoic acid in each organic phase to decrease. These phenomena are attributable to solvation of monomeric benzoic acid by 1-octanol and 2-octanone molecules in each mixed solvent.

  9. Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

    Science.gov (United States)

    Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

    2016-11-01

    Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Communication Architecture in Mixed-Reality Simulations of Unmanned Systems.

    Science.gov (United States)

    Selecký, Martin; Faigl, Jan; Rollo, Milan

    2018-03-14

    Verification of the correct functionality of multi-vehicle systems in high-fidelity scenarios is required before any deployment of such a complex system, e.g., in missions of remote sensing or in mobile sensor networks. Mixed-reality simulations where both virtual and physical entities can coexist and interact have been shown to be beneficial for development, testing, and verification of such systems. This paper deals with the problems of designing a certain communication subsystem for such highly desirable realistic simulations. Requirements of this communication subsystem, including proper addressing, transparent routing, visibility modeling, or message management, are specified prior to designing an appropriate solution. Then, a suitable architecture of this communication subsystem is proposed together with solutions to the challenges that arise when simultaneous virtual and physical message transmissions occur. The proposed architecture can be utilized as a high-fidelity network simulator for vehicular systems with implicit mobility models that are given by real trajectories of the vehicles. The architecture has been utilized within multiple projects dealing with the development and practical deployment of multi-UAV systems, which support the architecture's viability and advantages. The provided experimental results show the achieved similarity of the communication characteristics of the fully deployed hardware setup to the setup utilizing the proposed mixed-reality architecture.

  11. Communication Architecture in Mixed-Reality Simulations of Unmanned Systems

    Directory of Open Access Journals (Sweden)

    Martin Selecký

    2018-03-01

    Full Text Available Verification of the correct functionality of multi-vehicle systems in high-fidelity scenarios is required before any deployment of such a complex system, e.g., in missions of remote sensing or in mobile sensor networks. Mixed-reality simulations where both virtual and physical entities can coexist and interact have been shown to be beneficial for development, testing, and verification of such systems. This paper deals with the problems of designing a certain communication subsystem for such highly desirable realistic simulations. Requirements of this communication subsystem, including proper addressing, transparent routing, visibility modeling, or message management, are specified prior to designing an appropriate solution. Then, a suitable architecture of this communication subsystem is proposed together with solutions to the challenges that arise when simultaneous virtual and physical message transmissions occur. The proposed architecture can be utilized as a high-fidelity network simulator for vehicular systems with implicit mobility models that are given by real trajectories of the vehicles. The architecture has been utilized within multiple projects dealing with the development and practical deployment of multi-UAV systems, which support the architecture’s viability and advantages. The provided experimental results show the achieved similarity of the communication characteristics of the fully deployed hardware setup to the setup utilizing the proposed mixed-reality architecture.

  12. Proposal for the standardisation of multi-centre trials in nuclear medicine imaging

    DEFF Research Database (Denmark)

    Dickson, John Caddell; Tossici-Bolt, Livia; Sera, Terez

    2012-01-01

    Multi-centre trials are an important part of proving the efficacy of procedures, drugs and interventions. Imaging components in such trials are becoming increasingly common; however, without sufficient control measures the usefulness of these data can be compromised. This paper describes a framew...

  13. Violent women : A multicentre study into gender differences in forensic psychiatric patients

    NARCIS (Netherlands)

    de Vogel, Vivienne; Stam, Jeantine; Bouman, Yvonne H. A.; Ter Horst, P.R.M.; Lancel, Marike

    2016-01-01

    To gain insight into the relatively small, but increasing group of women in forensic psychiatry, a retrospective multicentre study was started gathering information from the files of 275 female patients of four Dutch forensic psychiatric hospitals on characteristics and violence risk factors.

  14. Mixing and CP violation in the D0 and B0s systems

    International Nuclear Information System (INIS)

    Ligeti, Zoltan; Ligeti, Zoltan

    2007-01-01

    Recent developments for mixing and CP violation in the D0 and Bs systems are reviewed, including (i) the recently emerging evidence for D0-D0bar mixing and the interpretations of the measurements; (ii) the theoretical status of the calculations of Delta(Gamma D ) and Delta(m D ); and (iii) some implications of the measurement of Bs mixing for new physics

  15. Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

    Science.gov (United States)

    Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

    2017-06-01

    To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

  16. Uncertain pollination environment promotes the evolution of a stable mixed reproductive system in the self-incompatible Hypochaeris salzmanniana (Asteraceae).

    Science.gov (United States)

    Arista, M; Berjano, R; Viruel, J; Ortiz, M Á; Talavera, M; Ortiz, P L

    2017-09-01

    The transition from outcrossing to selfing is a repeated pattern in angiosperm diversification and according to general theory this transition should occur quickly and mixed reproductive systems should be infrequent. However, a large proportion of flowering plants have mixed reproductive systems, even showing inbreeding depression. Recently, several theoretical studies have shown that mixed mating systems can be stable, but empirical studies supporting these assumptions are still scarce. Hypochaeris salzmanniana, an annual species with populations differing in their self-incompatibility expression, was used as a study case to assess the stability of its mixed reproductive system. Here a descriptive study of the pollination environment was combined with measurements of the stability of the self-incompatibility system, outcrossing rate, reproductive assurance and inbreeding depression in four populations for two consecutive years. The reproductive system of populations exhibited a geographical pattern: the proportion of plants decreased from west to east. Pollinator environment also varied geographically, being less favourable from west to east. The self-incompatibility expression of some populations changed markedly in only one year. After selfing, progeny was mainly self-compatible, while after outcrossing both self-incompatible and self-compatible plants were produced. In general, both reproductive assurance and high inbreeding depression were found in all populations and years. The lowest values of inbreeding depression were found in 2014 in the easternmost populations, which experienced a marked increase in self-compatibility in 2015. The mixed reproductive system of H. salzmanniana seems to be an evolutionarily stable strategy, with selfing conferring reproductive assurance when pollinator attendance is low, but strongly limited by inbreeding depression. The fact that the highest frequencies of self-compatible plants appeared in the environments most

  17. Conservative Management of Macrodontia in the Mixed Dentition Stage--A Case Report.

    Science.gov (United States)

    Harker, Ann R; Walley, Sian; Albadri, Sondos

    2015-12-01

    Macrodontia is a rare dental abnormality, which can cause cosmetic concerns. Various management techniques for this condition have been documented in the literature. This case describes the initial management of macrodontia in the mixed dentition stage with the use of a minimally invasive approach to treatment. CPD/Clinical Relevance: The importance of early referral of dental abnormities is highlighted. Short- and long-term treatment options for macrodontia are described, including the impact such anomalies can have on the developing dentition.

  18. How the policy mix impacts innovation : Findings from company case studies on offshore wind in Germany

    NARCIS (Netherlands)

    Reichardt, Kristin; Rogge, Karoline

    2016-01-01

    Transforming the energy system to one with a greater importance of renewables requires redirecting and accelerating technological change. In this transition, so-called policy mixes play a crucial role. Yet precisely how policy mixes affect technological innovation remains poorly understood. To

  19. The paramagnetic properties of ferromagnetic mixed-spin chain system

    International Nuclear Information System (INIS)

    Hu, Ai-Yuan; Wu, Zhi-Min; Cui, Yu-Ting; Qin, Guo-Ping

    2015-01-01

    The double-time Green's function method is used to investigate the paramagnetic properties of ferromagnetic mixed-spin chain system within the random-phase approximation and Anderson–Callen's decoupling approximation. The analytic expressions of the transverse susceptibility, longitudinal susceptibility and correlation length are obtained under transverse and longitudinal magnetic field. Using the analytic expressions of the transverse and longitudinal susceptibility to fit the experimental results, our results well agree with experimental data and the results from the high temperature series expansion within a simple Padé approximation. - Highlights: • We investigate the magnetic properties of a ferromagnetic mixed-spin chain system. • We use the double-time temperature-dependent Green's function technique. • Different single-ion anisotropy values for different spin values are considered. • Our results agree with experimental data and the results from the other theoretical methods

  20. Multicentre epidemiological survey on the incidence of Streptococcus agalactiae in pregnancy

    Directory of Open Access Journals (Sweden)

    Leonardo Lodolo

    2010-03-01

    Full Text Available ß-hemolytic streptococci group B (GBS cause infections of the urinary tract, endometrium, amnion, and superinfection of wounds, with complications in 2% -4% of cases in pregnant woman.The infection transmitted to newborns is a cause of sepsis and meningitis with high incidence of mortality.A recent report on a multicentric study of the ISS, showed that detection of S. agalactiae in pregnant women in different realities of healthcare, ranging from 3.9% to 19.4%. This survey covers a sample of 29607 women screened in a total of 36852 childbirths, with a positivity of 4183 subjects equal to 14.1%. Thanks to the GBS Study Group of Piemonte and Valle d’Aosta microbiology laboratories, with the support of 42 study centres have been involved. Collection techniques, types of medium, environmental of incubation of the culture, possible enrichment in broth, of the swabs of 28491 women during 2006/2007 have been considered. 24.36% were vaginal swab while 75.64% vagino/rectal. According to data collected at 31 centers with eligible data (22,175 pregnant GBS positivity was 12.7% (CI [Confidence Interval] + / -95%: 13.1% -12.2% with wide variability between individual centers (2% -22.6%. The enrichment broth is used by 6 out of 9 centers with positivity> 15% (M: 20.05%, from 6 to 14 with positivity between 10-15% (M: 12.61%, from none to 8 centers with less than 10% positivity (M: 4.95%.This multicentre survey underlined the preference for vagino/rectal swab, as recommended by the literature. The frequency of GBS positivity of pregnant women on the whole samples is similar to that found in other national surveys, even if with large differences between the different centers.The sensitivity tends to increase with the use of enrichment techniques, whose use is uneven between the centers, perhaps indicating the need for greater uniformity of protocols based on the results of microbiological analysis EBM (Evidence Based Medicine.

  1. The challenges of managing coexistent disorders with phenylketonuria : 30 cases

    NARCIS (Netherlands)

    MacDonald, A.; Ahring, K.; Almeida, M. F.; Belanger-Quintana, A.; Blau, N.; Burlina, A.; Cleary, M.; Coskum, T.; Dokoupil, K.; Evans, S.; Feillet, F.; Gizewska, M.; Ozel, H. Gokmen; Lotz-Havla, A. S.; Kamienska, E.; Maillot, F.; Lammardo, A. M.; Muntau, A. C.; Puchwein-Schwepcke, A.; Robert, M.; Rocha, J. C.; Santra, S.; Skeath, R.; Straczek, K.; Trefz, F. K.; van Dam, E.; van Rijn, M.; van Spronsen, F.; Vijay, S.

    2015-01-01

    Introduction: The few published case reports of co-existent disease with phenylketonuria (PKU) are mainly genetic and familial conditions from consanguineous marriages. The clinical and demographic features of 30 subjects with PKU and co-existent conditions were described in this multi-centre,

  2. Case-Based Fault Diagnostic System

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2014-01-01

    Nowadays, case-based fault diagnostic (CBFD) systems have become important and widely applied problem solving technologies. They are based on the assumption that “similar faults have similar diagnosis”. On the other hand, CBFD systems still suffer from some limitations. Common ones of them are: (1) failure of CBFD to have the needed diagnosis for the new faults that have no similar cases in the case library. (2) Limited memorization when increasing the number of stored cases in the library. The proposed research introduces incorporating the neural network into the case based system to enable the system to diagnose all the faults. Neural networks have proved their success in the classification and diagnosis problems. The suggested system uses the neural network to diagnose the new faults (cases) that cannot be diagnosed by the traditional CBR diagnostic system. Besides, the proposed system can use the another neural network to control adding and deleting the cases in the library to manage the size of the cases in the case library. However, the suggested system has improved the performance of the case based fault diagnostic system when applied for the motor rolling bearing as a case of study

  3. Perinatal complications in patients with unisutural craniosynostosis: An international multicentre retrospective cohort study

    NARCIS (Netherlands)

    Cornelissen, Martijn J.; Softeland, Madiha; Apon, Inge; Ladfors, Lars; Mathijssen, Irene M. J.; Cohen-Overbeek, Titia E.; Bonsel, Gouke J.; Kolby, Lars

    2017-01-01

    Purpose Craniosynostosis may lead to hampered fetal head molding and birth complications. To study the interaction between single suture craniosynostosis and delivery complications, an international, multicentre, retrospective cohort study was performed. Materials and methods All infants born

  4. Traffic simulation for mixed traffic systems | Mbam | Global Journal of ...

    African Journals Online (AJOL)

    Traffic problem is classified into single and mixed, especially in most developing countries, where motorbikes are used as the most popular transportation system. The aim of this paper is to introduce the motorbike symbol into the traffic light control system to separate cars/lorries indicator from that of motorbike. This is likely ...

  5. The Case for Mixed-Age Grouping in Early Education.

    Science.gov (United States)

    Katz, Lilian G.; And Others

    In six brief chapters, mixed-age grouping of young children in schools and child care centers is explored and advocated. Chapter 1 defines mixed-age grouping, examines limitations of single-age grouping, and points out positive characteristics of mixed-age classes. Chapter 2 discusses social development as seen in children's interactions in…

  6. Computer simulation of mixed classical-quantum systems

    International Nuclear Information System (INIS)

    Kalia, R.K.; Vashishta, P.

    1988-11-01

    We briefly review three important methods that are currently used in the simulation of mixed systems. Two of these techniques, path integral Monte Carlo or molecular dynamics and dynamical simulated annealing, have the limitation that they can only describe the structural properties in the ground state. The third so-called quantum molecular dynamics (QMD) method can provide not only the static properties but also the real-time dynamics of a quantum particle at finite temperatures. 10 refs

  7. The Effect of English Language Learning on Creative Thinking Skills: A Mixed Methods Case Study

    Science.gov (United States)

    Sehic, Sandro

    2017-01-01

    The purpose of this sequential explanatory mixed-methods case study was to investigate the effects of English language learning on creative thinking skills in the domains of fluency, flexibility, originality, and elaboration as measured with the Alternate Uses Test. Unlike the previous research studies that investigated the links between English…

  8. Multicentre validation of IMRT pre-treatment verification: Comparison of in-house and external audit

    International Nuclear Information System (INIS)

    Jornet, Núria; Carrasco, Pablo; Beltrán, Mercè; Calvo, Juan Francisco; Escudé, Lluís; Hernández, Victor; Quera, Jaume; Sáez, Jordi

    2014-01-01

    Background and purpose: We performed a multicentre intercomparison of IMRT optimisation and dose planning and IMRT pre-treatment verification methods and results. The aims were to check consistency between dose plans and to validate whether in-house pre-treatment verification results agreed with those of an external audit. Materials and methods: Participating centres used two mock cases (prostate and head and neck) for the intercomparison and audit. Compliance to dosimetric goals and total number of MU per plan were collected. A simple quality index to compare the different plans was proposed. We compared gamma index pass rates using the centre’s equipment and methodology to those of an external audit. Results: While for the prostate case, all centres fulfilled the dosimetric goals and plan quality was homogeneous, that was not the case for the head and neck case. The number of MU did not correlate with the plan quality index. Pre-treatment verifications results of the external audit did not agree with those of the in-house measurements for two centres: being within tolerance for in-house measurements and unacceptable for the audit or the other way round. Conclusions: Although all plans fulfilled dosimetric constraints, plan quality is highly dependent on the planner expertise. External audits are an excellent tool to detect errors in IMRT implementation and cannot be replaced by intercomparison using results obtained by centres

  9. I-MOVE multicentre case-control study 2010/11 to 2014/15: Is there within-season waning of influenza type/subtype vaccine effectiveness with increasing time since vaccination?

    Science.gov (United States)

    Kissling, Esther; Nunes, Baltazar; Robertson, Chris; Valenciano, Marta; Reuss, Annicka; Larrauri, Amparo; Cohen, Jean Marie; Oroszi, Beatrix; Rizzo, Caterina; Machado, Ausenda; Pitigoi, Daniela; Domegan, Lisa; Paradowska-Stankiewicz, Iwona; Buchholz, Udo; Gherasim, Alin; Daviaud, Isabelle; Horváth, Judit Krisztina; Bella, Antonino; Lupulescu, Emilia; O Donnell, Joan; Korczyńska, Monika; Moren, Alain

    2016-04-21

    Since the 2008/9 influenza season, the I-MOVE multicentre case-control study measures influenza vaccine effectiveness (VE) against medically-attended influenza-like-illness (ILI) laboratory confirmed as influenza. In 2011/12, European studies reported a decline in VE against influenza A(H3N2) within the season. Using combined I-MOVE data from 2010/11 to 2014/15 we studied the effects of time since vaccination on influenza type/subtype-specific VE. We modelled influenza type/subtype-specific VE by time since vaccination using a restricted cubic spline, controlling for potential confounders (age, sex, time of onset, chronic conditions). Over 10,000 ILI cases were included in each analysis of influenza A(H3N2), A(H1N1)pdm09 and B; with 4,759, 3,152 and 3,617 influenza positive cases respectively. VE against influenza A(H3N2) reached 50.6% (95% CI: 30.0-65.1) 38 days after vaccination, declined to 0% (95% CI: -18.1-15.2) from 111 days onwards. At day 54 VE against influenza A(H1N1)pdm09 reached 55.3% (95% CI: 37.9-67.9) and remained between this value and 50.3% (95% CI: 34.8-62.1) until season end. VE against influenza B declined from 70.7% (95% CI: 51.3-82.4) 44 days after vaccination to 21.4% (95% CI: -57.4-60.8) at season end. To assess if vaccination campaign strategies need revising more evidence on VE by time since vaccination is urgently needed.

  10. Patch testing with the "sesquiterpene lactone mix"

    DEFF Research Database (Denmark)

    Ducombs, G; Benezra, C; Talaga, P

    1990-01-01

    6278 patients were patch tested with a sesquiterpene lactone mix (SL-mix) in 10 European clinics. 4011 patients were tested only with 0.1% SL-mix, 63 (approximately 1.5%) of whom were positive, with 26 (41%) of these cases being considered clinically relevant. There were no cases of active...

  11. Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program.

    Science.gov (United States)

    Khanna, Niharika; Shaya, Fadia T; Chirikov, Viktor V; Sharp, David; Steffen, Ben

    2016-01-01

    We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality. © Copyright 2016 by the American Board of Family Medicine.

  12. Area law for fixed points of rapidly mixing dissipative quantum systems

    Energy Technology Data Exchange (ETDEWEB)

    Brandão, Fernando G. S. L. [Quantum Architectures and Computation Group, Microsoft Research, Redmond, Washington 98052 (United States); Department of Computer Science, University College London, Gower Street, London WC1E 6BT (United Kingdom); Cubitt, Toby S. [Department of Computer Science, University College London, Gower Street, London WC1E 6BT (United Kingdom); DAMTP, University of Cambridge, Cambridge (United Kingdom); Lucia, Angelo, E-mail: anlucia@ucm.es [Departamento de Análisis Matemático, Universidad Complutense de Madrid, Madrid (Spain); Michalakis, Spyridon [Institute for Quantum Information and Matter, Caltech, California 91125 (United States); Perez-Garcia, David [Departamento de Análisis Matemático, Universidad Complutense de Madrid, Madrid (Spain); IMI, Universidad Complutense de Madrid, Madrid (Spain); ICMAT, C/Nicolás Cabrera, Campus de Cantoblanco, 28049 Madrid (Spain)

    2015-10-15

    We prove an area law with a logarithmic correction for the mutual information for fixed points of local dissipative quantum system satisfying a rapid mixing condition, under either of the following assumptions: the fixed point is pure or the system is frustration free.

  13. forage systems mixed with forage legumes grazed by lactating cows

    Directory of Open Access Journals (Sweden)

    Clair Jorge Olivo

    2017-02-01

    Full Text Available Current research evaluates productivity, stocking and nutritional rates of three forage systems with Elephant Grass (EG + Italian Ryegrass (IR + Spontaneous Growth Species (SGS, without forage legumes; EG + IR + SGS + Forage Peanut (FP, mixed with FP; and EG + IR + SGS + Red Clover (RC, mixed with RC, in rotational grazing method by lactating cows. IR developed between rows of EG. FP was maintained, whilst RC was sow to respective forage systems. The experimental design was completely randomized, with three treatments and two replication, subdivided into parcels over time. Mean rate for forage yield and average stocking rate were 10.6, 11.6 and 14.4 t ha-1; 3.0, 2.8 and 3.1 animal unit ha-1 day-1, for the respective systems. Levels of crude protein and total digestible nutrients were 17.8, 18.7 and 17.5%; 66.5, 66.8 and 64.8%, for the respective forage systems. The presence of RC results in better and higher forage yield in the mixture, whilst FP results in greater control of SGS. The inclusion of forage legumes in pasture systems provides better nutritional rates.

  14. Large eddy simulation on thermal fluid mixing in a T-junction piping system

    Energy Technology Data Exchange (ETDEWEB)

    Selvam, P. Karthick; Kulenovic, R.; Laurien, E. [Stuttgart Univ. (Germany). Inst fuer Kernenergie und Energiesysteme (IKE)

    2014-11-15

    High cycle thermal fatigue damage caused in piping systems is an important problem encountered in the context of nuclear safety and lifetime management of a Nuclear Power Plant (NPP). The T-junction piping system present in the Residual Heat Removal System (RHRS) is more vulnerable to thermal fatigue cracking. In this numerical study, thermal mixing of fluids at temperature difference (?T) of 117 K between the mixing fluids is analyzed. Large Eddy Simulation (LES) is performed with conjugate heat transfer between the fluid and structure. LES is performed based on the Fluid-Structure Interaction (FSI) test facility at University of Stuttgart. The results show an intense turbulent mixing of fluids downstream of T-junction. Amplitude of temperature fluctuations near the wall region and its corresponding frequency distribution is analyzed. LES is performed using commercial CFD software ANSYS CFX 14.0.

  15. Myositis in primary Sjögren's syndrome: data from a multicentre cohort.

    Science.gov (United States)

    Colafrancesco, Serena; Priori, Roberta; Gattamelata, Angelica; Picarelli, Giovanna; Minniti, Antonina; Brancatisano, Filippo; D'Amati, Giulia; Giordano, Carla; Cerbelli, Bruna; Maset, Marta; Quartuccio, Luca; Bartoloni, Elena; Carubbi, Francesco; Cipriani, Paola; Baldini, Chiara; Luciano, Nicoletta; De Vita, Salvatore; Gerli, Roberto; Giacomelli, Roberto; Bombardieri, Stefano; Valesini, Guido

    2015-01-01

    In primary Sjögren's syndrome (pSS), muscle pain and/or muscular weakness is relatively frequent while myositis has been reported in 3% of patients. The aim of this study was to describe the prevalence of myositis in a multicentre Italian pSS cohort and to address the clinical manifestations, histological findings and therapeutic strategies. Clinical, serological and therapeutic data from a pSS cohort of patients were retrospectively collected. According to Bohan and Peter's criteria, inflammatory myopathy (IM) was suspected in case of muscular weakness associated with increased creatine-phosphokinase (CPK) or abnormal electromyography (EMG). When performed, muscle biopsies were analysed. In a cohort of 1320 patients, 17 (1.28%) presented muscular weakness [in some cases myalgias (7/17, 41.1%)], accompanied by increased CPK [13/17, (76.4%)] and/or abnormal EMG [13/14, (92.8%)]. Ten out of 17 (58.8%) fulfilled at least three diagnostic criteria for IM. Muscular biopsy was performed in 13/17 (76.4%) cases with histologically confirmed myositis in 6/13 (46.1%) (1"IBM-like"-5"PM-like"). In two "PM-like" cases, several fibres showed a decreased histochemical cytochrome C oxidase (COX) stain. Two biopsies tested "negative", four showed "non-specific" findings. All patients were treated with corticosteroids followed by different DMARDs. Our retrospective analysis shows a prevalence of myositis in pSS lower than previously reported, mainly appearing as an overlapping syndrome. Histological findings confirm the possible presence of an IBM or of a myopathy more similar to PM with a decreased COX activity. Classical immunosuppressants are effective although in most difficult cases IVIg or RTX may be used with benefit.

  16. Online soft sensor for hybrid systems with mixed continuous and discrete measurements

    Czech Academy of Sciences Publication Activity Database

    Suzdaleva, Evgenia; Nagy, Ivan

    2012-01-01

    Roč. 36, č. 10 (2012), s. 294-300 ISSN 0098-1354 R&D Projects: GA MŠk 1M0572; GA TA ČR TA01030123 Grant - others:Skoda Auto, a.s.(CZ) ENS/2009/UTIA Institutional research plan: CEZ:AV0Z10750506 Keywords : online state prediction * hybrid filter * state-space model * mixed data Subject RIV: BC - Control Systems Theory Impact factor: 2.091, year: 2012 http://library.utia.cas.cz/separaty/2011/AS/suzdaleva-online soft sensor for hybrid systems with mixed continuous and discrete measurements.pdf

  17. Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases.

    Science.gov (United States)

    Eaton, J L; Mohammad, A; Mohr, D C; Brustein, D J; Kirkhorn, S R

    2017-12-30

    Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners. Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.

  18. The impact of case mix on timely access to appointments in a primary care group practice.

    Science.gov (United States)

    Ozen, Asli; Balasubramanian, Hari

    2013-06-01

    At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician's appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions.

  19. [Mixed vaginitis prevalence in Latin-American women, according to physician perception. Preference, effectiveness and security of clindamycin plus ketoconazole].

    Science.gov (United States)

    Hernández Bueno, José Alberto; Vázquez Alanís, Alejandro; Olguín Ramírez, Claudia; Dumet Hinostroza, Pablo F; Gutiérrez Ramos, Miguel; De Zordo, Daniel

    2008-11-01

    Vaginitis is an inflammatory process in vaginal mucosa that affects millions of woman worldwide. To evaluate prevalence perception and prescription preference among Latin-American gyneco-obstetricians in mixed vaginitis, and to identify attributes of various active principles. multicentric and transversal study during January 2008. Close Up was used to poll gyneco-obstetricians prescribing clyndamicin plus ketoconazole. 1,198 gyneco-obstetricians were selected to answer a poll (scales and measuring attributes) to identify differences among various therapeutic schemes to mixed vaginitis. 34% of gyneco-obstetricians consider that 30 to 50% of them patients had mixed vaginitis, 38% consider a 50 to 70% of its prevalence, and 20% a 70% or higher figure. In a bad to excellent scale, 97% had very good to excellent results with antimycotic and antibacterial mix, 73% had a bad to good result with antimycotics alone and 79% with antibacterial alone. Clyndamicin plus ketoconazole had a meaningful difference from mean results (standard), and from the second best mix (metronidazole plus nystatin), with a rapid itch healing, efficacy, and relapse decrease. Metronidazole plus nystatin had the highest score in tolerance and treatment period. 90% of polled Latin-American obstetricians prescribe clyndamicin plus ketoconazole as the best available treatment to mixed vaginitis.

  20. Implications of Upwells as Hydrodynamic Jets in a Pulse Jet Mixed System

    Energy Technology Data Exchange (ETDEWEB)

    Pease, Leonard F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Bamberger, Judith A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Minette, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-08-01

    This report evaluates the physics of the upwell flow in pulse jet mixed systems in the Hanford Tank Waste Treatment and Immobilization Plant (WTP). Although the initial downward flow and radial flow from pulse jet mixers (PJMs) has been analyzed in some detail, the upwells have received considerably less attention despite having significant implications for vessel mixing. Do the upwells behave like jets? How do the upwells scale? When will the central upwell breakthrough? What proportion of the vessel is blended by the upwells themselves? Indeed, how the physics of the central upwell is affected by multiple PJMs (e.g., six in the proposed mixing vessels), non-Newtonian rheology, and significant multicomponent solids loadings remain unexplored. The central upwell must satisfy several criteria to be considered a free jet. First, it must travel for several diameters in a nearly constant direction. Second, its velocity must decay with the inverse of elevation. Third, it should have an approximately Gaussian profile. Fourth, the influence of surface or body forces must be negligible. A combination of historical data in a 12.75 ft test vessel, newly analyzed data from the 8 ft test vessel, and conservation of momentum arguments derived specifically for PJM operating conditions demonstrate that the central upwell satisfies these criteria where vigorous breakthrough is achieved. An essential feature of scaling from one vessel to the next is the requirement that the underlying physics does not change adversely. One may have confidence in scaling if (1) correlations and formulas capture the relevant physics; (2) the underlying physics does not change from the conditions under which it was developed to the conditions of interest; (3) all factors relevant to scaling have been incorporated, including flow, material, and geometric considerations; and (4) the uncertainty in the relationships is sufficiently narrow to meet required specifications. Although the central upwell

  1. Estimation of the common cause failure probabilities of the components under mixed testing schemes

    International Nuclear Information System (INIS)

    Kang, Dae Il; Hwang, Mee Jeong; Han, Sang Hoon

    2009-01-01

    For the case where trains or channels of standby safety systems consisting of more than two redundant components are tested in a staggered manner, the standby safety components within a train can be tested simultaneously or consecutively. In this case, mixed testing schemes, staggered and non-staggered testing schemes, are used for testing the components. Approximate formulas, based on the basic parameter method, were developed for the estimation of the common cause failure (CCF) probabilities of the components under mixed testing schemes. The developed formulas were applied to the four redundant check valves of the auxiliary feed water system as a demonstration study for their appropriateness. For a comparison, we estimated the CCF probabilities of the four redundant check valves for the mixed, staggered, and non-staggered testing schemes. The CCF probabilities of the four redundant check valves for the mixed testing schemes were estimated to be higher than those for the staggered testing scheme, and lower than those for the non-staggered testing scheme.

  2. Clinical utilisation of the "G.T. MSRS", the rating scale for mixed states: 35 cases report.

    Science.gov (United States)

    Tavormina, Giuseppe

    2015-09-01

    The knowledge of the clinical features of the mixed states and of the symptoms of the "mixity" of mood disorders is crucial: to mis-diagnose or mis-treat patients with these symptoms may increase the suicide risk and make worse the evolution of mood disorders. The rating scale "G.T. MSRS" has been designed to improve the clinical effectiveness of both psychiatrists and GPs by enabling them to make an early "general" diagnosis of mixed states. This study presents some cases in which the "G.T. MSRS" scale has been used, in order to demonstrate its usefullness.

  3. Comparison of Mixing Calculations for Reacting and Non-Reacting Flows in a Cylindrical Duct

    Science.gov (United States)

    Oechsle, V. L.; Mongia, H. C.; Holdeman, J. D.

    1994-01-01

    A production 3-D elliptic flow code has been used to calculate non-reacting and reacting flow fields in an experimental mixing section relevant to a rich burn/quick mix/lean burn (RQL) combustion system. A number of test cases have been run to assess the effects of the variation in the number of orifices, mass flow ratio, and rich-zone equivalence ratio on the flow field and mixing rates. The calculated normalized temperature profiles for the non-reacting flow field agree qualitatively well with the normalized conserved variable isopleths for the reacting flow field indicating that non-reacting mixing experiments are appropriate for screening and ranking potential rapid mixing concepts. For a given set of jet momentum-flux ratio, mass flow ratio, and density ratio (J, MR, and DR), the reacting flow calculations show a reduced level of mixing compared to the non-reacting cases. In addition, the rich-zone equivalence ratio has noticeable effect on the mixing flow characteristics for reacting flows.

  4. User-composable Electronic Health Record Improves Efficiency of Clinician Data Viewing for Patient Case Appraisal: A Mixed-Methods Study.

    Science.gov (United States)

    Senathirajah, Yalini; Kaufman, David; Bakken, Suzanne

    2016-01-01

    Challenges in the design of electronic health records (EHRs) include designing usable systems that must meet the complex, rapidly changing, and high-stakes information needs of clinicians. The ability to move and assemble elements together on the same page has significant human-computer interaction (HCI) and efficiency advantages, and can mitigate the problems of negotiating multiple fixed screens and the associated cognitive burdens. We compare MedWISE-a novel EHR that supports user-composable displays-with a conventional EHR in terms of the number of repeat views of data elements for patient case appraisal. The study used mixed-methods for examination of clinical data viewing in four patient cases. The study compared use of an experimental user-composable EHR with use of a conventional EHR, for case appraisal. Eleven clinicians used a user-composable EHR in a case appraisal task in the laboratory setting. This was compared with log file analysis of the same patient cases in the conventional EHR. We investigated the number of repeat views of the same clinical information during a session and across these two contexts, and compared them using Fisher's exact test. There was a significant difference (puser-composable EHR (14.6 percent) and conventional EHR (72.6 percent). Users of conventional EHRs repeatedly viewed the same information elements in the same session, as revealed by log files. Our findings are consistent with the hypothesis that conventional systems require that the user view many screens and remember information between screens, causing the user to forget information and to have to access the information a second time. Other mechanisms (such as reduction in navigation over a population of users due to interface sharing, and information selection) may also contribute to increased efficiency in the experimental system. Systems that allow a composable approach that enables the user to gather together on the same screen any desired information elements

  5. The outcome of a multi-centre feasibility study of online adaptive radiotherapy for muscle-invasive bladder cancer TROG 10.01 BOLART

    International Nuclear Information System (INIS)

    Foroudi, Farshad; Pham, Daniel; Rolfo, Aldo; Bressel, Mathias; Tang, Colin I.; Tan, Alex; Turner, Sandra; Hruby, George; Williams, Stephen; Hayne, Dickon; Lehman, Margot; Skala, Marketa; Jose, Chakiath C.; Gogna, Kumar; Kron, Tomas

    2014-01-01

    Purpose: To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology. Materials and methods: A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three “plan of the day”, was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department. Results: 54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a ‘standard’ CTV to PTV margin of 1.5 cm was used for one or more fractions where the pre-treatment bladder CTV was larger than any of the three adaptive plans. The bladder CTV extended beyond the PTV on post treatment imaging in 9 (18%) of the 49 patients. Conclusions: From a technical perspective an online adaptive radiotherapy technique can be instituted in a multi-centre setting. However, without further bladder filling control or imaging, a CTV to PTV margin of 7 mm is insufficient

  6. Effect of Mixed Systems on Crop Productivity

    Science.gov (United States)

    Senturklu, Songul; Landblom, Douglas; Cihacek, Larry; Brevik, Eric

    2017-04-01

    The goals of this non-irrigated research has been to determine the effect of mixed systems integration on crop, soil, and beef cattle production in the northern Great Plains region of the United States. Over a 5-year period, growing spring wheat (HRSW-C) continuously year after year was compared to a 5-year crop rotation that included spring wheat (HRSW-R), cover crop (dual crop consisting of winter triticale/hairy vetch seeded in the fall and harvested for hay followed by a 7-species cover crop that was seeded in June after hay harvest), forage corn, field pea/barley, and sunflower. Control 5-year HRSW yield was 2690 kg/ha compared to 2757 kg/ha for HRSW grown in rotation. Available soil nitrogen (N) is often the most important limitation for crop production. Expensive fertilizer inputs were reduced in this study due to the mixed system's complementarity in which the rotation system that included beef cattle grazing sustained N availability and increased nutrient cycling, which had a positive effect on all crops grown in the rotation. Growing HRSW continuously requires less intensive management and in this research was 14.5% less profitable. Whereas, when crop management increased and complementing crops were grown in rotation to produce crops and provide feed for grazing livestock, soil nutrient cycling improved. Increased nutrient cycling increased crop rotation yields and yearling beef cattle steers that grazing annual forages in the rotation gain more body weight than similar steers grazing NGP native range. Results of this long-term research will be presented in a PICO format for participant discussion.

  7. Testing and evaluation of alternative process systems for immobilizing radioactive mixed particulate waste in cement

    International Nuclear Information System (INIS)

    Weingardt, K.M.; Weber, J.R.

    1994-03-01

    Radioactive and Hazardous Mixed Wastes have accumulated at the Department of Energy (DOE) Hanford Site in south-central Washington State. Ongoing operations and planned facilities at Hanford will also contribute to this waste stream. To meet the Resource Conservation and Recovery Act (RCRA) Land Disposal Restrictions most of this waste will need to be treated to permit disposal. In general this treatment will need to include stabilization/solidification either as a sole method or as part of a treatment train. A planned DOE facility, the Waste Receiving and Processing (WRAP) Module 2A, is scoped to provide this required treatment for containerized contact-handled (CH), mixed low-level waste (MLLW) at Hanford. An engineering development program has been conducted by Westinghouse Hanford Company (WHC) to select the best system for utilizing a cement based process in WRAP Module 2A. Three mixing processes were developed for analysis and testing; in-drum mixing, continuous mixing, and batch mixing. Some full scale tests were conducted and 55 gallon drums of solidified product were produced. These drums were core sampled and examined to evaluate mixing effectiveness. Total solids loading and the order of addition of waste and binder constituents were also varied. The highest confidence approach to meet the WRAP Module 2A waste immobilization system needs appears to be the out-of-drum batch mixing concept. This system is believed to offer the most flexibility and efficiency, given the highly variable and troublesome waste streams feeding the facility

  8. Prophylactic antibiotic regimens in tumour surgery (PARITY) : a pilot multicentre randomised controlled trial

    NARCIS (Netherlands)

    Ghert, M.; Bhandari, M.; Deheshi, B.; Guyatt, G.; Holt, G.; O'Shea, T.; Randall, R. L.; Thabane, L.; Wunder, J.; Evaniew, N.; McKay, P.; Schneider, P.; Turcotte, R.; Madden, K.; Scott, T.; Sprague, S.; Simunovic, N.; Swinton, M.; Racano, A.; Heels-Ansdell, D.; Buckingham, L.; Rose, P.; Brigman, B.; Pullenayegum, E.; Ghert, M.; Evaniew, N.; Mckay, P.; Schneider, P.; Sobhi, G.; Chan, R.; Biljan, M.; Ferguson, P.; Wunder, J.; Griffin, A.; Mantas, I.; Wylie, A.; Han, A.; Grewal, G.; Turcotte, R.; Goulding, K.; Dandachli, F.; Matte, G.; Werier, J.; Abdelbary, H.; Paquin, K.; Cosgrove, H.; Dugal, A-M.; Jutte, P.; Ploegmakers, J. J. W.; Stevens, M.

    2015-01-01

    Objective Clinical studies of patients with bone sarcomas have been challenged by insufficient numbers at individual centres to draw valid conclusions. Our objective was to assess the feasibility of conducting a definitive multi-centre randomised controlled trial (RCT) to determine whether a

  9. Argonne National Laboratory's photo-oxidation organic mixed waste treatment system - installation and startup testing

    International Nuclear Information System (INIS)

    Shearer, T.L.; Nelson, R.A.; Torres, T.; Conner, C.; Wygmans, D.

    1997-01-01

    This paper describes the installation and startup testing of the Argonne National Laboratory (ANL-E) Photo-Oxidation Organic Mixed Waste Treatment System. This system will treat organic mixed (i.e., radioactive and hazardous) waste by oxidizing the organics to carbon dioxide and inorganic salts in an aqueous media. The residue will be treated in the existing radwaste evaporators. The system is installed in the Waste Management Facility at the ANL-E site in Argonne, Illinois. 1 fig

  10. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    Directory of Open Access Journals (Sweden)

    Gashi-Luci Lumturije

    2011-02-01

    Full Text Available Abstract Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed Müllerian tumor, heterologous type. The epithelial component was positive for cytokeratin 7 and vimentin whereas the mesenchymal component was positive for Vimentin, S100 and focally for CK7. The histogenesis of this tumor arising from the peritoneum is still speculative. Based on the previous reports and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion.

  11. A comprehensive assessment of maternal deaths in Argentina: translating multicentre collaborative research into action.

    Science.gov (United States)

    Ramos, Silvina; Karolinski, Ariel; Romero, Mariana; Mercer, Raúl

    2007-08-01

    To perform a comprehensive assessment of maternal mortality in Argentina, the ultimate purpose being to strengthen the surveillance system and reorient reproductive health policies to prevent maternal deaths. Our multicentre population-based study combining qualitative and quantitative methodologies included a descriptive analysis of under-registration and distribution of causes of death, a case-control study to identify risk factors in health-care delivery and verbal autopsies to analyse social determinants associated with maternal deaths. A total of 121 maternal deaths occurred during 2002. The most common causes were abortion complications (27.4%), haemorrhage (22.1%), infection/sepsis (9.5%), hypertensive disorders (8.4%) and other causes (32.6%). Under-registration was 9.5% for maternal deaths (n = 95) and 15.4% for late maternal deaths (n = 26). The probability of dying was 10 times greater in the absence of essential obstetric care, active emergency care and qualified staff, and doubled with every 10-year increase in age. Other contributing factors included delays in recognizing "alarm signals"; reluctance in seeking care owing to desire to hide an induced abortion; delays in receiving timely treatment due to misdiagnosis or lack of supplies; and delays in referral/transportation in rural areas. A combination of methodologies is required to improve research on and understanding of maternal mortality via the systematic collection of health surveillance data. There is an urgent need for a comprehensive intervention to address public health and human rights issues in maternal mortality, and our results contribute to the consensus-building necessary to improve the existing surveillance system and prevention strategies.

  12. Ocular and multicentric T-cell lymphoma in horse

    Directory of Open Access Journals (Sweden)

    Mariana C. Oliveira

    2016-11-01

    Full Text Available ABSTRACT. Oliveira M.C., Faleiro R.D., Santos C.C.A., Oliveira G.F., Daoualibi Y., Sonne L., Brito M.F. & Ubiali D.G. [Ocular and multicentric T-cell lymphoma in horse.] Linfoma de células T multicêntrico e ocular em equino. Revista Brasileira de Medicina Veterinária, 38(Supl.2:147-151, 2016. Setor de Anatomia Patológica, Departamento Epidemiologia e Saúde Pública, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23890-000, Brasil. E-mail: danielubiali@hotmail.com A 10-year-old gelding, mixed breed had body score condition 3 (1-10, with reluctance to move due to the loss of visual acuity in both eyes, right eye swelling and marked dyspnea. The ophthalmic examination showed no response to threat of reflection, objects test or direct reflection and consensus of both eyes. Examination with visor magnifier and Finoff transilluminator revealed buftalmia, hyphema, aqueous flare, corneal neovascularization and posterior synechiae with irregular bulging of the iris in the right eye and aqueous flare, central anterior synechiae and mature cataract in the left eye. It was found corneal integrity in both eyes with the fluorescein test. Urine sample submitted for PCR to Leptospira sp. resulted negative. Euthanasia was performed after unsuccessful treatment attempts. At necropsy there was a mass in the right eyeball, the pleural surface of the diaphragm and the mesentery. There was multifocal to coalescing whitish nodules between 1 and 4 cm in diameter in the lung, filling about 80% of the lungs’ surface, mainly in the ventral region. Morphology of masses was histopathologically compatible with lymphoma. Anti-CD3 antibody resulted positive in all samples analyzed characterizing immunophenotypic T-cell lymphoma.

  13. Epstein-Barr virus myelitis and Castleman's disease in a patient with acquired immune deficiency syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Balderacchi Jasminka

    2011-05-01

    Full Text Available Abstract Introduction Few cases of Epstein-Barr virus myelitis have been described in the literature. Multi-centric Castleman's disease is a lymphoproliferative disorder that is well known for its associations with the human immunodeficiency virus, human herpes virus 8, and Kaposi's sarcoma. The concurrent presentation of these two diseases in a patient at the same time is extremely unusual. Case Presentation We describe the case of a 43-year-old Caucasian man with acquired immune deficiency syndrome who presented with fever, weight loss and diffuse lymphadenopathy, and was diagnosed with multi-centric Castleman's disease. He presented three weeks later with lower extremity weakness and urinary retention, at which time cerebrospinal fluid contained lymphocytic pleocytosis and elevated protein. Magnetic resonance imaging demonstrated abnormal spinal cord signal intensity over several cervical and thoracic segments, suggesting the diagnosis of myelitis. Our patient was ultimately diagnosed with Epstein-Barr virus myelitis, as Epstein-Barr virus DNA was detected by polymerase chain reaction in the cerebrospinal fluid. Conclusion To the best of our knowledge, this is the first case of multi-centric Castleman's disease followed by acute Epstein-Barr virus myelitis in a human immunodeficiency virus-infected patient. Clinicians caring for human immunodeficiency virus-infected patients should be vigilant about monitoring patients with increasing lymphadenopathy, prompting thorough diagnostic investigations when necessary.

  14. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  15. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

  16. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  17. Iohexol in investigations of the spinal canal. Multicentre study

    International Nuclear Information System (INIS)

    Bories, J.

    1988-01-01

    The author presents the results of a multicentric study of Iohexol in investigation of the spinal canal undertaken at the request of Winthrop Laboratories in 32 Radiological departments. The study involved 329 adults of both sexes. It confirmed the excellent quality of results obtained with this preparation in the literature and its excellent tolerance. On the basis of these results Iohexol may be considered to be definitely one of the best currently available preparations for investigation of the spinal canal [fr

  18. Transportable vitrification system demonstration on mixed waste. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Zamecnik, J.R.; Whitehouse, J.C. [Westinghouse Savannah River Co., Aiken, SC (United States); Wilson, C.N. [Lockheed Martin Hanford Corp., Richland, WA (United States); Van Ryn, F.R. [Bechtel Jacobs Co., Oak Ridge, TN (United States)

    1998-04-22

    The Transportable Vitrification System (TVS) is a large scale, fully integrated, vitrification system for the treatment of low-level and mixed wastes in the form of sludges, soils, incinerator ash, and many other waste streams. It was demonstrated on surrogate waste at Clemson University and at the Oak Ridge Reservation (ORR) prior to treating actual mixed waste. Treatment of a combination of dried B and C Pond sludge and CNF sludge was successfully demonstrated at ORR in 1997. The demonstration produced 7,616 kg of glass from 7,328 kg of mixed wastes with a 60% reduction in volume. Glass formulations for the wastes treated were developed using a combination of laboratory crucible studies with the actual wastes and small melter studies at Clemson with both surrogate and actual wastes. Initial characterization of the B and C Pond sludge had not shown the presence of carbon or fluoride, which required a modified glass formulation be developed to maintain proper glass redox and viscosity. The CNF sludge challenges the glass formulations due to high levels of phosphate and iron. The demonstration was delayed several times by permitting problems, a glass leak, and electrical problems. The demonstration showed that the two wastes could be successfully vitrified, although the design glass production rate was not achieved. The glass produced met the Universal Treatment Standards and the emissions from the TVS were well within the allowable permit limits.

  19. Transportable vitrification system demonstration on mixed waste. Revision 1

    International Nuclear Information System (INIS)

    Zamecnik, J.R.; Whitehouse, J.C.; Wilson, C.N.; Van Ryn, F.R.

    1998-01-01

    The Transportable Vitrification System (TVS) is a large scale, fully integrated, vitrification system for the treatment of low-level and mixed wastes in the form of sludges, soils, incinerator ash, and many other waste streams. It was demonstrated on surrogate waste at Clemson University and at the Oak Ridge Reservation (ORR) prior to treating actual mixed waste. Treatment of a combination of dried B and C Pond sludge and CNF sludge was successfully demonstrated at ORR in 1997. The demonstration produced 7,616 kg of glass from 7,328 kg of mixed wastes with a 60% reduction in volume. Glass formulations for the wastes treated were developed using a combination of laboratory crucible studies with the actual wastes and small melter studies at Clemson with both surrogate and actual wastes. Initial characterization of the B and C Pond sludge had not shown the presence of carbon or fluoride, which required a modified glass formulation be developed to maintain proper glass redox and viscosity. The CNF sludge challenges the glass formulations due to high levels of phosphate and iron. The demonstration was delayed several times by permitting problems, a glass leak, and electrical problems. The demonstration showed that the two wastes could be successfully vitrified, although the design glass production rate was not achieved. The glass produced met the Universal Treatment Standards and the emissions from the TVS were well within the allowable permit limits

  20. Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

    Science.gov (United States)

    Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

    2018-05-04

    To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Mediastinal mixed germ cell tumor in an infertile male with Klinefelter syndrome:A case report and literature review

    Directory of Open Access Journals (Sweden)

    Dinesh Pradhan

    2015-01-01

    Full Text Available Klinefelter syndrome (KS is a well-documented abnormality of the sex chromosome, with an incidence of 1 in 600 newborn males. It is characterized by a 47, XXY or a mosaic karyotype, hypergonadotrophic hypogonadism, infertility, reduced body hair, gynecomastia, and tall stature. Different neoplasms such as breast, testicular, and lymphoreticular malignancies may occur in 1% to2% of the cases with KS. Herein we describe a case of mediastinal mixed germ cell tumor (GCT in a 40-year-old male with KS. Interestingly, this case also had mitral valve prolapse, and an incidental papillary microcarcinoma of the thyroid gland. In view of the presence of pulmonary nodules, antemortem differential diagnoses considered were mycobacterial infection, lymphoma, thymic carcinoma, and a primary/metastatic neoplasm of the lung. As GCT was not considered, the serum markers of a GCT were not performed. The diagnosis of this rare mediastinal mixed GCT with KS was made at autopsy.

  2. On-orbit servicing system assessment and optimization methods based on lifecycle simulation under mixed aleatory and epistemic uncertainties

    Science.gov (United States)

    Yao, Wen; Chen, Xiaoqian; Huang, Yiyong; van Tooren, Michel

    2013-06-01

    To assess the on-orbit servicing (OOS) paradigm and optimize its utilities by taking advantage of its inherent flexibility and responsiveness, the OOS system assessment and optimization methods based on lifecycle simulation under uncertainties are studied. The uncertainty sources considered in this paper include both the aleatory (random launch/OOS operation failure and on-orbit component failure) and the epistemic (the unknown trend of the end-used market price) types. Firstly, the lifecycle simulation under uncertainties is discussed. The chronological flowchart is presented. The cost and benefit models are established, and the uncertainties thereof are modeled. The dynamic programming method to make optimal decision in face of the uncertain events is introduced. Secondly, the method to analyze the propagation effects of the uncertainties on the OOS utilities is studied. With combined probability and evidence theory, a Monte Carlo lifecycle Simulation based Unified Uncertainty Analysis (MCS-UUA) approach is proposed, based on which the OOS utility assessment tool under mixed uncertainties is developed. Thirdly, to further optimize the OOS system under mixed uncertainties, the reliability-based optimization (RBO) method is studied. To alleviate the computational burden of the traditional RBO method which involves nested optimum search and uncertainty analysis, the framework of Sequential Optimization and Mixed Uncertainty Analysis (SOMUA) is employed to integrate MCS-UUA, and the RBO algorithm SOMUA-MCS is developed. Fourthly, a case study on the OOS system for a hypothetical GEO commercial communication satellite is investigated with the proposed assessment tool. Furthermore, the OOS system is optimized with SOMUA-MCS. Lastly, some conclusions are given and future research prospects are highlighted.

  3. Low sodium diet and pregnancy-induced hypertension: a multi-centre randomised controlled trial

    NARCIS (Netherlands)

    Knuist, M.; Bonsel, G. J.; Zondervan, H. A.; Treffers, P. E.

    1998-01-01

    To examine the effectiveness of the standard policy in the Netherlands to prescribe a sodium restricted diet to prevent or to treat mild pregnancy-induced hypertension. Multi-centre randomised controlled trial between April 1992 and April 1994. Seven practices of independent midwives and one

  4. The role of public relations in the marketing mix. Case study : the Athenaeum InterContinental Athens

    OpenAIRE

    Μαρκέζη, Μ.

    2011-01-01

    The main objective of the present dissertation is to examine the importance of the Public Relations (PR) in the Marketing Mix through a case analysis of the PR office at the Athenaeum InterContinental Athens and its multifunctional operation within the hotel. Initially, a quite detailed analysis of the PR advantages and disadvantages as well as its main objectives, methods, tools and tactics are presented. The second chapter introduces us to the Case Study of the Athenaeum InterContinental At...

  5. A Novel Evolutionary Engineering Design Approach for Mixed-Domain Systems

    DEFF Research Database (Denmark)

    Fan, Zhun; Hu, J.; Seo, K.

    2004-01-01

    This paper presents an approach to engineering design of mixed-domain dynamic systems. The approach aims at system-level design and has two key features: first, it generates engineering designs that satisfy predefined specifications in an automatic manner; second, it can design systems belonging ...... often encountered in evolutionary computation, a HFC (Hierarchical Fair Competition) model is adopted in this work. Examples of an analog filter design and a MEM filter design illustrate the application of the approach....

  6. Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.

    Science.gov (United States)

    Kaul, Rahul; Chhabra, Harvinder Singh; Vaccaro, Alexander R; Abel, Rainer; Tuli, Sagun; Shetty, Ajoy Prasad; Das, Kali Dutta; Mohapatra, Bibhudendu; Nanda, Ankur; Sangondimath, Gururaj M; Bansal, Murari Lal; Patel, Nishit

    2017-05-01

    The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not

  7. Evaluation of mixed infection cases with both herpes simplex virus types 1 and 2.

    Science.gov (United States)

    Kaneko, Hisatoshi; Kawana, Takashi; Ishioka, Ken; Ohno, Shigeaki; Aoki, Koki; Suzutani, Tatsuo

    2008-05-01

    Herpes simplex virus type 1 (HSV-1) is isolated principally from the upper half of the body innervated by the trigeminal ganglia whereas herpes simplex virus type 2 (HSV-2) is generally isolated from the lower half of the body innervated by the sacral ganglia. However, recent reports suggest that HSV-1 and HSV-2 can each infect both the upper and lower half of the body causing a variety of symptoms and there is a possibility that HSV-1 and HSV-2 infections can occur simultaneously with both causing symptoms. HSV type in clinical isolates from 87 patients with genital herpes and 57 with ocular herpes was determined by the polymerase chain reaction (PCR), and six cases of mixed infection with both HSV-1 and HSV-2 were identified. Of the six cases, three were patients with genital herpes and three were ocular herpes patients. Analysis of the copy number of the HSV-1 and HSV-2 genome by a quantitative real time PCR demonstrated that HSV-1 was dominant at a ratio of approximately 100:1 in the ocular infections. In contrast, the HSV-2 genome was present at a 4-40 times higher frequency in isolates from genital herpes patients. There was no obvious difference between the clinical course of mixed infection and those of single HSV-1 or HSV-2 infections. This study indicated that the frequency of mixed infection with both HSV-1 and HSV-2 is comparatively higher than those of previous reports. The genome ratio of HSV-1 and HSV-2 reflects the preference of each HSV type for the target organ.

  8. Rice production systems and avian influenza: Interactions between mixed-farming systems, poultry and wild birds

    Science.gov (United States)

    Muzaffar, S.B.; Takekawa, John Y.; Prosser, D.J.; Newman, S.H.; Xiao, X.

    2010-01-01

    Wild waterfowl are the reservoir for avian influenza viruses (AIVs), a family of RNA viruses that may cause mild sickness in waterbirds. Emergence of H5N1, a highly pathogenic avian influenza (HPAI) strain, causing severe disease and mortality in wild birds, poultry and humans, had raised concerns about the role of wild birds in possible transmission of the disease. In this review, the link between rice production systems, poultry production systems, and wild bird ecology is examined to assess the extent to which these interactions could contribute towards the persistence and evolution of HPAI H5N1. The rice (Oryza sativa) and poultry production systems in Asia described, and then migration and movements of wild birds discussed. Mixed farming systems in Asia and wild bird movement and migration patterns create opportunities for the persistence of low pathogenic AIVs in these systems. Nonetheless, there is no evidence of long-term persistence of HPAI viruses (including the H5N1 subtype) in the wild. There are still significant gaps in the understanding of how AIVs circulate in rice systems. A better understanding of persistence of AIVs in rice farms, particularly of poultry origins, is essential in limiting exchange of AIVs between mixed-farming systems, poultry and wild birds.

  9. On the Use of an Algebraic Signature Analyzer for Mixed-Signal Systems Testing

    Directory of Open Access Journals (Sweden)

    Vadim Geurkov

    2014-01-01

    Full Text Available We propose an approach to design of an algebraic signature analyzer that can be used for mixed-signal systems testing. The analyzer does not contain carry propagating circuitry, which improves its performance as well as fault tolerance. The common design technique of a signature analyzer for mixed-signal systems is based on the rules of an arithmetic finite field. The application of this technique to the systems with an arbitrary radix is a challenging task and the devices designed possess high hardware complexity. The proposed technique is simple and applicable to systems of any size and radix. The hardware complexity is low. The technique can also be used in arithmetic/algebraic coding and cryptography.

  10. A 3-D mixed-reality system for stereoscopic visualization of medical dataset.

    Science.gov (United States)

    Ferrari, Vincenzo; Megali, Giuseppe; Troia, Elena; Pietrabissa, Andrea; Mosca, Franco

    2009-11-01

    We developed a simple, light, and cheap 3-D visualization device based on mixed reality that can be used by physicians to see preoperative radiological exams in a natural way. The system allows the user to see stereoscopic "augmented images," which are created by mixing 3-D virtual models of anatomies obtained by processing preoperative volumetric radiological images (computed tomography or MRI) with real patient live images, grabbed by means of cameras. The interface of the system consists of a head-mounted display equipped with two high-definition cameras. Cameras are mounted in correspondence of the user's eyes and allow one to grab live images of the patient with the same point of view of the user. The system does not use any external tracker to detect movements of the user or the patient. The movements of the user's head and the alignment of virtual patient with the real one are done using machine vision methods applied on pairs of live images. Experimental results, concerning frame rate and alignment precision between virtual and real patient, demonstrate that machine vision methods used for localization are appropriate for the specific application and that systems based on stereoscopic mixed reality are feasible and can be proficiently adopted in clinical practice.

  11. Impact of siltuximab on patient-related outcomes in multicentric Castleman’s disease

    Directory of Open Access Journals (Sweden)

    Sitenga J

    2018-01-01

    Full Text Available Jenna Sitenga,1 Gregory Aird,1 Aabra Ahmed,1 Peter T Silberstein2 1Division of Education, Creighton University School of Medicine, Omaha, NE, USA; 2Division of Hematology/Oncology, Creighton University School of Medicine, Omaha, NE, USA Abstract: Multicentric Castleman’s disease (MCD is a rare, widespread lymphoproliferative disorder and a life-threatening disease involving hyperactivity of the immune system, excessive proinflammatory cytokine release, immune cell proliferation, and organ system dysfunction. Interleukin-6 (IL-6 is a cytokine that plays a key role in the pathogenesis of MCD, as it is involved in the synthesis of acute-phase reactants and aids in the induction of B-cell proliferation. Siltuximab is an anti-IL-6 chimeric monoclonal antibody that acts as a novel treatment modality to bind to IL-6 with high affinity, thus neutralizing the cytokine bioactivity and inhibiting B-cell proliferation. Clinical trials with siltuximab have shown early clinical promise for patients with MCD for many years, leading to recent US Food and Drug Administration approval as a novel agent for the treatment of MCD. Here, a systematic review was conducted to include 171 cases of MCD patients treated with siltuximab. While traditional treatment methods were able to achieve a 5-year survival rate of only 55%–77%, results of siltuximab treatment demonstrated 5-year survival rates of nearly 96.4% (only 2 deaths reported out of 55 patients with follow-up data. Ultimately, the results from multiple clinical trials have demonstrated that siltuximab is extremely efficacious in alleviating disease symptoms (fatigue, pain, and lymphadenopathy while simultaneously achieving disease remission, thus extending progression-free survival for years longer than the average 5-year survival rates for MCD. Keywords: Castleman’s disease, angiofollicular lymph node hyperplasia, giant lymph node hyperplasia, siltuximab, IL-6 receptor

  12. Protocol for a multicentre, multistage, prospective study in China using system-based approaches for consistent improvement in surgical safety.

    Science.gov (United States)

    Yu, Xiaochu; Jiang, Jingmei; Liu, Changwei; Shen, Keng; Wang, Zixing; Han, Wei; Liu, Xingrong; Lin, Guole; Zhang, Ye; Zhang, Ying; Ma, Yufen; Bo, Haixin; Zhao, Yupei

    2017-06-15

    Surgical safety has emerged as a crucial global health issue in the past two decades. Although several safety-enhancing tools are available, the pace of large-scale improvement remains slow, especially in developing countries such as China. The present project (Modern Surgery and Anesthesia Safety Management System Construction and Promotion) aims to develop and validate system-based integrated approaches for reducing perioperative deaths and complications using a multicentre, multistage design. The project involves collection of clinical and outcome information for 1 20 000 surgical inpatients at four regionally representative academic/teaching general hospitals in China during three sequential stages: preparation and development, effectiveness validation and improvement of implementation for promotion. These big data will provide the evidence base for the formulation, validation and improvement processes of a system-based stratified safety intervention package covering the entire surgical pathway. Attention will be directed to managing inherent patient risks and regulating medical safety behaviour. Information technology will facilitate data collection and intervention implementation, provide supervision mechanisms and guarantee transfer of key patient safety messages between departments and personnel. Changes in rates of deaths, surgical complications during hospitalisation, length of stay, system adoption and implementation rates will be analysed to evaluate effectiveness and efficiency. This study was approved by the institutional review boards of Peking Union Medical College Hospital, First Hospital of China Medical University, Qinghai Provincial People's Hospital, Xiangya Hospital Central South University and the Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences. Study findings will be disseminated via peer-reviewed journals, conference presentations and patent papers. © Article author(s) (or their employer(s) unless otherwise

  13. A new Gauss quadrature for multicentre integrals over STOs in the Gaussian integral transform approach

    International Nuclear Information System (INIS)

    Bouferguene, Ahmed

    2005-01-01

    When computing multicentre integrals over Slater-type orbitals (STOs) by means of the Shavitt and Karplus Gaussian integral transforms (Shavitt and Karplus 1962 J. Chem. Phys. 36 550), one usually ends up with a multiple integral of the form ∫ 0 1 du ∫ 0 1 dv ...∫ 0 ∞ dz F(u, v, ..., z) (Shavitt and Karplus 1965 J. Chem. Phys. 43 398) in which all the integrals are inter-related. The most widely used approach for computing such an integral is to apply a product of Gauss-Legendre quadratures for the integrals over [0, 1] while the semi-infinite term is evaluated by a special procedure. Although numerous approaches have been developed to accurately perform the integration over [0, ∞) efficiently, it is the aim of this work to add a new tool that could be of some benefit in carrying out the hard task of multicentre integrals over STOs. The new approach relies on a special Gauss quadrature referred to as Gauss-Bessel to accurately evaluate the semi-infinite integral of interest. In this work, emphasis is put on accuracy rather than efficiency since its aim is essentially to bring a proof of concept showing that Gauss-Bessel quadrature can successfully be applied in the context of multicentre integrals over STOs. The obtained accuracy is comparable to that obtained with other methods available in the literature

  14. Orthodontic Management of a Severely Rotated Maxillary Central Incisor in the Mixed Dentition: A Case Report

    Directory of Open Access Journals (Sweden)

    Arezoo Jahanbin

    2014-06-01

    Full Text Available The aim of this case report was to introduce an appliance for correcting severe rotation of anterior teeth in the mixed dentition period. A 9-year-old Iranian boy with a mixed dentition Class I malocclusion complained of a severely rotated of upper right central incisor. There was a mesiodens between the central incisors. The supernumerary tooth was first extracted and then a Whip appliance which is composed of a removable plate, a cantilever spring and a central bracket on the rotated tooth was utilized. After 8 months, the upper right central incisor was orthodontically brought into proper alignment. Circumferential supracrestal fibrotomy was performed on the overcorrected tooth. One week after surgery, the device was removed and the retention was started. The whip appliance is a removable appliance that can effectively correct severe rotation of anterior teeth especially during the mixed dentition period.

  15. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

  16. Evaluation of the preliminary auditory profile test battery in an international multi-centre study

    NARCIS (Netherlands)

    van Esch, T.E.M.; Kollmeier, B.; Vormann, M.; Lijzenga, J.; Houtgast, T.; Hallgren, M.; Larsby, B.; Athalye, S.P.; Lutman, M.E.; Dreschler, W.A.

    2013-01-01

    Objective: This paper describes the composition and international multi-centre evaluation of a battery of tests termed the preliminary auditory profile. It includes measures of loudness perception, listening effort, speech perception, spectral and temporal resolution, spatial hearing, self-reported

  17. Productivity--a key to managing cost-per-case. Part 1.

    Science.gov (United States)

    Orefice, J J; Jennings, M C

    1983-08-01

    Productivity and productivity management are critical to effective case-mix management. Case-mix management expands on traditional productivity management to include the relationship between such intermediate products as patient days, tests and meals, and the ultimate end product, the case. As hospitals search to increase the profitability of specific case types, they must focus on two critical productivity control points. First, they must examine length of stay and ancillary utilization as one level of productivity. Then they must turn to more traditional analyses and review departmental productivity in the production of the intermediate products. No case-mix management system is complete unless it focuses on both of these critical relationships. Part two of this article will explore performance reporting and its role in managing both productivity and case mix.

  18. Implementing diffusion-weighted MRI for body imaging in prospective multicentre trials. Current considerations and future perspectives

    Energy Technology Data Exchange (ETDEWEB)

    DeSouza, N.M.; Winfield, J.M.; Weller, A.; Papoutsaki, M.V.; Doran, S.J.; Collins, D.J. [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, CRUK Cancer Imaging Centre, Surrey (United Kingdom); Waterton, J.C.; Jackson, A. [University of Manchester, Manchester Academic Health Sciences Institute, Manchester (United Kingdom); Fournier, L. [Universite Paris Descartes Sorbonne Paris Cite, Assistance Publique-Hopitaux de Paris, Hopital Europeen Georges Pompidou, Radiology Department, Paris (France); Sullivan, D. [Duke Comprehensive Cancer Institute, Durham, NC (United States); Chenevert, T. [University of Michigan Health System, Department of Radiology, Ann Arbor, MI (United States); Boss, M. [National Institute of Standards and Technology (NIST), Applied Physics Division, Boulder, CO (United States); Trattnig, S. [Medical University of Vienna, Department of Biomedical Imaging and Image Guided Therapy, Vienna (Austria); Liu, Y. [European Organisation for Research and Treatment of Cancer, Brussels (Belgium)

    2018-03-15

    For body imaging, diffusion-weighted MRI may be used for tumour detection, staging, prognostic information, assessing response and follow-up. Disease detection and staging involve qualitative, subjective assessment of images, whereas for prognosis, progression or response, quantitative evaluation of the apparent diffusion coefficient (ADC) is required. Validation and qualification of ADC in multicentre trials involves examination of i) technical performance to determine biomarker bias and reproducibility and ii) biological performance to interrogate a specific aspect of biology or to forecast outcome. Unfortunately, the variety of acquisition and analysis methodologies employed at different centres make ADC values non-comparable between them. This invalidates implementation in multicentre trials and limits utility of ADC as a biomarker. This article reviews the factors contributing to ADC variability in terms of data acquisition and analysis. Hardware and software considerations are discussed when implementing standardised protocols across multi-vendor platforms together with methods for quality assurance and quality control. Processes of data collection, archiving, curation, analysis, central reading and handling incidental findings are considered in the conduct of multicentre trials. Data protection and good clinical practice are essential prerequisites. Developing international consensus of procedures is critical to successful validation if ADC is to become a useful biomarker in oncology. (orig.)

  19. Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments.

    Science.gov (United States)

    Martin, Peter; Davies, Roger; Macdougall, Amy; Ritchie, Benjamin; Vostanis, Panos; Whale, Andy; Wolpert, Miranda

    2017-09-01

    Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS). To develop a case mix classification for CAMHS that is clinically meaningful and predictive of number of appointments attended and to investigate the influence of presenting problems, context and complexity factors and provider variation. We analysed 4573 completed episodes of outpatient care from 11 English CAMHS. Cluster analysis, regression trees and a conceptual classification based on clinical best practice guidelines were compared regarding their ability to predict number of appointments, using mixed effects negative binomial regression. The conceptual classification is clinically meaningful and did as well as data-driven classifications in accounting for number of appointments. There was little evidence for effects of complexity or context factors, with the possible exception of school attendance problems. Substantial variation in resource provision between providers was not explained well by case mix. The conceptually-derived classification merits further testing and development in the context of collaborative decision making.

  20. Multicentic primary angiosarcoma of bone mimicking metastasis on 18F-FDG PET/CT in a patient with a history of sigmoid colon cancer: A case report

    International Nuclear Information System (INIS)

    Yoo, Min Young; Kim, Seok Ki; Park, Seog Yun; Kwon, Young Mee; Yun, Tak; Kim, Tae Sung; Lee, Eun Seong

    2015-01-01

    Primary angiosarcoma of the bone (PAB) is a rare and fatal high-grade malignant vascular bone tumor. We report a rare case of multicentric PAB mimicking bone metastasis in a 59-year-old female patient with a history of sigmoid colon cancer. This patient complained of lower back and pelvic pain and presented with multiple osteolytic bone lesions on plain radiography and pelvic computed tomography. First, bone metastasis of sigmoid colon cancer was suspected. However, on the 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) scan, the patient presented unusual multiple hypermetabolic osteolytic bone lesions involving contiguous bones of the lower half of the body. After bone biopsy, these lesions were confirmed to be multicentric PAB. To the best of our knowledge, this is the first case report of an 18 F-FDG PET/CT scan in a patient with multicentric primary bone angiosarcoma

  1. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study.

    Science.gov (United States)

    Friedl, Alexander; Mühlstädt, Sandra; Zachoval, Roman; Giammò, Alessandro; Kivaranovic, Danijel; Rom, Maximilian; Fornara, Paolo; Brössner, Clemens

    2017-05-01

    To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS ® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  2. Speciation of Zinc Mixed Ligand Complexes in Salt Water Systems ...

    African Journals Online (AJOL)

    Speciation of Zinc Mixed Ligand Complexes in Salt Water Systems. ... method has been used to study heavy metal interaction in model lake water in KNO3 ... is of no consequential effect because in its normal state, the [OH-] of the lake water is ...

  3. Sustainability of a Compartmentalized Host-Parasite Replicator System under Periodic Washout-Mixing Cycles

    Directory of Open Access Journals (Sweden)

    Taro Furubayashi

    2018-01-01

    Full Text Available The emergence and dominance of parasitic replicators are among the major hurdles for the proliferation of primitive replicators. Compartmentalization of replicators is proposed to relieve the parasite dominance; however, it remains unclear under what conditions simple compartmentalization uncoupled with internal reaction secures the long-term survival of a population of primitive replicators against incessant parasite emergence. Here, we investigate the sustainability of a compartmentalized host-parasite replicator (CHPR system undergoing periodic washout-mixing cycles, by constructing a mathematical model and performing extensive simulations. We describe sustainable landscapes of the CHPR system in the parameter space and elucidate the mechanism of phase transitions between sustainable and extinct regions. Our findings revealed that a large population size of compartments, a high mixing intensity, and a modest amount of nutrients are important factors for the robust survival of replicators. We also found two distinctive sustainable phases with different mixing intensities. These results suggest that a population of simple host–parasite replicators assumed before the origin of life can be sustained by a simple compartmentalization with periodic washout-mixing processes.

  4. Thin TaC layer produced by ion mixing

    DEFF Research Database (Denmark)

    Barna, Árpád; Kotis, László; Pécz, Béla

    2012-01-01

    in strongly asymmetric ion mixing; the carbon was readily transported to the Ta layer, while the reverse process was much weaker. Because of the asymmetrical transport the C/TaC interface remained sharp independently from the applied fluence. The carbon transported to the Ta layer formed Ta......Ion-beam mixing in C/Ta layered systems was investigated. C 8nm/Ta 12nm and C 20nm/Ta 19nm/C 20nm layer systems were irradiated by Ga+ ions of energy in the range of 2–30keV. In case of the 8nm and 20nm thick C cover layers applying 5–8keV and 20–30keV Ga+ ion energy, respectively resulted...

  5. EFFECTS OF OXYGEN AND AIR MIXING ON VOID FRACTIONS IN A LARGE SCALE SYSTEM

    International Nuclear Information System (INIS)

    Leishear, R; Hector Guerrero, H; Michael Restivo, M

    2008-01-01

    Oxygen and air mixing with spargers was performed in a 30 foot tall by 30 inch diameter column, to investigate mass transfer as air sparged up through the column and removed saturated oxygen from solution. The mixing techniques required to support this research are the focus of this paper. The fluids tested included water, water with an antifoam agent (AFA), and a high, solids content, Bingham plastic, nuclear waste simulant with AFA, referred to as AZ01 simulant, which is non-radioactive. Mixing of fluids in the column was performed using a recirculation system and an air sparger. The re-circulation system consisted of the column, a re-circulating pump, and associated piping. The air sparger was fabricated from a two inch diameter pipe concentrically installed in the column and open near the bottom of the column. The column contents were slowly re-circulated while fluids were mixed with the air sparger. Samples were rheologically tested to ensure effective mixing, as required. Once the fluids were adequately mixed, oxygen was homogeneously added through the re-circulation loop using a sintered metal oxygen sparger followed by a static mixer. Then the air sparger was re-actuated to remove oxygen from solution as air bubbled up through solution. To monitor mixing effectiveness several variables were monitored, which included flow rates, oxygen concentration, differential pressures along the column height, fluid levels, and void fractions, which are defined as the percent of dissolved gas divided by the total volume of gas and liquid. Research showed that mixing was uniform for water and water with AFA, but mixing for the AZ101 fluid was far more complex. Although mixing of AZ101 was uniform throughout most of the column, gas entrapment and settling of solids significantly affected test results. The detailed test results presented here provide some insight into the complexities of mixing and void fractions for different fluids and how the mixing process itself

  6. EFFECTS OF OXYGEN AND AIR MIXING ON VOID FRACTIONS IN A LARGE SCALE SYSTEM

    Energy Technology Data Exchange (ETDEWEB)

    Leishear, R; Hector Guerrero, H; Michael Restivo, M

    2008-09-11

    Oxygen and air mixing with spargers was performed in a 30 foot tall by 30 inch diameter column, to investigate mass transfer as air sparged up through the column and removed saturated oxygen from solution. The mixing techniques required to support this research are the focus of this paper. The fluids tested included water, water with an antifoam agent (AFA), and a high, solids content, Bingham plastic, nuclear waste simulant with AFA, referred to as AZ01 simulant, which is non-radioactive. Mixing of fluids in the column was performed using a recirculation system and an air sparger. The re-circulation system consisted of the column, a re-circulating pump, and associated piping. The air sparger was fabricated from a two inch diameter pipe concentrically installed in the column and open near the bottom of the column. The column contents were slowly re-circulated while fluids were mixed with the air sparger. Samples were rheologically tested to ensure effective mixing, as required. Once the fluids were adequately mixed, oxygen was homogeneously added through the re-circulation loop using a sintered metal oxygen sparger followed by a static mixer. Then the air sparger was re-actuated to remove oxygen from solution as air bubbled up through solution. To monitor mixing effectiveness several variables were monitored, which included flow rates, oxygen concentration, differential pressures along the column height, fluid levels, and void fractions, which are defined as the percent of dissolved gas divided by the total volume of gas and liquid. Research showed that mixing was uniform for water and water with AFA, but mixing for the AZ101 fluid was far more complex. Although mixing of AZ101 was uniform throughout most of the column, gas entrapment and settling of solids significantly affected test results. The detailed test results presented here provide some insight into the complexities of mixing and void fractions for different fluids and how the mixing process itself

  7. Case-Based FCTF Reasoning System

    Directory of Open Access Journals (Sweden)

    Jing Lu

    2015-10-01

    Full Text Available Case-based reasoning uses old information to infer the answer of new problems. In case-based reasoning, a reasoner firstly records the previous cases, then searches the previous case list that is similar to the current one and uses that to solve the new case. Case-based reasoning means adapting old solving solutions to new situations. This paper proposes a reasoning system based on the case-based reasoning method. To begin, we show the theoretical structure and algorithm of from coarse to fine (FCTF reasoning system, and then demonstrate that it is possible to successfully learn and reason new information. Finally, we use our system to predict practical weather conditions based on previous ones and experiments show that the prediction accuracy increases with further learning of the FCTF reasoning system.

  8. [Influence of functional dependence on the case mix in a geriatric unit].

    Science.gov (United States)

    González-Guerrero, José Luis; Alonso-Fernández, Teresa; Gálvez, Noemí; García-Mayolín, Nieves

    2008-01-01

    To determine the influence of pre-admission functional status on the case mix in a geriatric unit, after adjustment by the diagnosis-related groups (DRG) patient classification system. We performed a retrospective observational study in patients admitted to the geriatric unit of a general hospital over a 2-year period. Patients with a length of stay of less than 2 days and transfers from other medical services and hospitals were excluded. The following data were obtained from the minimum data set and from chart review: age, sex, place of residence before admission, Charlson comorbidity index, pre-admission functional status and mobility, cognitive status, length of hospital stay, rate of in-hospital mortality, and the DRG (and DRG weight) for each patient. A total of 1065 patients were included in this study. The mean age was 84 years (64-102), and 64% were women. Patients with lower functional status were more often female (67.1 vs 55.8%; PDRG weight (P=.03). Once the more frequent DRG were reviewed, patients who were dependent had a greater number of respiratory infections and renal problems and had fewer cerebrovascular diseases. Some clinical characteristics differ in patients with functional dependence. This finding could influence the clinical management of medical services that treat more dependent patients.

  9. An interval fixed-mix stochastic programming method for greenhouse gas mitigation in energy systems under uncertainty

    International Nuclear Information System (INIS)

    Xie, Y.L.; Li, Y.P.; Huang, G.H.; Li, Y.F.

    2010-01-01

    In this study, an interval fixed-mix stochastic programming (IFSP) model is developed for greenhouse gas (GHG) emissions reduction management under uncertainties. In the IFSP model, methods of interval-parameter programming (IPP) and fixed-mix stochastic programming (FSP) are introduced into an integer programming framework, such that the developed model can tackle uncertainties described in terms of interval values and probability distributions over a multi-stage context. Moreover, it can reflect dynamic decisions for facility-capacity expansion during the planning horizon. The developed model is applied to a case of planning GHG-emission mitigation, demonstrating that IFSP is applicable to reflecting complexities of multi-uncertainty, dynamic and interactive energy management systems, and capable of addressing the problem of GHG-emission reduction. A number of scenarios corresponding to different GHG-emission mitigation levels are examined; the results suggest that reasonable solutions have been generated. They can be used for generating plans for energy resource/electricity allocation and capacity expansion and help decision makers identify desired GHG mitigation policies under various economic costs and environmental requirements.

  10. Assessment of the importance of mixing in the Yucca Mountain hydrogeological system

    International Nuclear Information System (INIS)

    Gomez, Javier B.; Auque, Luis F.; Gimeno, Maria; Acero, Patricia; Peterman, Zell; Oliver, Thomas A.; Gascoyne, Mel; Laaksoharju, Marcus

    2011-02-01

    The main objective of this work is to assess the importance of mixing on the hydrochemistry of waters in and around Yucca Mountain, most importantly in those waters south of Yucca Mountain. Due to the general north-south gradient of groundwater flow in the Yucca Mountain area, leakage from the proposed high-level radioactive waste repository would have the greatest consequences in the saturated zone waters south of Yucca Mountain. In this area (Amargosa River, Amargosa Flat and Ash Meadows), three main aquifers interact: the Regional Palaeozoic Carbonate Aquifer (RCA), the Tertiary Tuffs Aquifer (TTA) and the Quaternary Basin-fill Aquifer (QBfA). One consequence of upward leakage from the Palaeozoic Carbonate Aquifer would be to dilute the contaminant plume should one develop from the radioactive waste repository at Yucca Mountain. The reverse, downward leakage from the Tertiary Tuffs Aquifer or the Quaternary Basin-fill Aquifer into the Palaeozoic Carbonate Aquifer would contaminate a major aquifer system. It is clearly of the utmost importance to explore the links between theses aquifer systems and to assess the degree of mixing between the groundwaters. To attain this general objective, the following specific objectives have been either defined in advance or decided as being important during the development of the project: 1. Compile a dataset of water samples from the Yucca Mountain area. This dataset should contain samples from all the potential water types that contribute to the chemistry of the groundwaters in the aquifer systems in the area. 2. Perform a careful total-system exploratory analysis on the initial (raw) dataset in order to identify trends and outliers. 3. Perform a detailed exploratory analysis of each individual hydrofacies with the aim of identifying and eliminating from the raw dataset all the samples heavily affected by processes other than mixing (e.g. water-rock interaction, evaporation, cation exchange). PHREEQC simulations were

  11. Assessment of the importance of mixing in the Yucca Mountain hydrogeological system

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Javier B.; Auque, Luis F.; Gimeno, Maria; Acero, Patricia (Geochemical Modelling Group, Dept. of Earth Sciences, Univ. of Zaragoza (Spain)); Peterman, Zell; Oliver, Thomas A. (U.S. Geological Survey (United States)); Gascoyne, Mel (Gascoyne Geoprojects Inc (Canada)); Laaksoharju, Marcus (Geopoint AB (Sweden))

    2011-02-15

    The main objective of this work is to assess the importance of mixing on the hydrochemistry of waters in and around Yucca Mountain, most importantly in those waters south of Yucca Mountain. Due to the general north-south gradient of groundwater flow in the Yucca Mountain area, leakage from the proposed high-level radioactive waste repository would have the greatest consequences in the saturated zone waters south of Yucca Mountain. In this area (Amargosa River, Amargosa Flat and Ash Meadows), three main aquifers interact: the Regional Palaeozoic Carbonate Aquifer (RCA), the Tertiary Tuffs Aquifer (TTA) and the Quaternary Basin-fill Aquifer (QBfA). One consequence of upward leakage from the Palaeozoic Carbonate Aquifer would be to dilute the contaminant plume should one develop from the radioactive waste repository at Yucca Mountain. The reverse, downward leakage from the Tertiary Tuffs Aquifer or the Quaternary Basin-fill Aquifer into the Palaeozoic Carbonate Aquifer would contaminate a major aquifer system. It is clearly of the utmost importance to explore the links between theses aquifer systems and to assess the degree of mixing between the groundwaters. To attain this general objective, the following specific objectives have been either defined in advance or decided as being important during the development of the project: 1. Compile a dataset of water samples from the Yucca Mountain area. This dataset should contain samples from all the potential water types that contribute to the chemistry of the groundwaters in the aquifer systems in the area. 2. Perform a careful total-system exploratory analysis on the initial (raw) dataset in order to identify trends and outliers. 3. Perform a detailed exploratory analysis of each individual hydrofacies with the aim of identifying and eliminating from the raw dataset all the samples heavily affected by processes other than mixing (e.g. water-rock interaction, evaporation, cation exchange). PHREEQC simulations were

  12. Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II.

    Science.gov (United States)

    González-Castro, A; Ortiz-Lasa, M; Leizaola, O; Salgado, E; Irriguible, T; Sánchez-Satorra, M; Lomas-Fernández, C; Barral-Segade, P; Cordero-Vallejo, M; Rodrigo-Calabia, E; Dierssen-Sotos, T

    2017-05-01

    To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Case-Based Reasoning in Mixed Paradigm Settings and with Learning

    Science.gov (United States)

    1994-04-30

    Learning Prototypical Cases OFF-BROADWAY, MCI and RMHC -* are three CBR-ML systems that learn case prototypes. We feel that methods that enable the...at Irvine Machine Learning Repository, including heart disease and breast cancer databases. OFF-BROADWAY, MCI and RMHC -* made the following notable

  14. On a mixed problem for a coupled nonlinear system

    Directory of Open Access Journals (Sweden)

    Marcondes R. Clark

    1997-03-01

    Full Text Available In this article we prove the existence and uniqueness of solutions to the mixed problem associated with the nonlinear system $$ u_{tt}-M(int_Omega |abla u|^2dxDelta u+|u|^ ho u+heta =f $$ $$ heta _t -Delta heta +u_{t}=g $$ where $M$ is a positive real function, and $f$ and $g$ are known real functions.

  15. Multi-centre audit of VMAT planning and pre-treatment verification.

    Science.gov (United States)

    Jurado-Bruggeman, Diego; Hernández, Victor; Sáez, Jordi; Navarro, David; Pino, Francisco; Martínez, Tatiana; Alayrach, Maria-Elena; Ailleres, Norbert; Melero, Alejandro; Jornet, Núria

    2017-08-01

    We performed a multi-centre intercomparison of VMAT dose planning and pre-treatment verification. The aims were to analyse the dose plans in terms of dosimetric quality and deliverability, and to validate whether in-house pre-treatment verification results agreed with those of an external audit. The nine participating centres encompassed different machines, equipment, and methodologies. Two mock cases (prostate and head and neck) were planned using one and two arcs. A plan quality index was defined to compare the plans and different complexity indices were calculated to check their deliverability. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit (global 3D gamma, absolute dose differences, 10% of maximum dose threshold). Log-file analysis was performed to look for delivery errors. All centres fulfilled the dosimetric goals but plan quality and delivery complexity were heterogeneous and uncorrelated, depending on the manufacturer and the planner's methodology. Pre-treatment verifications results were within tolerance in all cases for gamma 3%-3mm evaluation. Nevertheless, differences between the external audit and in-house measurements arose due to different equipment or methodology, especially for 2%-2mm criteria with differences up to 20%. No correlation was found between complexity indices and verification results amongst centres. All plans fulfilled dosimetric constraints, but plan quality and complexity did not correlate and were strongly dependent on the planner and the vendor. In-house measurements cannot completely replace external audits for credentialing. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Broadband Shock Noise in Internally-Mixed Dual-Stream Jets

    Science.gov (United States)

    Bridges, James E.

    2009-01-01

    Broadband shock noise (BBSN) has been studied in some detail in single-flow jets and recently in dual-stream jets with separate flow exhaust systems. Shock noise is of great concern in these latter cases because of the noise created for the aircraft cabin by the underexpanded nozzle flow at cruise. Another case where shock noise is of concern is in the case of future supersonic aircraft that are expected to have bypass ratios small enough to justify internally mixed exhaust systems, and whose mission will push cycles to the point of imperfectly expanded flows. Dual-stream jets with internally mixed plume have some simplifying aspects relative to the separate flow jets, having a single shock structure given by the common nozzle pressure. This is used to separate the contribution of the turbulent shear layer to the broadband shock noise. Shock structure is held constant while the geometry and strength of the inner and merged shear layers are varying by changing splitter area ratio and core stream temperature. Flow and noise measurements are presented which document the efforts at separating the contribution of the inner shear layer to the broadband shock noise.

  17. Lung volume reduction coil treatment for patients with severe emphysema : a European multicentre trial

    NARCIS (Netherlands)

    Deslee, Gaetan; Klooster, Karin; Hetzel, Martin; Stanzel, Franz; Kessler, Romain; Marquette, Charles-Hugo; Witt, Christian; Blaas, Stefan; Gesierich, Wolfgang; Herth, Felix J. F.; Hetzel, Juergen; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial

  18. A Mixed-Signal Embedded Platform for Automotive Sensor Conditioning

    Directory of Open Access Journals (Sweden)

    Emilio Volpi

    2010-01-01

    Full Text Available A mixed-signal embedded system called Intelligent Sensor InterFace (ISIF suited to fast identify, trim, and verify an architecture to interface a given sensor is presented. This system has been developed according to a platform-based design approach, a methodology that has proved to be efficient for building complex mixed-signal embedded systems with short time-to-market. Such platform consists in a wide set of optimized high-performance analog, digital, and software intellectual property (IP modules for various kinds of sensors. These IPs can be easily defined for fast prototyping of the interface circuit for the given sensor. Final ASIC implementation for the given sensor conditioning can be easily derived with reduced risk and short development time. Some case examples are presented to demonstrate the effectiveness and flexibility of this system.

  19. A Mixed-Signal Embedded Platform for Automotive Sensor Conditioning

    Directory of Open Access Journals (Sweden)

    Giambastiani Adolfo

    2010-01-01

    Full Text Available Abstract A mixed-signal embedded system called Intelligent Sensor InterFace (ISIF suited to fast identify, trim, and verify an architecture to interface a given sensor is presented. This system has been developed according to a platform-based design approach, a methodology that has proved to be efficient for building complex mixed-signal embedded systems with short time-to-market. Such platform consists in a wide set of optimized high-performance analog, digital, and software intellectual property (IP modules for various kinds of sensors. These IPs can be easily defined for fast prototyping of the interface circuit for the given sensor. Final ASIC implementation for the given sensor conditioning can be easily derived with reduced risk and short development time. Some case examples are presented to demonstrate the effectiveness and flexibility of this system.

  20. Unitarity constraints on trimaximal mixing

    International Nuclear Information System (INIS)

    Kumar, Sanjeev

    2010-01-01

    When the neutrino mass eigenstate ν 2 is trimaximally mixed, the mixing matrix is called trimaximal. The middle column of the trimaximal mixing matrix is identical to tribimaximal mixing and the other two columns are subject to unitarity constraints. This corresponds to a mixing matrix with four independent parameters in the most general case. Apart from the two Majorana phases, the mixing matrix has only one free parameter in the CP conserving limit. Trimaximality results in interesting interplay between mixing angles and CP violation. A notion of maximal CP violation naturally emerges here: CP violation is maximal for maximal 2-3 mixing. Similarly, there is a natural constraint on the deviation from maximal 2-3 mixing which takes its maximal value in the CP conserving limit.

  1. Mesenchymal Chondrosarcoma of Maxilla: A Rare Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    R Thriveni

    2010-01-01

    Full Text Available Mesenchymal condrosarcomas are rare malignant neoplasms that can arise from both soft and hard tissues. They are distinct tumors arising in unicentric or multicentric locations. They reveal unusual clinical behavior, characteristic histopathological features, and poor prognosis with late recurrences. Here is a case report of a rare case of mesenchymal chondrosarcoma arising in a 19-year-old female patient′s right maxilla.

  2. An experimental investigation of ionic transport properties in CuI-Ag2WO4 and CuI-Ag2CrO4 mixed systems

    International Nuclear Information System (INIS)

    Suthanthiraraj, S. Austin; Premchand, Y. Daniel

    2004-01-01

    The phenomenon of ionic transport in the case of two different mixed systems (CuI) (1-x) -(Ag 2 WO 4 ) x (0.15= (1-y) -(Ag 2 CrO 4 ) y (0.15= -3 Scm -1 for the composition (CuI) 0.45 -(Ag 2 WO 4 ) 0.55 and 1.1x10 -4 Scm -1 in the case of (CuI) 0.55 -(Ag 2 CrO 4 ) 0.45 at room temperature has been discussed in terms of the observed characteristics

  3. Diversity in the dry land mixed system and viability of dairy sheep farming

    Directory of Open Access Journals (Sweden)

    Jose Rivas

    2015-05-01

    Full Text Available Castilla La Mancha is a Spanish region where sheep farming system is traditionally pasture-based. Recently, this territory has undergone a recession of dairy sheep activity, which changed the type and intensity of land utilization and led to environmental and landscape degradation. The present study analyzed the diversity and viability of dairy sheep of mixed systems. Multivariate analysis was conducted on 157 dairy sheep farms, factor analysis selected 3 productivity factors (level of intensification, land use, size and family labour, and cluster analysis classified farms into three groups. Group 1, smallholders – with the smallest size (405.5 ewes and 564.7 ha, lowest area in ownership (1.5%, and agriculture activity (6.5% crops area: family farms (90.8% highly dependent on external inputs. Group 2, large-scale farms (1058.7 ewes and 1755.1 ha – with the lowest stocking rate (0.14 livestock unit/ha and productivity: nonfamily farms (39.1% with low area in ownership (4.1% and agriculture activity (7.6%. Group 3, mixed-technified – with the highest levels of technology and least use of family labour (27.0%: large-scale farms (1387.4 ewes and 955.8 ha, combining milk production with agricultural activities (55.7% crops area, with the highest area in ownership (63.1% and the best productivity performance. In conclusion, the dry land mixed system of Castilla La Mancha showed diversity of farms. Improving viability requires a systemic approach where the key tool is grazing, allowing the mixed system to be consolidated as a model that enhances the positive impact of livestock on the environment in the Mediterranean basin.

  4. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area

    Directory of Open Access Journals (Sweden)

    Niakas Dimitris

    2006-11-01

    Full Text Available Abstract Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426 residing in the broader Athens area (response rate 70.6%. Perceived health-related quality of life (HRQOL, as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a last-month visits to public sector physicians, b last-month visits to private sector physicians, c last-year visits to hospital emergency departments and d last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector. Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

  5. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.

    Science.gov (United States)

    Pappa, Evelina; Niakas, Dimitris

    2006-11-02

    Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

  6. Implications of Upwells as Hydrodynamic Jets in a Pulse Jet Mixed System

    Energy Technology Data Exchange (ETDEWEB)

    Pease, Leonard F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Bamberger, Judith A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Minette, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-02-28

    This report evaluates the physics of the upwell flow in pulse jet mixed systems in the Hanford Tank Waste Treatment and Immobilization Plant (WTP). Although the initial downward flow and radial flow from jets characteristic of pulse jet mixers (PJMs) has been analyzed, the upwells have received considerably less attention despite having significant implications for vessel mixing. Do the upwells behave like jets? How do the upwells scale? When will the central upwell break through? What proportion of the vessel is blended by the upwells themselves? Indeed, how the physics of the central upwell is affected by multiple PJMs (e.g., six in the proposed mixing vessels), non-Newtonian rheology, and significant multicomponent solids loadings remain unexplored.

  7. An open source Bayesian Monte Carlo isotope mixing model with applications in Earth surface processes

    Science.gov (United States)

    Arendt, Carli A.; Aciego, Sarah M.; Hetland, Eric A.

    2015-05-01

    The implementation of isotopic tracers as constraints on source contributions has become increasingly relevant to understanding Earth surface processes. Interpretation of these isotopic tracers has become more accessible with the development of Bayesian Monte Carlo (BMC) mixing models, which allow uncertainty in mixing end-members and provide methodology for systems with multicomponent mixing. This study presents an open source multiple isotope BMC mixing model that is applicable to Earth surface environments with sources exhibiting distinct end-member isotopic signatures. Our model is first applied to new δ18O and δD measurements from the Athabasca Glacier, which showed expected seasonal melt evolution trends and vigorously assessed the statistical relevance of the resulting fraction estimations. To highlight the broad applicability of our model to a variety of Earth surface environments and relevant isotopic systems, we expand our model to two additional case studies: deriving melt sources from δ18O, δD, and 222Rn measurements of Greenland Ice Sheet bulk water samples and assessing nutrient sources from ɛNd and 87Sr/86Sr measurements of Hawaiian soil cores. The model produces results for the Greenland Ice Sheet and Hawaiian soil data sets that are consistent with the originally published fractional contribution estimates. The advantage of this method is that it quantifies the error induced by variability in the end-member compositions, unrealized by the models previously applied to the above case studies. Results from all three case studies demonstrate the broad applicability of this statistical BMC isotopic mixing model for estimating source contribution fractions in a variety of Earth surface systems.

  8. Ranking system for mixed radioactive and hazardous waste sites

    International Nuclear Information System (INIS)

    Hawley, K.A.; Napier, B.A.

    1985-01-01

    The Environmental Protection Agency's Hazard Ranking System (HRS) is a simplified management decision tool that provides a common basis for evaluating a multitude of hazardous waste sites. A deficiency in the HRS for application to Department of Energy mixed radioactive and hazardous waste sites is its inability to explicitly handle radioactive material. A modification to the basic HRS to add the capability to consider radioactivity is described. The HRS considers the exposure routes of direct contact, fire/explosion, atmospheric release, surface-water release, and ground-water release. Each exposure route is further divided into release, route, containment, waste, and target characteristics. To maintain the basic HRS structure, only the waste characteristics section of each exposure route was modified. A ranking system was developed, using radiation dose pathway analysis, to group radionuclides by dose factors. For mixed waste sites, the ranking factor derived for radionuclides is compared with the ranking factor obtained for hazardous chemicals and the most restrictive is used in the overall ranking. The modified HRS has the advantages of being compatible with the original HRS, has reasonable information requirements, and provides scientifically defensible conclusions. 17 references, 2 figures, 6 tables

  9. Neoadjuvant radiotherapy of primary irresectable unicentric Castleman's disease: a case report and review of the literature

    International Nuclear Information System (INIS)

    Vries, Iris AC de; Acht, Marjolein MS van; Demeyere, Thomas BJ; Lybeert, Marnix LM; Zoete, Jean-Paul de; Nieuwenhuijzen, Grard AP

    2010-01-01

    Castleman disease (CD) is a rare benign disorder characterised by hyperplasia of lymphoid tissue that may develop at a single site or throughout the body. The etiology of this disorder is unclear, although the histopathological presentation can be differentiated into a hyaline vascular variant, a plasma cell variant and a mixed variant. Clinically, it has been recorded that 3 manifestations of CD are characterized: a localized unicentric type, a generalized multicentric type and a mixed form. Surgery remains the main treatment for resectable unicentric CD, since removal of the large node is possible without further complications. No consensus has been reached concerning the most adequate treatment for irresectable unicentric CD. Case report of a 67 year old woman. This report, describes the case of a 67-year-old woman with unicentric Castleman disease located in the right lower abdomen. The patient had symptoms of fatigue, dyspnoea and pain in the right lower abdomen. Computed tomography (CT)- examination revealed a tumour, which had grown to form a close relationship with the common iliac vessels and the sacral bone. A Laparotomy procedure revealed that the tumour was an irresectable mass. Neo-adjuvant radiotherapy (40 Gy) was administered in order to downsize the tumour. Six weeks later a new CT-scan revealed a major reduction of the tumour, which enabled a successful radical resection of the tumour to be performed. Histopathological analysis of the tumour showed the hyaline vascular type of CD. Neo-adjuvant radiotherapy should be considered in case of an irresectable unicentric CD

  10. Computerized detection of breast lesions in multi-centre and multi-instrument DCE-MR data using 3D principal component maps and template matching

    Science.gov (United States)

    Ertas, Gokhan; Doran, Simon; Leach, Martin O.

    2011-12-01

    In this study, we introduce a novel, robust and accurate computerized algorithm based on volumetric principal component maps and template matching that facilitates lesion detection on dynamic contrast-enhanced MR. The study dataset comprises 24 204 contrast-enhanced breast MR images corresponding to 4034 axial slices from 47 women in the UK multi-centre study of MRI screening for breast cancer and categorized as high risk. The scans analysed here were performed on six different models of scanner from three commercial vendors, sited in 13 clinics around the UK. 1952 slices from this dataset, containing 15 benign and 13 malignant lesions, were used for training. The remaining 2082 slices, with 14 benign and 12 malignant lesions, were used for test purposes. To prevent false positives being detected from other tissues and regions of the body, breast volumes are segmented from pre-contrast images using a fast semi-automated algorithm. Principal component analysis is applied to the centred intensity vectors formed from the dynamic contrast-enhanced T1-weighted images of the segmented breasts, followed by automatic thresholding to eliminate fatty tissues and slowly enhancing normal parenchyma and a convolution and filtering process to minimize artefacts from moderately enhanced normal parenchyma and blood vessels. Finally, suspicious lesions are identified through a volumetric sixfold neighbourhood connectivity search and calculation of two morphological features: volume and volumetric eccentricity, to exclude highly enhanced blood vessels, nipples and normal parenchyma and to localize lesions. This provides satisfactory lesion localization. For a detection sensitivity of 100%, the overall false-positive detection rate of the system is 1.02/lesion, 1.17/case and 0.08/slice, comparing favourably with previous studies. This approach may facilitate detection of lesions in multi-centre and multi-instrument dynamic contrast-enhanced breast MR data.

  11. Multicentre evaluation of a novel vaginal dose reporting method in 153 cervical cancer patients

    DEFF Research Database (Denmark)

    Westerveld, Henrike; de Leeuw, Astrid; Kirchheiner, Kathrin

    2016-01-01

    Background and purpose Recently, a vaginal dose reporting method for combined EBRT and BT in cervical cancer patients was proposed. The current study was to evaluate vaginal doses with this method in a multicentre setting, wherein different applicators, dose rates and protocols were used. Materia...

  12. Multicentre Double-Blind Placebo-Controlled Food Challenge Study in Children Sensitised to Cashew Nut

    NARCIS (Netherlands)

    van der Valk, Johanna P. M.; van Wijk, Roy Gerth; Dubois, Anthony E. J.; de Groot, Hans; Reitsma, Marit; Vlieg-Boerstra, Berber; Savelkoul, Huub F. J.; Wichers, Harry J.; de Jong, Nicolette W.

    2016-01-01

    Background Few studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut. The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to

  13. Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011.

    Science.gov (United States)

    Koroukian, Siran M; Basu, Jayasree; Schiltz, Nicholas K; Navale, Suparna; Bakaki, Paul M; Warner, David F; Dor, Avi; Given, Charles W; Stange, Kurt C

    2018-01-01

    Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204). HRS participants who were also enrolled in Medicare. Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059). Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.

  14. Estimates of pandemic influenza vaccine effectiveness in Europe, 2009-2010: results of Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE multicentre case-control study.

    Directory of Open Access Journals (Sweden)

    Marta Valenciano

    2011-01-01

    Full Text Available BACKGROUND: A multicentre case-control study based on sentinel practitioner surveillance networks from seven European countries was undertaken to estimate the effectiveness of 2009-2010 pandemic and seasonal influenza vaccines against medically attended influenza-like illness (ILI laboratory-confirmed as pandemic influenza A (H1N1 (pH1N1. METHODS AND FINDINGS: Sentinel practitioners swabbed ILI patients using systematic sampling. We included in the study patients meeting the European ILI case definition with onset of symptoms >14 days after the start of national pandemic vaccination campaigns. We compared pH1N1 cases to influenza laboratory-negative controls. A valid vaccination corresponded to >14 days between receiving a dose of vaccine and symptom onset. We estimated pooled vaccine effectiveness (VE as 1 minus the odds ratio with the study site as a fixed effect. Using logistic regression, we adjusted VE for potential confounding factors (age group, sex, month of onset, chronic diseases and related hospitalizations, smoking history, seasonal influenza vaccinations, practitioner visits in previous year. We conducted a complete case analysis excluding individuals with missing values and a multiple multivariate imputation to estimate missing values. The multivariate imputation (n = 2902 adjusted pandemic VE (PIVE estimates were 71.9% (95% confidence interval [CI] 45.6-85.5 overall; 78.4% (95% CI 54.4-89.8 in patients <65 years; and 72.9% (95% CI 39.8-87.8 in individuals without chronic disease. The complete case (n = 1,502 adjusted PIVE were 66.0% (95% CI 23.9-84.8, 71.3% (95% CI 29.1-88.4, and 70.2% (95% CI 19.4-89.0, respectively. The adjusted PIVE was 66.0% (95% CI -69.9 to 93.2 if vaccinated 8-14 days before ILI onset. The adjusted 2009-2010 seasonal influenza VE was 9.9% (95% CI -65.2 to 50.9. CONCLUSIONS: Our results suggest good protection of the pandemic monovalent vaccine against medically attended pH1N1 and no effect of the

  15. Stochastic Modelling and Self Tuning Control of a Continuous Cement Raw Material Mixing System

    Directory of Open Access Journals (Sweden)

    Hannu T. Toivonen

    1980-01-01

    Full Text Available The control of a continuously operating system for cement raw material mixing is studied. The purpose of the mixing system is to maintain a constant composition of the cement raw meal for the kiln despite variations of the raw material compositions. Experimental knowledge of the process dynamics and the characteristics of the various disturbances is used for deriving a stochastic model of the system. The optimal control strategy is then obtained as a minimum variance strategy. The control problem is finally solved using a self-tuning minimum variance regulator, and results from a successful implementation of the regulator are given.

  16. The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

    Directory of Open Access Journals (Sweden)

    Gianpaolo Maso

    Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

  17. Stability of neutral type descriptor system with mixed delays

    International Nuclear Information System (INIS)

    Li Hong; Li Houbiao; Zhong Shouming

    2007-01-01

    In this paper, the stability problems of general neutral type descriptor system with mixed delays are considered. Some new delay-independent stability and robust stability criteria, which are simpler and less conservative than existing results, are derived in terms of the stability of a new operator I and linear matrix inequalities (LMIs). Therefore, criteria can be easily checked by utilizing the Matlab LMI toolbox

  18. Water isotope composition as a tracer for study of mixing processes in rivers. Part II. Determination of mixing degrees in the tributary-main river systems

    International Nuclear Information System (INIS)

    Owczarczyk, A.; Wierzchnicki, R.; Zimnicki, R.; Ptaszek, S.; Palige, J.; Dobrowolski, A.

    2006-01-01

    Two river-tributary systems have been chosen for the investigation of mixing processes: the Narew River-the Bug River-Zegrzynski Reservoir and the Bugo-Narew River-the Vistula River. In both river systems, several profiles for the water sampling have been selected down to the tributary confluent line. Each sample position has been precisely determined by means of GPS. Then, the δDi have been measured in IRMS (isotope ratio mass spectroscopy). The δD distributions in selected profiles have been presented for both investigated river systems. Presented results will be applied for the verification of the mathematical model for transport and mixing in river systems

  19. Analysis of the mixing processes in the subtropical Advancetown Lake, Australia

    Science.gov (United States)

    Bertone, Edoardo; Stewart, Rodney A.; Zhang, Hong; O'Halloran, Kelvin

    2015-03-01

    This paper presents an extensive investigation of the mixing processes occurring in the subtropical monomictic Advancetown Lake, which is the main water body supplying the Gold Coast City in Australia. Meteorological, chemical and physical data were collected from weather stations, laboratory analysis of grab samples and an in-situ Vertical Profiling System (VPS), for the period 2008-2012. This comprehensive, high frequency dataset was utilised to develop a one-dimensional model of the vertical transport and mixing processes occurring along the water column. Multivariate analysis revealed that air temperature and rain forecasts enabled a reliable prediction of the strength of the lake stratification. Vertical diffusion is the main process driving vertical mixing, particularly during winter circulation. However, a high reservoir volume and warm winters can limit the degree of winter mixing, causing only partial circulation to occur, as was the case in 2013. This research study provides a comprehensive approach for understanding and predicting mixing processes for similar lakes, whenever high-frequency data are available from VPS or other autonomous water monitoring systems.

  20. A mixed odontogenic sarcoma: A challenging histopathologic case and brief review of the literature.

    Science.gov (United States)

    Atarbashi-Moghadam, Saede; Lotfi, Ali; Mokhtari, Sepideh

    2018-01-01

    Ameloblastic fibro-odontosarcoma (AFOS) is an extremely rare malignant mixed odontogenic tumor. The ectomesenchymal part of the neoplasm shows malignancy, whereas the epithelial component is rather benign. In addition, small areas with deposition of enamel matrix and dentine material are seen. The rarity of this neoplasm and microscopic similarities with other malignant and benign tumors can lead to diagnostic problems. Here, we describe the histopathologic features of a new case of AFOS of the mandible in a 34-year-old female patient. It is essential for oral pathologists to be familiar with the microscopic features of this rare neoplasm to have a proper diagnosis. This is also the first reported case of AFOS that closely resembles osteosarcoma in some areas.