WorldWideScience

Sample records for modelling multiple hospital

  1. [Prediction model of health workforce and beds in county hospitals of Hunan by multiple linear regression].

    Science.gov (United States)

    Ling, Ru; Liu, Jiawang

    2011-12-01

    To construct prediction model for health workforce and hospital beds in county hospitals of Hunan by multiple linear regression. We surveyed 16 counties in Hunan with stratified random sampling according to uniform questionnaires,and multiple linear regression analysis with 20 quotas selected by literature view was done. Independent variables in the multiple linear regression model on medical personnels in county hospitals included the counties' urban residents' income, crude death rate, medical beds, business occupancy, professional equipment value, the number of devices valued above 10 000 yuan, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, and utilization rate of hospital beds. Independent variables in the multiple linear regression model on county hospital beds included the the population of aged 65 and above in the counties, disposable income of urban residents, medical personnel of medical institutions in county area, business occupancy, the total value of professional equipment, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, utilization rate of hospital beds, and length of hospitalization. The prediction model shows good explanatory and fitting, and may be used for short- and mid-term forecasting.

  2. Distributed learning: Developing a predictive model based on data from multiple hospitals without data leaving the hospital - A real life proof of concept.

    Science.gov (United States)

    Jochems, Arthur; Deist, Timo M; van Soest, Johan; Eble, Michael; Bulens, Paul; Coucke, Philippe; Dries, Wim; Lambin, Philippe; Dekker, Andre

    2016-12-01

    One of the major hurdles in enabling personalized medicine is obtaining sufficient patient data to feed into predictive models. Combining data originating from multiple hospitals is difficult because of ethical, legal, political, and administrative barriers associated with data sharing. In order to avoid these issues, a distributed learning approach can be used. Distributed learning is defined as learning from data without the data leaving the hospital. Clinical data from 287 lung cancer patients, treated with curative intent with chemoradiation (CRT) or radiotherapy (RT) alone were collected from and stored in 5 different medical institutes (123 patients at MAASTRO (Netherlands, Dutch), 24 at Jessa (Belgium, Dutch), 34 at Liege (Belgium, Dutch and French), 48 at Aachen (Germany, German) and 58 at Eindhoven (Netherlands, Dutch)). A Bayesian network model is adapted for distributed learning (watch the animation: http://youtu.be/nQpqMIuHyOk). The model predicts dyspnea, which is a common side effect after radiotherapy treatment of lung cancer. We show that it is possible to use the distributed learning approach to train a Bayesian network model on patient data originating from multiple hospitals without these data leaving the individual hospital. The AUC of the model is 0.61 (95%CI, 0.51-0.70) on a 5-fold cross-validation and ranges from 0.59 to 0.71 on external validation sets. Distributed learning can allow the learning of predictive models on data originating from multiple hospitals while avoiding many of the data sharing barriers. Furthermore, the distributed learning approach can be used to extract and employ knowledge from routine patient data from multiple hospitals while being compliant to the various national and European privacy laws. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  3. Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

    Directory of Open Access Journals (Sweden)

    Congdon Peter

    2006-11-01

    Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In

  4. The Hospitable Meal Model

    DEFF Research Database (Denmark)

    Justesen, Lise; Overgaard, Svend Skafte

    2017-01-01

    This article presents an analytical model that aims to conceptualize how meal experiences are framed when taking into account a dynamic understanding of hospitality: the meal model is named The Hospitable Meal Model. The idea behind The Hospitable Meal Model is to present a conceptual model...... that can serve as a frame for developing hospitable meal competencies among professionals working within the area of institutional foodservices as well as a conceptual model for analysing meal experiences. The Hospitable Meal Model transcends and transforms existing meal models by presenting a more open......-ended approach towards meal experiences. The underlying purpose of The Hospitable Meal Model is to provide the basis for creating value for the individuals involved in institutional meal services. The Hospitable Meal Model was developed on the basis of an empirical study on hospital meal experiences explored...

  5. Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling.

    Science.gov (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Estabrooks, Carole A; Giovannetti, Phyllis B

    2011-01-01

    Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs. To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events). Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada. Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties. Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals. Copyright © 2010 Elsevier Ltd. All rights reserved.

  6. Estimating solid waste generation by hospitality industry during major festivals: A quantification model based on multiple regression.

    Science.gov (United States)

    Abdulredha, Muhammad; Al Khaddar, Rafid; Jordan, David; Kot, Patryk; Abdulridha, Ali; Hashim, Khalid

    2018-04-26

    Major-religious festivals hosted in the city of Kerbala, Iraq, annually generate large quantities of Municipal Solid Waste (MSW) which negatively impacts the environment and human health when poorly managed. The hospitality sector, specifically hotels, is one of the major sources of MSW generated during these festivals. Because it is essential to establish a proper waste management system for such festivals, accurate information regarding MSW generation is required. This study therefore investigated the rate of production of MSW from hotels in Kerbala during major festivals. A field questionnaire survey was conducted with 150 hotels during the Arba'een festival, one of the largest festivals in the world, attended by about 18 million participants, to identify how much MSW is produced and what features of hotels impact on this. Hotel managers responded to questions regarding features of the hotel such as size (Hs), expenditure (Hex), area (Ha) and number of staff (Hst). An on-site audit was also carried out with all participating hotels to estimate the mass of MSW generated from these hotels. The results indicate that MSW produced by hotels varies widely. In general, it was found that each hotel guest produces an estimated 0.89 kg of MSW per day. However, this figure varies according to the hotels' rating. Average rates of MSW production from one and four star hotels were 0.83 and 1.22 kg per guest per day, respectively. Statistically, it was found that the relationship between MSW production and hotel features can be modelled with an R 2 of 0.799, where the influence of hotel feature on MSW production followed the order Hs > Hex > Hst. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. An Intuitionistic Multiplicative ORESTE Method for Patients’ Prioritization of Hospitalization

    Directory of Open Access Journals (Sweden)

    Cheng Zhang

    2018-04-01

    Full Text Available The tension brought about by sickbeds is a common and intractable issue in public hospitals in China due to the large population. Assigning the order of hospitalization of patients is difficult because of complex patient information such as disease type, emergency degree, and severity. It is critical to rank the patients taking full account of various factors. However, most of the evaluation criteria for hospitalization are qualitative, and the classical ranking method cannot derive the detailed relations between patients based on these criteria. Motivated by this, a comprehensive multiple criteria decision making method named the intuitionistic multiplicative ORESTE (organísation, rangement et Synthèse dedonnées relarionnelles, in French was proposed to handle the problem. The subjective and objective weights of criteria were considered in the proposed method. To do so, first, considering the vagueness of human perceptions towards the alternatives, an intuitionistic multiplicative preference relation model is applied to represent the experts’ preferences over the pairwise alternatives with respect to the predetermined criteria. Then, a correlation coefficient-based weight determining method is developed to derive the objective weights of criteria. This method can overcome the biased results caused by highly-related criteria. Afterwards, we improved the general ranking method, ORESTE, by introducing a new score function which considers both the subjective and objective weights of criteria. An intuitionistic multiplicative ORESTE method was then developed and further highlighted by a case study concerning the patients’ prioritization.

  8. Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

    Directory of Open Access Journals (Sweden)

    Jan Krüger

    Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

  9. Geometrical model of multiple production

    International Nuclear Information System (INIS)

    Chikovani, Z.E.; Jenkovszky, L.L.; Kvaratshelia, T.M.; Struminskij, B.V.

    1988-01-01

    The relation between geometrical and KNO-scaling and their violation is studied in a geometrical model of multiple production of hadrons. Predictions concerning the behaviour of correlation coefficients at future accelerators are given

  10. Cumulative radiation dose of multiple trauma patients during their hospitalization

    International Nuclear Information System (INIS)

    Wang Zhikang; Sun Jianzhong; Zhao Zudan

    2012-01-01

    Objective: To study the cumulative radiation dose of multiple trauma patients during their hospitalization and to analyze the dose influence factors. Methods: The DLP for CT and DR were retrospectively collected from the patients during June, 2009 and April, 2011 at a university affiliated hospital. The cumulative radiation doses were calculated by summing typical effective doses of the anatomic regions scanned. Results: The cumulative radiation doses of 113 patients were collected. The maximum,minimum and the mean values of cumulative effective doses were 153.3, 16.48 mSv and (52.3 ± 26.6) mSv. Conclusions: Multiple trauma patients have high cumulative radiation exposure. Therefore, the management of cumulative radiation doses should be enhanced. To establish the individualized radiation exposure archives will be helpful for the clinicians and technicians to make decision whether to image again and how to select the imaging parameters. (authors)

  11. Modelling Hospital Materials Management Processes

    Directory of Open Access Journals (Sweden)

    Raffaele Iannone

    2013-06-01

    integrated and detailed analysis and description model for hospital materials management data and tasks, which is able to tackle information from patient requirements to usage, from replenishment requests to supplying and handling activities. The model takes account of medical risk reduction, traceability and streamlined processes perspectives. Second, the paper translates this information into a business process model and mathematical formalization.The study provides a useful guide to the various relevant technology‐related, management and business issues, laying the foundations of an efficient reengineering of the supply chain to reduce healthcare costs and improve the quality of care.

  12. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures.

    Science.gov (United States)

    Gili-Miner, M; López-Méndez, J; Vilches-Arenas, A; Ramírez-Ramírez, G; Franco-Fernández, D; Sala-Turrens, J; Béjar-Prado, L

    2016-10-22

    The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple casualty events.

    Science.gov (United States)

    Bayram, Jamil D; Zuabi, Shawki; Subbarao, Italo

    2011-06-01

    Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion. A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes. Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity. Defining and quantitatively benchmarking the

  14. Acceptance model of a Hospital Information System.

    Science.gov (United States)

    Handayani, P W; Hidayanto, A N; Pinem, A A; Hapsari, I C; Sandhyaduhita, P I; Budi, I

    2017-03-01

    The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0. The study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users' opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals. Based on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS. Copyright © 2016

  15. Medical Professionals Designing Hospital Management Models

    DEFF Research Database (Denmark)

    Byg, Vibeke

    Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

  16. Multiple Indicator Stationary Time Series Models.

    Science.gov (United States)

    Sivo, Stephen A.

    2001-01-01

    Discusses the propriety and practical advantages of specifying multivariate time series models in the context of structural equation modeling for time series and longitudinal panel data. For time series data, the multiple indicator model specification improves on classical time series analysis. For panel data, the multiple indicator model…

  17. Modeling Multiple Causes of Carcinogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Jones, T D

    1999-01-24

    An array of epidemiological results and databases on test animal indicate that risk of cancer and atherosclerosis can be up- or down-regulated by diet through a range of 200%. Other factors contribute incrementally and include the natural terrestrial environment and various human activities that jointly produce complex exposures to endotoxin-producing microorganisms, ionizing radiations, and chemicals. Ordinary personal habits and simple physical irritants have been demonstrated to affect the immune response and risk of disease. There tends to be poor statistical correlation of long-term risk with single agent exposures incurred throughout working careers. However, Agency recommendations for control of hazardous exposures to humans has been substance-specific instead of contextually realistic even though there is consistent evidence for common mechanisms of toxicological and carcinogenic action. That behavior seems to be best explained by molecular stresses from cellular oxygen metabolism and phagocytosis of antigenic invasion as well as breakdown of normal metabolic compounds associated with homeostatic- and injury-related renewal of cells. There is continually mounting evidence that marrow stroma, comprised largely of monocyte-macrophages and fibroblasts, is important to phagocytic and cytokinetic response, but the complex action of the immune process is difficult to infer from first-principle logic or biomarkers of toxic injury. The many diverse database studies all seem to implicate two important processes, i.e., the univalent reduction of molecular oxygen and breakdown of aginuine, an amino acid, by hydrolysis or digestion of protein which is attendant to normal antigen-antibody action. This behavior indicates that protection guidelines and risk coefficients should be context dependent to include reference considerations of the composite action of parameters that mediate oxygen metabolism. A logic of this type permits the realistic common-scale modeling of

  18. Determinants of customer satisfaction with hospitals: a managerial model.

    Science.gov (United States)

    Andaleeb, S S

    1998-01-01

    States that rapid changes in the environment have exerted significant pressures on hospitals to incorporate patient satisfaction in their strategic stance and quest for market share and long-term viability. This study proposes and tests a five-factor model that explains considerable variation in customer satisfaction with hospitals. These factors include communication with patients, competence of the staff, their demeanour, quality of the facilities, and perceived costs; they also represent strategic concepts that managers can address in their bid to remain competitive. A probability sample was selected and a multiple regression model used to test the hypotheses. The results indicate that all five variables were significant in the model and explained 62 per cent of the variation in the dependent variable. Managerial implications of the proposed model are discussed.

  19. Designing Customer Relationship Management Model in Hospital

    OpenAIRE

    Mohammad Abbaszadeh; Roohollah Askari; Morad Alizadeh; Mohammad Amin Bahrami

    2017-01-01

    Background: Customer relationship management is a modern marketing concept which is also considered as a successful business strategy. The present study aimed to design a customer relationship management model in the hospital. Methods: The study is an applied research performed in 2 phases of 1) texts investigation and 2) the experts' opinions to achieve consensus. Data were analyzed using SPSS 18 software along with descriptive statistics. Results: The designed model included areas of ...

  20. Multiplicity Control in Structural Equation Modeling

    Science.gov (United States)

    Cribbie, Robert A.

    2007-01-01

    Researchers conducting structural equation modeling analyses rarely, if ever, control for the inflated probability of Type I errors when evaluating the statistical significance of multiple parameters in a model. In this study, the Type I error control, power and true model rates of famsilywise and false discovery rate controlling procedures were…

  1. Comparative analytics of infusion pump data across multiple hospital systems.

    Science.gov (United States)

    Catlin, Ann Christine; Malloy, William X; Arthur, Karen J; Gaston, Cindy; Young, James; Fernando, Sudheera; Fernando, Ruchith

    2015-02-15

    A Web-based analytics system for conducting inhouse evaluations and cross-facility comparisons of alert data generated by smart infusion pumps is described. The Infusion Pump Informatics (IPI) project, a collaborative effort led by research scientists at Purdue University, was launched in 2009 to provide advanced analytics and tools for workflow analyses to assist hospitals in determining the significance of smart-pump alerts and reducing nuisance alerts. The IPI system allows facility-specific analyses of alert patterns and trends, as well as cross-facility comparisons of alert data uploaded by more than 55 participating institutions using different types of smart pumps. Tools accessible through the IPI portal include (1) charts displaying aggregated or breakout data on the top drugs associated with alerts, numbers of alerts per device or care area, and override-to-alert ratios, (2) investigative reports that can be used to characterize and analyze pump-programming errors in a variety of ways (e.g., by drug, by infusion type, by time of day), and (3) "drill-down" workflow analytics enabling users to evaluate alert patterns—both internally and in relation to patterns at other hospitals—in a quick and efficient stepwise fashion. The formation of the IPI analytics system to support a community of hospitals has been successful in providing sophisticated tools for member facilities to review, investigate, and efficiently analyze smart-pump alert data, not only within a member facility but also across other member facilities, to further enhance smart pump drug library design. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  2. Graphical modeling and query language for hospitals.

    Science.gov (United States)

    Barzdins, Janis; Barzdins, Juris; Rencis, Edgars; Sostaks, Agris

    2013-01-01

    So far there has been little evidence that implementation of the health information technologies (HIT) is leading to health care cost savings. One of the reasons for this lack of impact by the HIT likely lies in the complexity of the business process ownership in the hospitals. The goal of our research is to develop a business model-based method for hospital use which would allow doctors to retrieve directly the ad-hoc information from various hospital databases. We have developed a special domain-specific process modelling language called the MedMod. Formally, we define the MedMod language as a profile on UML Class diagrams, but we also demonstrate it on examples, where we explain the semantics of all its elements informally. Moreover, we have developed the Process Query Language (PQL) that is based on MedMod process definition language. The purpose of PQL is to allow a doctor querying (filtering) runtime data of hospital's processes described using MedMod. The MedMod language tries to overcome deficiencies in existing process modeling languages, allowing to specify the loosely-defined sequence of the steps to be performed in the clinical process. The main advantages of PQL are in two main areas - usability and efficiency. They are: 1) the view on data through "glasses" of familiar process, 2) the simple and easy-to-perceive means of setting filtering conditions require no more expertise than using spreadsheet applications, 3) the dynamic response to each step in construction of the complete query that shortens the learning curve greatly and reduces the error rate, and 4) the selected means of filtering and data retrieving allows to execute queries in O(n) time regarding the size of the dataset. We are about to continue developing this project with three further steps. First, we are planning to develop user-friendly graphical editors for the MedMod process modeling and query languages. The second step is to do evaluation of usability the proposed language and tool

  3. Design of Xen Hybrid Multiple Police Model

    Science.gov (United States)

    Sun, Lei; Lin, Renhao; Zhu, Xianwei

    2017-10-01

    Virtualization Technology has attracted more and more attention. As a popular open-source virtualization tools, XEN is used more and more frequently. Xsm, XEN security model, has also been widespread concern. The safety status classification has not been established in the XSM, and it uses the virtual machine as a managed object to make Dom0 a unique administrative domain that does not meet the minimum privilege. According to these questions, we design a Hybrid multiple police model named SV_HMPMD that organically integrates multiple single security policy models include DTE,RBAC,BLP. It can fullfill the requirement of confidentiality and integrity for security model and use different particle size to different domain. In order to improve BLP’s practicability, the model introduce multi-level security labels. In order to divide the privilege in detail, we combine DTE with RBAC. In order to oversize privilege, we limit the privilege of domain0.

  4. Multiple Model Approaches to Modelling and Control,

    DEFF Research Database (Denmark)

    on the ease with which prior knowledge can be incorporated. It is interesting to note that researchers in Control Theory, Neural Networks,Statistics, Artificial Intelligence and Fuzzy Logic have more or less independently developed very similar modelling methods, calling them Local ModelNetworks, Operating......, and allows direct incorporation of high-level and qualitative plant knowledge into themodel. These advantages have proven to be very appealing for industrial applications, and the practical, intuitively appealing nature of the framework isdemonstrated in chapters describing applications of local methods...... to problems in the process industries, biomedical applications and autonomoussystems. The successful application of the ideas to demanding problems is already encouraging, but creative development of the basic framework isneeded to better allow the integration of human knowledge with automated learning...

  5. Multiple model cardinalized probability hypothesis density filter

    Science.gov (United States)

    Georgescu, Ramona; Willett, Peter

    2011-09-01

    The Probability Hypothesis Density (PHD) filter propagates the first-moment approximation to the multi-target Bayesian posterior distribution while the Cardinalized PHD (CPHD) filter propagates both the posterior likelihood of (an unlabeled) target state and the posterior probability mass function of the number of targets. Extensions of the PHD filter to the multiple model (MM) framework have been published and were implemented either with a Sequential Monte Carlo or a Gaussian Mixture approach. In this work, we introduce the multiple model version of the more elaborate CPHD filter. We present the derivation of the prediction and update steps of the MMCPHD particularized for the case of two target motion models and proceed to show that in the case of a single model, the new MMCPHD equations reduce to the original CPHD equations.

  6. Predictive performance models and multiple task performance

    Science.gov (United States)

    Wickens, Christopher D.; Larish, Inge; Contorer, Aaron

    1989-01-01

    Five models that predict how performance of multiple tasks will interact in complex task scenarios are discussed. The models are shown in terms of the assumptions they make about human operator divided attention. The different assumptions about attention are then empirically validated in a multitask helicopter flight simulation. It is concluded from this simulation that the most important assumption relates to the coding of demand level of different component tasks.

  7. 29 CFR 1904.39 - Reporting fatalities and multiple hospitalization incidents to OSHA.

    Science.gov (United States)

    2010-07-01

    ... to OSHA. 1904.39 Section 1904.39 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY... fatalities and multiple hospitalization incidents to OSHA. (a) Basic requirement. Within eight (8) hours... Administration (OSHA), U.S. Department of Labor, that is nearest to the site of the incident. You may also use...

  8. Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; Dijk, L. van; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  9. Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P.P.; Francke, A.L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  10. Negotiating jurisdiction in the workplace : A multiple-case study of nurse prescribing in hospital settings

    NARCIS (Netherlands)

    Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P. P.; Francke, A. L.

    2014-01-01

    This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

  11. Model construction of nursing service satisfaction in hospitalized tumor patients.

    Science.gov (United States)

    Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

    2014-01-01

    This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients' expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved.

  12. Performance of in-hospital mortality prediction models for acute hospitalization: Hospital Standardized Mortality Ratio in Japan

    Directory of Open Access Journals (Sweden)

    Motomura Noboru

    2008-11-01

    Full Text Available Abstract Objective In-hospital mortality is an important performance measure for quality improvement, although it requires proper risk adjustment. We set out to develop in-hospital mortality prediction models for acute hospitalization using a nation-wide electronic administrative record system in Japan. Methods Administrative records of 224,207 patients (patients discharged from 82 hospitals in Japan between July 1, 2002 and October 31, 2002 were randomly split into preliminary (179,156 records and test (45,051 records groups. Study variables included Major Diagnostic Category, age, gender, ambulance use, admission status, length of hospital stay, comorbidity, and in-hospital mortality. ICD-10 codes were converted to calculate comorbidity scores based on Quan's methodology. Multivariate logistic regression analysis was then performed using in-hospital mortality as a dependent variable. C-indexes were calculated across risk groups in order to evaluate model performances. Results In-hospital mortality rates were 2.68% and 2.76% for the preliminary and test datasets, respectively. C-index values were 0.869 for the model that excluded length of stay and 0.841 for the model that included length of stay. Conclusion Risk models developed in this study included a set of variables easily accessible from administrative data, and still successfully exhibited a high degree of prediction accuracy. These models can be used to estimate in-hospital mortality rates of various diagnoses and procedures.

  13. Value increasing business model for e-hospital.

    Science.gov (United States)

    Null, Robert; Wei, June

    2009-01-01

    This paper developed a business value increasing model for electronic hospital (e-hospital) based on electronic value chain analysis. From this model, 58 hospital electronic business (e-business) solutions were developed. Additionally, this paper investigated the adoption patterns of these 58 e-business solutions within six US leading hospitals. The findings show that only 36 of 58 or 62% of the e-business solutions are fully or partially implemented within the six hospitals. Ultimately, the research results will be beneficial to managers and executives for accelerating e-business adoptions for e-hospital.

  14. Application of Multiple Evaluation Models in Brazil

    Directory of Open Access Journals (Sweden)

    Rafael Victal Saliba

    2008-07-01

    Full Text Available Based on two different samples, this article tests the performance of a number of Value Drivers commonly used for evaluating companies by finance practitioners, through simple regression models of cross-section type which estimate the parameters associated to each Value Driver, denominated Market Multiples. We are able to diagnose the behavior of several multiples in the period 1994-2004, with an outlook also on the particularities of the economic activities performed by the sample companies (and their impacts on the performance through a subsequent analysis with segregation of companies in the sample by sectors. Extrapolating simple multiples evaluation standards from analysts of the main financial institutions in Brazil, we find that adjusting the ratio formulation to allow for an intercept does not provide satisfactory results in terms of pricing errors reduction. Results found, in spite of evidencing certain relative and absolute superiority among the multiples, may not be generically representative, given samples limitation.

  15. Multiple model adaptive control with mixing

    Science.gov (United States)

    Kuipers, Matthew

    Despite the remarkable theoretical accomplishments and successful applications of adaptive control, the field is not sufficiently mature to solve challenging control problems requiring strict performance and safety guarantees. Towards addressing these issues, a novel deterministic multiple-model adaptive control approach called adaptive mixing control is proposed. In this approach, adaptation comes from a high-level system called the supervisor that mixes into feedback a number of candidate controllers, each finely-tuned to a subset of the parameter space. The mixing signal, the supervisor's output, is generated by estimating the unknown parameters and, at every instant of time, calculating the contribution level of each candidate controller based on certainty equivalence. The proposed architecture provides two characteristics relevant to solving stringent, performance-driven applications. First, the full-suite of linear time invariant control tools is available. A disadvantage of conventional adaptive control is its restriction to utilizing only those control laws whose solutions can be feasibly computed in real-time, such as model reference and pole-placement type controllers. Because its candidate controllers are computed off line, the proposed approach suffers no such restriction. Second, the supervisor's output is smooth and does not necessarily depend on explicit a priori knowledge of the disturbance model. These characteristics can lead to improved performance by avoiding the unnecessary switching and chattering behaviors associated with some other multiple adaptive control approaches. The stability and robustness properties of the adaptive scheme are analyzed. It is shown that the mean-square regulation error is of the order of the modeling error. And when the parameter estimate converges to its true value, which is guaranteed if a persistence of excitation condition is satisfied, the adaptive closed-loop system converges exponentially fast to a closed

  16. Model Pembelajaran Berbasis Penstimulasian Multiple Intelligences Siswa

    OpenAIRE

    Edy Legowo

    2017-01-01

    Tulisan ini membahas mengenai penerapan teori multiple intelligences dalam pembelajaran di sekolah. Pembahasan diawali dengan menguraikan perkembangan konsep inteligensi dan multiple intelligences. Diikuti dengan menjelaskan dampak teori multiple intelligences dalam bidang pendidikan dan pembelajaran di sekolah. Bagian selanjutnya menguraikan tentang implementasi teori multiple intelligences dalam praktik pembelajaran di kelas yaitu bagaimana pemberian pengalaman belajar siswa yang difasilita...

  17. A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis.

    Science.gov (United States)

    Xu, Duo; Zhao, Ruo-Chi; Gao, Wen-Hui; Cui, Han-Bin

    2017-04-05

    Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model. A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model. The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = -7.34 + 2.99 × [Ccr model demonstrated that a Ccr prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with

  18. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  19. Medical Professionals Designing Hospital Management Models

    OpenAIRE

    Byg, Vibeke

    2016-01-01

    Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research lit...

  20. Model Pembelajaran Berbasis Penstimulasian Multiple Intelligences Siswa

    Directory of Open Access Journals (Sweden)

    Edy Legowo

    2017-03-01

    Full Text Available Tulisan ini membahas mengenai penerapan teori multiple intelligences dalam pembelajaran di sekolah. Pembahasan diawali dengan menguraikan perkembangan konsep inteligensi dan multiple intelligences. Diikuti dengan menjelaskan dampak teori multiple intelligences dalam bidang pendidikan dan pembelajaran di sekolah. Bagian selanjutnya menguraikan tentang implementasi teori multiple intelligences dalam praktik pembelajaran di kelas yaitu bagaimana pemberian pengalaman belajar siswa yang difasilitasi guru dapat menstimulasi multiple intelligences siswa. Evaluasi hasil belajar siswa dari pandangan penerapan teori multiple intelligences seharusnya dilakukan menggunakan authentic assessment dan portofolio yang lebih memfasilitasi para siswa mengungkapkan atau mengaktualisasikan hasil belajarnya melalui berbagai cara sesuai dengan kekuatan jenis inteligensinya.

  1. Multiple Temperature Model for Near Continuum Flows

    International Nuclear Information System (INIS)

    XU, Kun; Liu, Hongwei; Jiang, Jianzheng

    2007-01-01

    In the near continuum flow regime, the flow may have different translational temperatures in different directions. It is well known that for increasingly rarefied flow fields, the predictions from continuum formulation, such as the Navier-Stokes equations, lose accuracy. These inaccuracies may be partially due to the single temperature assumption in the Navier-Stokes equations. Here, based on the gas-kinetic Bhatnagar-Gross-Krook (BGK) equation, a multitranslational temperature model is proposed and used in the flow calculations. In order to fix all three translational temperatures, two constraints are additionally proposed to model the energy exchange in different directions. Based on the multiple temperature assumption, the Navier-Stokes relation between the stress and strain is replaced by the temperature relaxation term, and the Navier-Stokes assumption is recovered only in the limiting case when the flow is close to the equilibrium with the same temperature in different directions. In order to validate the current model, both the Couette and Poiseuille flows are studied in the transition flow regime

  2. [First aid and management of multiple trauma: in-hospital trauma care].

    Science.gov (United States)

    Boschin, Matthias; Vordemvenne, Thomas

    2012-11-01

    Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

  3. Patient choice modelling: how do patients choose their hospitals?

    Science.gov (United States)

    Smith, Honora; Currie, Christine; Chaiwuttisak, Pornpimol; Kyprianou, Andreas

    2018-06-01

    As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.

  4. [The multiple social roles of female lay caretakers of hospitalized children].

    Science.gov (United States)

    Wegner, Wiliam; Pedro, Eva Neri Rubim

    2010-06-01

    This is a qualitative, descriptive, exploratory, and interventionist research carried out with nine female lay caretakers of children undergoing oncologic treatment. The objectives were to present the multiple social roles performed by female lay caretakers of children with cancer and to discuss the caretaker's role in society. The study was carried out between March and April, 2007, at Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil. The data collection was performed with the focal group technique. The results were examined through the analysis of thematic content, which evidenced the multiple social roles performed by women, the main group of caretakers in society, regardless of the context. Final considerations enhance a discussion in the educational, political and social levels about the redistribution of social roles, particularly family responsibility between men and women. The participation of the nursing staff can take place through the comprehension of those roles imposed by the context and facilitate family inclusion in the care relationship.

  5. Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

    Science.gov (United States)

    Weiner, B J; Alexander, J A

    1993-08-01

    We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

  6. A model of antibiotic-resistant bacterial epidemics in hospitals

    OpenAIRE

    Webb, Glenn F.; D'Agata, Erika M. C.; Magal, Pierre; Ruan, Shigui

    2005-01-01

    The emergence of drug-resistant strains of bacteria is an increasing threat to society, especially in hospital settings. Many antibiotics that were formerly effective in combating bacterial infections in hospital patients are no longer effective because of the evolution of resistant strains, which compromises medical care worldwide. In this article, we formulate a two-level population model to quantify key elements in nosocomial (hospital-acquired) infections. At the bacteria level, patients ...

  7. Hospital daily outpatient visits forecasting using a combinatorial model based on ARIMA and SES models.

    Science.gov (United States)

    Luo, Li; Luo, Le; Zhang, Xinli; He, Xiaoli

    2017-07-10

    Accurate forecasting of hospital outpatient visits is beneficial for the reasonable planning and allocation of healthcare resource to meet the medical demands. In terms of the multiple attributes of daily outpatient visits, such as randomness, cyclicity and trend, time series methods, ARIMA, can be a good choice for outpatient visits forecasting. On the other hand, the hospital outpatient visits are also affected by the doctors' scheduling and the effects are not pure random. Thinking about the impure specialty, this paper presents a new forecasting model that takes cyclicity and the day of the week effect into consideration. We formulate a seasonal ARIMA (SARIMA) model on a daily time series and then a single exponential smoothing (SES) model on the day of the week time series, and finally establish a combinatorial model by modifying them. The models are applied to 1 year of daily visits data of urban outpatients in two internal medicine departments of a large hospital in Chengdu, for forecasting the daily outpatient visits about 1 week ahead. The proposed model is applied to forecast the cross-sectional data for 7 consecutive days of daily outpatient visits over an 8-weeks period based on 43 weeks of observation data during 1 year. The results show that the two single traditional models and the combinatorial model are simplicity of implementation and low computational intensiveness, whilst being appropriate for short-term forecast horizons. Furthermore, the combinatorial model can capture the comprehensive features of the time series data better. Combinatorial model can achieve better prediction performance than the single model, with lower residuals variance and small mean of residual errors which needs to be optimized deeply on the next research step.

  8. Multiple Scattering Model for Optical Coherence Tomography with Rytov Approximation

    KAUST Repository

    Li, Muxingzi

    2017-01-01

    of speckles due to multiple scatterers within the coherence length, and other random noise. Motivated by the above two challenges, a multiple scattering model based on Rytov approximation and Gaussian beam optics is proposed for the OCT setup. Some previous

  9. Multiple physical signs detection and decision support system for hospitalized older adults

    International Nuclear Information System (INIS)

    Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J

    2015-01-01

    Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Smart monitoring systems automate patient monitoring tasks and thereby improve patient workflow management. Moreover, expert systems have the potential to assist clinicians and improve their performance by accurately executing repetitive tasks, to which humans are ill-suited. Clinicians working in hospital wards are responsible for conducting a multitude of tasks which require constant vigilance, and thus the need for a smart decision support system has arisen. In particular, wireless patient monitoring systems are emerging as a low cost, reliable and accurate means of healthcare delivery.Vital signs monitoring systems are rapidly becoming part of today’s healthcare delivery. The paradigm has shifted from traditional and manual recording to computer-based electronic records and, further, to handheld devices as versatile and innovative healthcare monitoring systems. The current study focuses on interpreting multiple physical signs and early warning for hospitalized older adults so that severe consequences can be minimized. Data from a total of 30 patients have been collated in New Zealand hospitals under local and national ethics approvals. The system records blood pressure, heart rate (pulse), oxygen saturation (SpO2), ear temperature and blood glucose levels from hospitalized patients and transfers this information to a web-based software application for remote monitoring and further interpretation. Ultimately, this system is aimed to achieve a high level of agreement with clinicians’ interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia to generate early warnings. The performance of the vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between

  10. Hospital distribution in a metropolitan city: assessment by a geographical information system grid modelling approach

    Directory of Open Access Journals (Sweden)

    Kwang-Soo Lee

    2014-05-01

    Full Text Available Grid models were used to assess urban hospital distribution in Seoul, the capital of South Korea. A geographical information system (GIS based analytical model was developed and applied to assess the situation in a metropolitan area with a population exceeding 10 million. Secondary data for this analysis were obtained from multiple sources: the Korean Statistical Information Service, the Korean Hospital Association and the Statistical Geographical Information System. A grid of cells measuring 1 × 1 km was superimposed on the city map and a set of variables related to population, economy, mobility and housing were identified and measured for each cell. Socio-demographic variables were included to reflect the characteristics of each area. Analytical models were then developed using GIS software with the number of hospitals as the dependent variable. Applying multiple linear regression and geographically weighted regression models, three factors (highway and major arterial road areas; number of subway entrances; and row house areas were statistically significant in explaining the variance of hospital distribution for each cell. The overall results show that GIS is a useful tool for analysing and understanding location strategies. This approach appears a useful source of information for decision-makers concerned with the distribution of hospitals and other health care centres in a city.

  11. After the Recall: Reexamining Multiple Magnet Ingestion at a Large Pediatric Hospital.

    Science.gov (United States)

    Rosenfield, Daniel; Strickland, Matt; Hepburn, Charlotte Moore

    2017-07-01

    To evaluate the effectiveness of a mandatory product recall on the frequency of multiple mini-magnet ingestion at a large tertiary pediatric hospital, and to examine the morbidity and mortality associated with these ingestions. In this retrospective chart review, we searched our institution's electronic patient record for patients aged magnetic foreign bodies between 2002 and 2015, a period that included the mandatory product recall. We compared the frequency and character of ingestions before and after the recall. Comparing the postrecall years (January 1, 2014, to December 31, 2015) with the 2 years immediately preceding the recall year (January 1, 2011, to December 31, 2012) yields an incidence rate ratio of 0.34 (95% CI, 0.18-0.64) for all magnet ingestions and 0.20 (95% CI, 0.08-0.53) for ingestion of multiple magnets. Based on the Fisher exact test, the incidence of both magnet ingestion (P magnet ingestion (P magnet ingestion decreased. There were no deaths in either study period. There was a significant decrease in multiple mini-magnet ingestion following a mandatory product recall. This study supports the effectiveness of the recall, which should bolster efforts to keep it in place in jurisdictions where it is being appealed. More broadly, the result provides general evidence of a recall helping decrease further harm from a product that carries a potential hazard. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Testing for Nonuniform Differential Item Functioning with Multiple Indicator Multiple Cause Models

    Science.gov (United States)

    Woods, Carol M.; Grimm, Kevin J.

    2011-01-01

    In extant literature, multiple indicator multiple cause (MIMIC) models have been presented for identifying items that display uniform differential item functioning (DIF) only, not nonuniform DIF. This article addresses, for apparently the first time, the use of MIMIC models for testing both uniform and nonuniform DIF with categorical indicators. A…

  13. Multiplicity distributions in the dual parton model

    International Nuclear Information System (INIS)

    Batunin, A.V.; Tolstenkov, A.N.

    1985-01-01

    Multiplicity distributions are calculated by means of a new mechanism of production of hadrons in a string, which was proposed previously by the authors and takes into account explicitly the valence character of the ends of the string. It is shown that allowance for this greatly improves the description of the low-energy multiplicity distributions. At superhigh energies, the contribution of the ends of the strings becomes negligibly small, but in this case multi-Pomeron contributions must be taken into account

  14. Optimization Model for Capacity Management and Bed Scheduling for Hospital

    Science.gov (United States)

    Sitepu, Suryati; Mawengkang, Herman; Husein, Ismail

    2018-01-01

    Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing.. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

  15. A partial test of a hospital behavioral model.

    Science.gov (United States)

    Hornbrook, M C; Goldfarb, M G

    1983-01-01

    The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these

  16. Evolving Four Part Harmony Using a Multiple Worlds Model

    DEFF Research Database (Denmark)

    Scirea, Marco; Brown, Joseph Alexander

    2015-01-01

    This application of the Multiple Worlds Model examines a collaborative fitness model for generating four part harmonies. In this model we have multiple populations and the fitness of the individuals is based on the ability of a member from each population to work with the members of other...

  17. Explaining clinical behaviors using multiple theoretical models

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-10-01

    the five surveys. For the predictor variables, the mean construct scores were above the mid-point on the scale with median values across the five behaviors generally being above four out of seven and the range being from 1.53 to 6.01. Across all of the theories, the highest proportion of the variance explained was always for intention and the lowest was for behavior. The Knowledge-Attitudes-Behavior Model performed poorly across all behaviors and dependent variables; CSSRM also performed poorly. For TPB, SCT, II, and LT across the five behaviors, we predicted median R2 of 25% to 42.6% for intention, 6.2% to 16% for behavioral simulation, and 2.4% to 6.3% for behavior. Conclusions We operationalized multiple theories measuring across five behaviors. Continuing challenges that emerge from our work are: better specification of behaviors, better operationalization of theories; how best to appropriately extend the range of theories; further assessment of the value of theories in different settings and groups; exploring the implications of these methods for the management of chronic diseases; and moving to experimental designs to allow an understanding of behavior change.

  18. Explaining clinical behaviors using multiple theoretical models.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; MacLennan, Graeme; Bonetti, Debbie; Glidewell, Liz; Pitts, Nigel B; Steen, Nick; Thomas, Ruth; Walker, Anne; Johnston, Marie

    2012-10-17

    , the mean construct scores were above the mid-point on the scale with median values across the five behaviors generally being above four out of seven and the range being from 1.53 to 6.01. Across all of the theories, the highest proportion of the variance explained was always for intention and the lowest was for behavior. The Knowledge-Attitudes-Behavior Model performed poorly across all behaviors and dependent variables; CSSRM also performed poorly. For TPB, SCT, II, and LT across the five behaviors, we predicted median R2 of 25% to 42.6% for intention, 6.2% to 16% for behavioral simulation, and 2.4% to 6.3% for behavior. We operationalized multiple theories measuring across five behaviors. Continuing challenges that emerge from our work are: better specification of behaviors, better operationalization of theories; how best to appropriately extend the range of theories; further assessment of the value of theories in different settings and groups; exploring the implications of these methods for the management of chronic diseases; and moving to experimental designs to allow an understanding of behavior change.

  19. Modelling length of hospital stay in motor victims

    Directory of Open Access Journals (Sweden)

    Mercedes Ayuso-Gutiérrez

    2015-03-01

    Full Text Available Objective. To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. Materials and methods. In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. Results. Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. Conclusions. Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

  20. Integration of multiple, excess, backup, and expected covering models

    OpenAIRE

    M S Daskin; K Hogan; C ReVelle

    1988-01-01

    The concepts of multiple, excess, backup, and expected coverage are defined. Model formulations using these constructs are reviewed and contrasted to illustrate the relationships between them. Several new formulations are presented as is a new derivation of the expected covering model which indicates more clearly the relationship of the model to other multi-state covering models. An expected covering model with multiple time standards is also presented.

  1. Using a modified technology acceptance model in hospitals.

    Science.gov (United States)

    Aggelidis, Vassilios P; Chatzoglou, Prodromos D

    2009-02-01

    The use of information technology in the health care sector and especially in hospitals offers great potential for improving the quality of services provided and the efficiency and effectiveness of the personnel, but also for reducing the organizational expenses. However, the main question that arises according to the literature is whether hospital personnel are willing to use state of the art information technology while performing their tasks. This study attempts to address this issue by developing and testing a modified technology acceptance model taking into consideration other relevant models found in the literature. The original TAM has been extended to include some exogenous variables in order to examine HIS acceptance by Greek hospital personnel. Correlation, explanatory and confirmation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique has also been used to evaluate the causal model. The results indicate that perceived usefulness, ease of use, social influence, attitude, facilitating conditions and self-efficacy significantly affect hospital personnel behavioral intention. Training has a strong indirect impact on behavioral intention through the mediators of facilitating condition and ease of use. Furthermore, the existence of significant positive effects between self-efficacy and social influence, perceived usefulness and anxiety, and facilitating conditions and social influence is also supported. The proposed model can explain 87% of the variance of behavioral intention indicating that the core constructs of the technology acceptance models have a strong and statistically significant influence on hospital personnel usage intention.

  2. The epidemiology of multiple sclerosis in Scotland: inferences from hospital admissions.

    Directory of Open Access Journals (Sweden)

    Adam E Handel

    2011-01-01

    Full Text Available Multiple sclerosis (MS is a neurological disorder with a highly characteristic disease distribution. Prevalence and incidence in general increase with increasing distance from the equator. Similarly the female to male sex ratio increases with increasing latitude. Multiple possible risk factors have been hypothesised for this epidemiological trend, including human leukocyte antigen allele frequencies, ultraviolet exposure and subsequent vitamin D levels, smoking and Epstein-Barr virus. In this study we undertook a study of medical records across Scotland on an NHS health board level of resolution to examine the epidemiology of MS in this region.We calculated the number and rate of patient-linked hospital admissions throughout Scotland between 1997 and 2009 from the Scottish Morbidity Records. We used weighted-regression to examine correlations between these measures of MS, and latitude and smoking prevalence. We found a highly significant relationship between MS patient-linked admissions and latitude (r weighted by standard error (r(sw = 0.75, p = 0.002. There was no significant relationship between smoking prevalence and MS patient-linked admissions.There is a definite latitudinal effect on MS risk across Scotland, arising primarily from an excess of female MS patients at more Northerly latitudes. Whether this is a true gradient or whether a threshold effect may apply at particular latitude will be revealed only by further research. A number of genetic and environmental factors may underlie this effect.

  3. Hospital-based expert model for health technology procurement planning in hospitals.

    Science.gov (United States)

    Miniati, R; Cecconi, G; Frosini, F; Dori, F; Regolini, J; Iadanza, E; Biffi Gentili, G

    2014-01-01

    Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.

  4. Work ability among hospital food service professionals: multiple associated variables require comprehensive intervention.

    Science.gov (United States)

    Fischer, Frida Marina; Martinez, Maria Carmen

    2012-01-01

    The work of hospital food service is characterized by demands that can be associated with work ability--WA. The aim of this study was to evaluate factors associated with WA among hospital food service professionals and recommend intervention measures. This is a cross sectional study carried out in 2009, conducted in a hospital of São Paulo, Brazil. Participants were 76 (96.2%) of the eligible. They filled out a questionnaire including socio-demographic data, life styles, working conditions and WA. Multivariate linear regression analyses were performed. Factors associated with WA were age (p = 0.051), over commitment (p = 0.011), effort-reward ratio (p = 0.002) and work injuries (p work injuries is consistent with the theoretical model that demonstrated that health status is the basis to maintain the WA. The association of effort-reward imbalance shows that issues related with work organization are relevant for these workers. The association of overcommittment suggests that workers recognize their responsibility with the therapeutic processes of patients. Results showed a number of features of different nature that should be taken into account when implementing measures to improve the WA, to be applied at different levels: individual, task and institutional.

  5. Establishing a Cloud Computing Success Model for Hospitals in Taiwan

    OpenAIRE

    Lian, Jiunn-Woei

    2017-01-01

    The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality...

  6. A test for the parameters of multiple linear regression models ...

    African Journals Online (AJOL)

    A test for the parameters of multiple linear regression models is developed for conducting tests simultaneously on all the parameters of multiple linear regression models. The test is robust relative to the assumptions of homogeneity of variances and absence of serial correlation of the classical F-test. Under certain null and ...

  7. [Hospital organizational analysis based on the Mintzberg model: the case of Sheikh Zayed Hospital, Rabat].

    Science.gov (United States)

    Makhloufi, Imane; Saadi, Janad; El Hiki, Lahcen; El Hassani, Amine

    2012-01-01

    The new system of hospital governance requires health institutions to develop new managerial, financial and social skills beyond their public service duties. As part of this new approach, the organizational modernization of hospitals involves introducing good management practices. However, managing the transition requires taking into account the specificities of existing organizational systems. Organizational systems are generally difficult to model and involve diverse and sometimes competing interests, concerns, habits, languages, cultures, tools and representations. This explains the high failure rate observed in hospital development projects at an organizational level. A number of organizational theories from a range of disciplines (sociology, biology, history, etc.) have examined the question of organization in hospitals. The many theories developed in this area are not incompatible. Rather, they form a set of useful tools for the analysis of organizational management. The purpose of this study was to conduct an organizational analysis of Sheikh Zayed Hospital (Rabat) based on the Mintzberg model as a prerequisite for the development and implementation of a restructuring plan.

  8. Improving Safe Sleep Modeling in the Hospital through Policy Implementation.

    Science.gov (United States)

    Heitmann, Rachel; Nilles, Ester K; Jeans, Ashley; Moreland, Jackie; Clarke, Chris; McDonald, Morgan F; Warren, Michael D

    2017-11-01

    Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.

  9. Rural model dedicated education unit: partnership between college and hospital.

    Science.gov (United States)

    Harmon, Lisa M

    2013-02-01

    This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

  10. Medicare capitation model, functional status, and multiple comorbidities: model accuracy

    Science.gov (United States)

    Noyes, Katia; Liu, Hangsheng; Temkin-Greener, Helena

    2012-01-01

    Objective This study examined financial implications of CMS-Hierarchical Condition Categories (HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. Study Design The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims. The pairs of comorbidities were formed based on the prior evidence about possible synergy between these conditions and activities of daily living (ADL) deficiencies and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, CHF and dementia. Methods For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual’s annualized costs to the mean annual Medicare cost of all people in the study. The actual Medicare cost ratios, by ADLs, were compared to the HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affects the accuracy of CMS-HCC model predictions. Results The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, congestive heart failure and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less than optimal adjustment for these chronic conditions. Conclusions Information about beneficiary functional status should be incorporated in reimbursement models since underpaying providers for caring for population with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions. PMID:18837646

  11. Multiple Scenario Generation of Subsurface Models

    DEFF Research Database (Denmark)

    Cordua, Knud Skou

    of information is obeyed such that no unknown assumptions and biases influence the solution to the inverse problem. This involves a definition of the probabilistically formulated inverse problem, a discussion about how prior models can be established based on statistical information from sample models...... of the probabilistic formulation of the inverse problem. This function is based on an uncertainty model that describes the uncertainties related to the observed data. In a similar way, a formulation of the prior probability distribution that takes into account uncertainties related to the sample model statistics...... similar to observation uncertainties. We refer to the effect of these approximations as modeling errors. Examples that show how the modeling error is estimated are provided. Moreover, it is shown how these effects can be taken into account in the formulation of the posterior probability distribution...

  12. Multiple system modelling of waste management

    International Nuclear Information System (INIS)

    Eriksson, Ola; Bisaillon, Mattias

    2011-01-01

    Highlights: → Linking of models will provide a more complete, correct and credible picture of the systems. → The linking procedure is easy to perform and also leads to activation of project partners. → The simulation procedure is a bit more complicated and calls for the ability to run both models. - Abstract: Due to increased environmental awareness, planning and performance of waste management has become more and more complex. Therefore waste management has early been subject to different types of modelling. Another field with long experience of modelling and systems perspective is energy systems. The two modelling traditions have developed side by side, but so far there are very few attempts to combine them. Waste management systems can be linked together with energy systems through incineration plants. The models for waste management can be modelled on a quite detailed level whereas surrounding systems are modelled in a more simplistic way. This is a problem, as previous studies have shown that assumptions on the surrounding system often tend to be important for the conclusions. In this paper it is shown how two models, one for the district heating system (MARTES) and another one for the waste management system (ORWARE), can be linked together. The strengths and weaknesses with model linking are discussed when compared to simplistic assumptions on effects in the energy and waste management systems. It is concluded that the linking of models will provide a more complete, correct and credible picture of the consequences of different simultaneous changes in the systems. The linking procedure is easy to perform and also leads to activation of project partners. However, the simulation procedure is a bit more complicated and calls for the ability to run both models.

  13. Mean multiplicity in the Regge models with rising cross sections

    International Nuclear Information System (INIS)

    Chikovani, Z.E.; Kobylisky, N.A.; Martynov, E.S.

    1979-01-01

    Behaviour of the mean multiplicity and the total cross section σsub(t) of hadron-hadron interactions is considered in the framework of the Regge models at high energies. Generating function was plotted for models of dipole and froissaron, and the mean multiplicity and multiplicity moments were calculated. It is shown that approximately ln 2 S (energy square) in the dipole model, which is in good agreement with the experiment. It is also found that in various Regge models approximately σsub(t)lnS

  14. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  15. Discrete choice models with multiplicative error terms

    DEFF Research Database (Denmark)

    Fosgerau, Mogens; Bierlaire, Michel

    2009-01-01

    The conditional indirect utility of many random utility maximization (RUM) discrete choice models is specified as a sum of an index V depending on observables and an independent random term ε. In general, the universe of RUM consistent models is much larger, even fixing some specification of V due...

  16. Structural model analysis of multiple quantitative traits.

    Directory of Open Access Journals (Sweden)

    Renhua Li

    2006-07-01

    Full Text Available We introduce a method for the analysis of multilocus, multitrait genetic data that provides an intuitive and precise characterization of genetic architecture. We show that it is possible to infer the magnitude and direction of causal relationships among multiple correlated phenotypes and illustrate the technique using body composition and bone density data from mouse intercross populations. Using these techniques we are able to distinguish genetic loci that affect adiposity from those that affect overall body size and thus reveal a shortcoming of standardized measures such as body mass index that are widely used in obesity research. The identification of causal networks sheds light on the nature of genetic heterogeneity and pleiotropy in complex genetic systems.

  17. Multiple-lesion track-structure model

    International Nuclear Information System (INIS)

    Wilson, J.W.; Cucinotta, F.A.; Shinn, J.L.

    1992-03-01

    A multilesion cell kinetic model is derived, and radiation kinetic coefficients are related to the Katz track structure model. The repair-related coefficients are determined from the delayed plating experiments of Yang et al. for the C3H10T1/2 cell system. The model agrees well with the x ray and heavy ion experiments of Yang et al. for the immediate plating, delaying plating, and fractionated exposure protocols employed by Yang. A study is made of the effects of target fragments in energetic proton exposures and of the repair-deficient target-fragment-induced lesions

  18. Multiplicative surrogate standard deviation: a group metric for the glycemic variability of individual hospitalized patients.

    Science.gov (United States)

    Braithwaite, Susan S; Umpierrez, Guillermo E; Chase, J Geoffrey

    2013-09-01

    Group metrics are described to quantify blood glucose (BG) variability of hospitalized patients. The "multiplicative surrogate standard deviation" (MSSD) is the reverse-transformed group mean of the standard deviations (SDs) of the logarithmically transformed BG data set of each patient. The "geometric group mean" (GGM) is the reverse-transformed group mean of the means of the logarithmically transformed BG data set of each patient. Before reverse transformation is performed, the mean of means and mean of SDs each has its own SD, which becomes a multiplicative standard deviation (MSD) after reverse transformation. Statistical predictions and comparisons of parametric or nonparametric tests remain valid after reverse transformation. A subset of a previously published BG data set of 20 critically ill patients from the first 72 h of treatment under the SPRINT protocol was transformed logarithmically. After rank ordering according to the SD of the logarithmically transformed BG data of each patient, the cohort was divided into two equal groups, those having lower or higher variability. For the entire cohort, the GGM was 106 (÷/× 1.07) mg/dl, and MSSD was 1.24 (÷/× 1.07). For the subgroups having lower and higher variability, respectively, the GGM did not differ, 104 (÷/× 1.07) versus 109 (÷/× 1.07) mg/dl, but the MSSD differed, 1.17 (÷/× 1.03) versus 1.31 (÷/× 1.05), p = .00004. By using the MSSD with its MSD, groups can be characterized and compared according to glycemic variability of individual patient members. © 2013 Diabetes Technology Society.

  19. Affine LIBOR Models with Multiple Curves

    DEFF Research Database (Denmark)

    Grbac, Zorana; Papapantoleon, Antonis; Schoenmakers, John

    2015-01-01

    are specified following the methodology of the affine LIBOR models and are driven by the wide and flexible class of affine processes. The affine property is preserved under forward measures, which allows us to derive Fourier pricing formulas for caps, swaptions, and basis swaptions. A model specification...... with dependent LIBOR rates is developed that allows for an efficient and accurate calibration to a system of caplet prices....

  20. SDG and qualitative trend based model multiple scale validation

    Science.gov (United States)

    Gao, Dong; Xu, Xin; Yin, Jianjin; Zhang, Hongyu; Zhang, Beike

    2017-09-01

    Verification, Validation and Accreditation (VV&A) is key technology of simulation and modelling. For the traditional model validation methods, the completeness is weak; it is carried out in one scale; it depends on human experience. The SDG (Signed Directed Graph) and qualitative trend based multiple scale validation is proposed. First the SDG model is built and qualitative trends are added to the model. And then complete testing scenarios are produced by positive inference. The multiple scale validation is carried out by comparing the testing scenarios with outputs of simulation model in different scales. Finally, the effectiveness is proved by carrying out validation for a reactor model.

  1. Modelling of rate effects at multiple scales

    DEFF Research Database (Denmark)

    Pedersen, R.R.; Simone, A.; Sluys, L. J.

    2008-01-01

    , the length scale in the meso-model and the macro-model can be coupled. In this fashion, a bridging of length scales can be established. A computational analysis of  a Split Hopkinson bar test at medium and high impact load is carried out at macro-scale and meso-scale including information from  the micro-scale.......At the macro- and meso-scales a rate dependent constitutive model is used in which visco-elasticity is coupled to visco-plasticity and damage. A viscous length scale effect is introduced to control the size of the fracture process zone. By comparison of the widths of the fracture process zone...

  2. Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

    2018-01-01

    . CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...

  3. Establishing a Cloud Computing Success Model for Hospitals in Taiwan

    Science.gov (United States)

    Lian, Jiunn-Woei

    2017-01-01

    The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services. PMID:28112020

  4. Establishing a Cloud Computing Success Model for Hospitals in Taiwan.

    Science.gov (United States)

    Lian, Jiunn-Woei

    2017-01-01

    The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

  5. Establishing a Cloud Computing Success Model for Hospitals in Taiwan

    Directory of Open Access Journals (Sweden)

    Jiunn-Woei Lian PhD

    2017-01-01

    Full Text Available The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

  6. New experimental model of multiple myeloma.

    Science.gov (United States)

    Telegin, G B; Kalinina, A R; Ponomarenko, N A; Ovsepyan, A A; Smirnov, S V; Tsybenko, V V; Homeriki, S G

    2001-06-01

    NSO/1 (P3x63Ay 8Ut) and SP20 myeloma cells were inoculated to BALB/c OlaHsd mice. NSO/1 cells allowed adequate stage-by-stage monitoring of tumor development. The adequacy of this model was confirmed in experiments with conventional cytostatics: prospidium and cytarabine caused necrosis of tumor cells and reduced animal mortality.

  7. Animal model of human disease. Multiple myeloma

    NARCIS (Netherlands)

    Radl, J.; Croese, J.W.; Zurcher, C.; Enden-Vieveen, M.H.M. van den; Leeuw, A.M. de

    1988-01-01

    Animal models of spontaneous and induced plasmacytomas in some inbred strains of mice have proven to be useful tools for different studies on tumorigenesis and immunoregulation. Their wide applicability and the fact that after their intravenous transplantation, the recipient mice developed bone

  8. Multiple Social Networks, Data Models and Measures for

    DEFF Research Database (Denmark)

    Magnani, Matteo; Rossi, Luca

    2017-01-01

    Multiple Social Network Analysis is a discipline defining models, measures, methodologies, and algorithms to study multiple social networks together as a single social system. It is particularly valuable when the networks are interconnected, e.g., the same actors are present in more than one...

  9. Modeling Rabbit Responses to Single and Multiple Aerosol ...

    Science.gov (United States)

    Journal Article Survival models are developed here to predict response and time-to-response for mortality in rabbits following exposures to single or multiple aerosol doses of Bacillus anthracis spores. Hazard function models were developed for a multiple dose dataset to predict the probability of death through specifying dose-response functions and the time between exposure and the time-to-death (TTD). Among the models developed, the best-fitting survival model (baseline model) has an exponential dose-response model with a Weibull TTD distribution. Alternative models assessed employ different underlying dose-response functions and use the assumption that, in a multiple dose scenario, earlier doses affect the hazard functions of each subsequent dose. In addition, published mechanistic models are analyzed and compared with models developed in this paper. None of the alternative models that were assessed provided a statistically significant improvement in fit over the baseline model. The general approach utilizes simple empirical data analysis to develop parsimonious models with limited reliance on mechanistic assumptions. The baseline model predicts TTDs consistent with reported results from three independent high-dose rabbit datasets. More accurate survival models depend upon future development of dose-response datasets specifically designed to assess potential multiple dose effects on response and time-to-response. The process used in this paper to dev

  10. Explaining clinical behaviors using multiple theoretical models

    OpenAIRE

    Eccles, Martin P; Grimshaw, Jeremy M; MacLennan, Graeme; Bonetti, Debbie; Glidewell, Liz; Pitts, Nigel B; Steen, Nick; Thomas, Ruth; Walker, Anne; Johnston, Marie

    2012-01-01

    Abstract Background In the field of implementation research, there is an increased interest in use of theory when designing implementation research studies involving behavior change. In 2003, we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different, commonly used, overlapping behavioral theories and models. We reflect on the strengths and weaknesses of...

  11. Airport choice model in multiple airport regions

    Directory of Open Access Journals (Sweden)

    Claudia Muñoz

    2017-02-01

    Full Text Available Purpose: This study aims to analyze travel choices made by air transportation users in multi airport regions because it is a crucial component when planning passenger redistribution policies. The purpose of this study is to find a utility function which makes it possible to know the variables that influence users’ choice of the airports on routes to the main cities in the Colombian territory. Design/methodology/approach: This research generates a Multinomial Logit Model (MNL, which is based on the theory of maximizing utility, and it is based on the data obtained on revealed and stated preference surveys applied to users who reside in the metropolitan area of Aburrá Valley (Colombia. This zone is the only one in the Colombian territory which has two neighboring airports for domestic flights. The airports included in the modeling process were Enrique Olaya Herrera (EOH Airport and José María Córdova (JMC Airport. Several structure models were tested, and the MNL proved to be the most significant revealing the common variables that affect passenger airport choice include the airfare, the price to travel the airport, and the time to get to the airport. Findings and Originality/value: The airport choice model which was calibrated corresponds to a valid powerful tool used to calculate the probability of each analyzed airport of being chosen for domestic flights in the Colombian territory. This is done bearing in mind specific characteristic of each of the attributes contained in the utility function. In addition, these probabilities will be used to calculate future market shares of the two airports considered in this study, and this will be done generating a support tool for airport and airline marketing policies.

  12. Multiple simultaneous event model for radiation carcinogenesis

    International Nuclear Information System (INIS)

    Baum, J.W.

    1976-01-01

    A mathematical model is proposed which postulates that cancer induction is a multi-event process, that these events occur naturally, usually one at a time in any cell, and that radiation frequently causes two of these events to occur simultaneously. Microdosimetric considerations dictate that for high LET radiations the simultaneous events are associated with a single particle or track. The model predicts: (a) linear dose-effect relations for early times after irradiation with small doses, (b) approximate power functions of dose (i.e. Dsup(x)) having exponent less than one for populations of mixed age examined at short times after irradiation with small doses, (c) saturation of effect at either long times after irradiation with small doses or for all times after irradiation with large doses, and (d) a net increase in incidence which is dependent on age of observation but independent of age at irradiation. Data of Vogel, for neutron induced mammary tumors in rats, are used to illustrate the validity of the formulation. This model provides a quantitative framework to explain several unexpected results obtained by Vogel. It also provides a logical framework to explain the dose-effect relations observed in the Japanese survivors of the atomic bombs. (author)

  13. Mathematical modelling : a tool for hospital infection control

    NARCIS (Netherlands)

    Grundmann, H; Hellriegel, B

    Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

  14. Mathematical modelling: a tool for hospital infection control

    NARCIS (Netherlands)

    Grundmann, Hajo; Hellriegel, B.

    2006-01-01

    Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

  15. Mathematical modelling: a tool for hospital infection control.

    NARCIS (Netherlands)

    Grundmann, Hajo; Hellriegel, B

    2006-01-01

    Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

  16. Change management in Iranian hospitals: social factors model

    Directory of Open Access Journals (Sweden)

    B. Delgoshaei

    2012-02-01

    Full Text Available Background: Continuous change in the complex health care environments is a major challenge for administrative managers. This study aimed to design a change model to facilitate change implementation in the Iranian hospitals. Methods: This is a descriptive and comparative study. The data were collected through library search and in-depth interview with 15 hospital managers. Nine well-established change theories developed by Lewin, Action Research, Kotter, Ackerman- Anderson and Anderson, Prosci , Kilman, Beer, Continuum, and Gelicher were compared. Common denominators of the theories were identified and tabulated. Experienced hospital managers’ suggestions about social factors were acquired. The initial model was designed and validated using the Delphi Technique. Results: The majority of the selected change models emphasize the significance of social factors in change implementation such as effective communication, organizational climate and culture, and leadership. The results from the interviews indicate that low readiness to change, lack of confidence (or trust for change, and autocratic leadership style ,and poor communication could hinder the change process. Conclusion: Based on the model developed in the study, effective communication, readiness of employees, and a contingency leadership/management combined could lead to successful implementation of change in the hospital.

  17. Multiple Imputation of Predictor Variables Using Generalized Additive Models

    NARCIS (Netherlands)

    de Jong, Roel; van Buuren, Stef; Spiess, Martin

    2016-01-01

    The sensitivity of multiple imputation methods to deviations from their distributional assumptions is investigated using simulations, where the parameters of scientific interest are the coefficients of a linear regression model, and values in predictor variables are missing at random. The

  18. AN EFFICIENT PATIENT INFLOW PREDICTION MODEL FOR HOSPITAL RESOURCE MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Kottalanka Srikanth

    2017-07-01

    Full Text Available There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.

  19. A financial planning model for estimating hospital debt capacity.

    Science.gov (United States)

    Hopkins, D S; Heath, D; Levin, P J

    1982-01-01

    A computer-based financial planning model was formulated to measure the impact of a major capital improvement project on the fiscal health of Stanford University Hospital. The model had to be responsive to many variables and easy to use, so as to allow for the testing of numerous alternatives. Special efforts were made to identify the key variables that needed to be presented in the model and to include all known links between capital investment, debt, and hospital operating expenses. Growth in the number of patient days of care was singled out as a major source of uncertainty that would have profound effects on the hospital's finances. Therefore this variable was subjected to special scrutiny in terms of efforts to gauge expected demographic trends and market forces. In addition, alternative base runs of the model were made under three distinct patient-demand assumptions. Use of the model enabled planners at the Stanford University Hospital (a) to determine that a proposed modernization plan was financially feasible under a reasonable (that is, not unduly optimistic) set of assumptions and (b) to examine the major sources of risk. Other than patient demand, these sources were found to be gross revenues per patient, operating costs, and future limitations on government reimbursement programs. When the likely financial consequences of these risks were estimated, both separately and in combination, it was determined that even if two or more assumptions took a somewhat more negative turn than was expected, the hospital would be able to offset adverse consequences by a relatively minor reduction in operating costs. PMID:7111658

  20. Modeling interdependencies between business and communication processes in hospitals.

    Science.gov (United States)

    Brigl, Birgit; Wendt, Thomas; Winter, Alfred

    2003-01-01

    The optimization and redesign of business processes in hospitals is an important challenge for the hospital information management who has to design and implement a suitable HIS architecture. Nevertheless, there are no tools available specializing in modeling information-driven business processes and the consequences on the communication between information processing, tools. Therefore, we will present an approach which facilitates the representation and analysis of business processes and resulting communication processes between application components and their interdependencies. This approach aims not only to visualize those processes, but to also to evaluate if there are weaknesses concerning the information processing infrastructure which hinder the smooth implementation of the business processes.

  1. Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI.

    Science.gov (United States)

    van Heesch, M M J; Evers, J L H; van der Hoeven, M A H B M; Dumoulin, J C M; van Beijsterveldt, C E M; Bonsel, G J; Dykgraaf, R H M; van Goudoever, J B; Koopman-Esseboom, C; Nelen, W L D M; Steiner, K; Tamminga, P; Tonch, N; Torrance, H L; Dirksen, C D

    2015-06-01

    Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5? Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable. Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birthweight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life. All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate- or high-risk). To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons. The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to €10 018 and €2093 during the birth admission period (P IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings

  2. Entrepreneurial intention modeling using hierarchical multiple regression

    Directory of Open Access Journals (Sweden)

    Marina Jeger

    2014-12-01

    Full Text Available The goal of this study is to identify the contribution of effectuation dimensions to the predictive power of the entrepreneurial intention model over and above that which can be accounted for by other predictors selected and confirmed in previous studies. As is often the case in social and behavioral studies, some variables are likely to be highly correlated with each other. Therefore, the relative amount of variance in the criterion variable explained by each of the predictors depends on several factors such as the order of variable entry and sample specifics. The results show the modest predictive power of two dimensions of effectuation prior to the introduction of the theory of planned behavior elements. The article highlights the main advantages of applying hierarchical regression in social sciences as well as in the specific context of entrepreneurial intention formation, and addresses some of the potential pitfalls that this type of analysis entails.

  3. Assessment of private hospital portals: A conceptual model

    Directory of Open Access Journals (Sweden)

    Mehdi Alipour-Hafezi

    2016-01-01

    Full Text Available Introduction: Hospital portals, as the first virtual entry, play an important role in connecting people with hospital and also presenting hospital virtual services. The main purpose of this article was to suggest a conceptual model to improve Tehran private hospital portals. The suggested model can be used by all the health portals that are in the same circumstances and all the health portals which are in progress. Method: This is a practical research, using evaluative survey research method. Research population includes all the private hospital portals in Tehran, 34 portals, and ten top international hospital portals. Data gathering tool used in this research was a researcher-made checklist including 14 criteria and 77 sub-criteria with their weight score. In fact, objective observation with the mentioned checklist was used to gather information. Descriptive statistics were used to analyze the data and tables and graphs were used to present the organized data. Also, data were analyzed using independent t-test. Conceptual modeling technique was used to design the model and demonstration method was used to evaluate the proposed model. In this regard, SPSS statistical software was used to perform the tests. Results:The comparative study between the two groups of portals, TPH and WTH, in the 14 main criteria showed that the value of t-test in contact information criteria was 0.862, portal page specification was -1.378, page design criteria -1.527, updating pages -0.322, general information and access roads -3.161, public services -7.302, patient services -4.154, patient data -8.703, research and education -9.155, public relationship -3.009, page technical specifications -4.726, telemedicine -7.488, pharmaceutical services -6.183, and financial services -2.782. Finally, the findings demonstrated that Tehran private hospital portals in criterion of contact information were favorable; page design criteria were relatively favorable; page technical

  4. Multiple Time Series Ising Model for Financial Market Simulations

    International Nuclear Information System (INIS)

    Takaishi, Tetsuya

    2015-01-01

    In this paper we propose an Ising model which simulates multiple financial time series. Our model introduces the interaction which couples to spins of other systems. Simulations from our model show that time series exhibit the volatility clustering that is often observed in the real financial markets. Furthermore we also find non-zero cross correlations between the volatilities from our model. Thus our model can simulate stock markets where volatilities of stocks are mutually correlated

  5. Hospital information system: reusability, designing, modelling, recommendations for implementing.

    Science.gov (United States)

    Huet, B

    1998-01-01

    The aims of this paper are to precise some essential conditions for building reuse models for hospital information systems (HIS) and to present an application for hospital clinical laboratories. Reusability is a general trend in software, however reuse can involve a more or less part of design, classes, programs; consequently, a project involving reusability must be precisely defined. In the introduction it is seen trends in software, the stakes of reuse models for HIS and the special use case constituted with a HIS. The main three parts of this paper are: 1) Designing a reuse model (which objects are common to several information systems?) 2) A reuse model for hospital clinical laboratories (a genspec object model is presented for all laboratories: biochemistry, bacteriology, parasitology, pharmacology, ...) 3) Recommendations for generating plug-compatible software components (a reuse model can be implemented as a framework, concrete factors that increase reusability are presented). In conclusion reusability is a subtle exercise of which project must be previously and carefully defined.

  6. Queueing network model for obstetric patient flow in a hospital.

    Science.gov (United States)

    Takagi, Hideaki; Kanai, Yuta; Misue, Kazuo

    2016-03-03

    A queueing network is used to model the flow of patients in a hospital using the observed admission rate of patients and the histogram for the length of stay for patients in each ward. A complete log of orders for every movement of all patients from room to room covering two years was provided to us by the Medical Information Department of the University of Tsukuba Hospital in Japan. We focused on obstetric patients, who are generally hospitalized at random times throughout the year, and we analyzed the patient flow probabilistically. On admission, each obstetric patient is assigned to a bed in one of the two wards: one for normal delivery and the other for high-risk delivery. Then, the patient may be transferred between the two wards before discharge. We confirm Little's law of queueing theory for the patient flow in each ward. Next, we propose a new network model of M/G/ ∞ and M/M/ m queues to represent the flow of these patients, which is used to predict the probability distribution for the number of patients staying in each ward at the nightly census time. Although our model is a very rough and simplistic approximation of the real patient flow, the predicted probability distribution shows good agreement with the observed data. The proposed method can be used for capacity planning of hospital wards to predict future patient load in each ward.

  7. Bilevel Fuzzy Chance Constrained Hospital Outpatient Appointment Scheduling Model

    Directory of Open Access Journals (Sweden)

    Xiaoyang Zhou

    2016-01-01

    Full Text Available Hospital outpatient departments operate by selling fixed period appointments for different treatments. The challenge being faced is to improve profit by determining the mix of full time and part time doctors and allocating appointments (which involves scheduling a combination of doctors, patients, and treatments to a time period in a department optimally. In this paper, a bilevel fuzzy chance constrained model is developed to solve the hospital outpatient appointment scheduling problem based on revenue management. In the model, the hospital, the leader in the hierarchy, decides the mix of the hired full time and part time doctors to maximize the total profit; each department, the follower in the hierarchy, makes the decision of the appointment scheduling to maximize its own profit while simultaneously minimizing surplus capacity. Doctor wage and demand are considered as fuzzy variables to better describe the real-life situation. Then we use chance operator to handle the model with fuzzy parameters and equivalently transform the appointment scheduling model into a crisp model. Moreover, interactive algorithm based on satisfaction is employed to convert the bilevel programming into a single level programming, in order to make it solvable. Finally, the numerical experiments were executed to demonstrate the efficiency and effectiveness of the proposed approaches.

  8. Correlations in multiple production on nuclei and Glauber model of multiple scattering

    International Nuclear Information System (INIS)

    Zoller, V.R.; Nikolaev, N.N.

    1982-01-01

    Critical analysis of possibility for describing correlation phenomena during multiple production on nuclei within the framework of the Glauber multiple seattering model generalized for particle production processes with Capella, Krziwinski and Shabelsky has been performed. It was mainly concluded that the suggested generalization of the Glauber model gives dependences on Ng(Np) (where Ng-the number of ''grey'' tracess, and Np-the number of protons flying out of nucleus) and, eventually, on #betta# (where #betta#-the number of intranuclear interactions) contradicting experience. Independent of choice of relation between #betta# and Ng(Np) in the model the rapidity corrletor Rsub(eta) is overstated in the central region and understated in the region of nucleus fragmentation. In mean multiplicities these two contradictions of experience are disguised with random compensation and agreement with experience in Nsub(S) (function of Ng) cannot be an argument in favour of the model. It is concluded that eiconal model doesn't permit to quantitatively describe correlation phenomena during the multiple production on nuclei

  9. Multiple Response Regression for Gaussian Mixture Models with Known Labels.

    Science.gov (United States)

    Lee, Wonyul; Du, Ying; Sun, Wei; Hayes, D Neil; Liu, Yufeng

    2012-12-01

    Multiple response regression is a useful regression technique to model multiple response variables using the same set of predictor variables. Most existing methods for multiple response regression are designed for modeling homogeneous data. In many applications, however, one may have heterogeneous data where the samples are divided into multiple groups. Our motivating example is a cancer dataset where the samples belong to multiple cancer subtypes. In this paper, we consider modeling the data coming from a mixture of several Gaussian distributions with known group labels. A naive approach is to split the data into several groups according to the labels and model each group separately. Although it is simple, this approach ignores potential common structures across different groups. We propose new penalized methods to model all groups jointly in which the common and unique structures can be identified. The proposed methods estimate the regression coefficient matrix, as well as the conditional inverse covariance matrix of response variables. Asymptotic properties of the proposed methods are explored. Through numerical examples, we demonstrate that both estimation and prediction can be improved by modeling all groups jointly using the proposed methods. An application to a glioblastoma cancer dataset reveals some interesting common and unique gene relationships across different cancer subtypes.

  10. [Factors affecting in-hospital mortality in patients with sepsis: Development of a risk-adjusted model based on administrative data from German hospitals].

    Science.gov (United States)

    König, Volker; Kolzter, Olaf; Albuszies, Gerd; Thölen, Frank

    2018-05-01

    Inpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. The analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). Following the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R 2 value=0.27), which is an excellent result. The CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals

  11. Adaptive Active Noise Suppression Using Multiple Model Switching Strategy

    Directory of Open Access Journals (Sweden)

    Quanzhen Huang

    2017-01-01

    Full Text Available Active noise suppression for applications where the system response varies with time is a difficult problem. The computation burden for the existing control algorithms with online identification is heavy and easy to cause control system instability. A new active noise control algorithm is proposed in this paper by employing multiple model switching strategy for secondary path varying. The computation is significantly reduced. Firstly, a noise control system modeling method is proposed for duct-like applications. Then a multiple model adaptive control algorithm is proposed with a new multiple model switching strategy based on filter-u least mean square (FULMS algorithm. Finally, the proposed algorithm was implemented on Texas Instruments digital signal processor (DSP TMS320F28335 and real time experiments were done to test the proposed algorithm and FULMS algorithm with online identification. Experimental verification tests show that the proposed algorithm is effective with good noise suppression performance.

  12. Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

    Directory of Open Access Journals (Sweden)

    Simona Jeners

    2013-06-01

    Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

  13. Stock management in hospital pharmacy using chance-constrained model predictive control.

    Science.gov (United States)

    Jurado, I; Maestre, J M; Velarde, P; Ocampo-Martinez, C; Fernández, I; Tejera, B Isla; Prado, J R Del

    2016-05-01

    One of the most important problems in the pharmacy department of a hospital is stock management. The clinical need for drugs must be satisfied with limited work labor while minimizing the use of economic resources. The complexity of the problem resides in the random nature of the drug demand and the multiple constraints that must be taken into account in every decision. In this article, chance-constrained model predictive control is proposed to deal with this problem. The flexibility of model predictive control allows taking into account explicitly the different objectives and constraints involved in the problem while the use of chance constraints provides a trade-off between conservativeness and efficiency. The solution proposed is assessed to study its implementation in two Spanish hospitals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Model Seleksi Premi Asuransi Jiwa Dwiguna untuk Kasus Multiple Decrement

    OpenAIRE

    Cita, Devi Ramana; Pane, Rolan; ', Harison

    2015-01-01

    This article discusses a select survival model for the case of multiple decrements in evaluating endowment life insurance premium for person currently aged ( + ) years, who is selected at age with ℎ years selection period. The case of multiple decrements in this case is limited to two cases. The calculation of the annual premium is done by prior evaluating of the single premium, and the present value of annuity depends on theconstant force assumption.

  15. AgMIP Training in Multiple Crop Models and Tools

    Science.gov (United States)

    Boote, Kenneth J.; Porter, Cheryl H.; Hargreaves, John; Hoogenboom, Gerrit; Thornburn, Peter; Mutter, Carolyn

    2015-01-01

    The Agricultural Model Intercomparison and Improvement Project (AgMIP) has the goal of using multiple crop models to evaluate climate impacts on agricultural production and food security in developed and developing countries. There are several major limitations that must be overcome to achieve this goal, including the need to train AgMIP regional research team (RRT) crop modelers to use models other than the ones they are currently familiar with, plus the need to harmonize and interconvert the disparate input file formats used for the various models. Two activities were followed to address these shortcomings among AgMIP RRTs to enable them to use multiple models to evaluate climate impacts on crop production and food security. We designed and conducted courses in which participants trained on two different sets of crop models, with emphasis on the model of least experience. In a second activity, the AgMIP IT group created templates for inputting data on soils, management, weather, and crops into AgMIP harmonized databases, and developed translation tools for converting the harmonized data into files that are ready for multiple crop model simulations. The strategies for creating and conducting the multi-model course and developing entry and translation tools are reviewed in this chapter.

  16. A Bayesian Hierarchical Model for Relating Multiple SNPs within Multiple Genes to Disease Risk

    Directory of Open Access Journals (Sweden)

    Lewei Duan

    2013-01-01

    Full Text Available A variety of methods have been proposed for studying the association of multiple genes thought to be involved in a common pathway for a particular disease. Here, we present an extension of a Bayesian hierarchical modeling strategy that allows for multiple SNPs within each gene, with external prior information at either the SNP or gene level. The model involves variable selection at the SNP level through latent indicator variables and Bayesian shrinkage at the gene level towards a prior mean vector and covariance matrix that depend on external information. The entire model is fitted using Markov chain Monte Carlo methods. Simulation studies show that the approach is capable of recovering many of the truly causal SNPs and genes, depending upon their frequency and size of their effects. The method is applied to data on 504 SNPs in 38 candidate genes involved in DNA damage response in the WECARE study of second breast cancers in relation to radiotherapy exposure.

  17. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...

  18. Comparison of childbirth care models in public hospitals, Brazil.

    Science.gov (United States)

    Vogt, Sibylle Emilie; Silva, Kátia Silveira da; Dias, Marcos Augusto Bastos

    2014-04-01

    To compare collaborative and traditional childbirth care models. Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

  19. Parametric modeling for damped sinusoids from multiple channels

    DEFF Research Database (Denmark)

    Zhou, Zhenhua; So, Hing Cheung; Christensen, Mads Græsbøll

    2013-01-01

    frequencies and damping factors are then computed with the multi-channel weighted linear prediction method. The estimated sinusoidal poles are then matched to each channel according to the extreme value theory of distribution of random fields. Simulations are performed to show the performance advantages......The problem of parametric modeling for noisy damped sinusoidal signals from multiple channels is addressed. Utilizing the shift invariance property of the signal subspace, the number of distinct sinusoidal poles in the multiple channels is first determined. With the estimated number, the distinct...... of the proposed multi-channel sinusoidal modeling methodology compared with existing methods....

  20. A Multiple Model Prediction Algorithm for CNC Machine Wear PHM

    Directory of Open Access Journals (Sweden)

    Huimin Chen

    2011-01-01

    Full Text Available The 2010 PHM data challenge focuses on the remaining useful life (RUL estimation for cutters of a high speed CNC milling machine using measurements from dynamometer, accelerometer, and acoustic emission sensors. We present a multiple model approach for wear depth estimation of milling machine cutters using the provided data. The feature selection, initial wear estimation and multiple model fusion components of the proposed algorithm are explained in details and compared with several alternative methods using the training data. The final submission ranked #2 among professional and student participants and the method is applicable to other data driven PHM problems.

  1. SEM Model Medical Solid Waste Hospital Management In Medan City

    Science.gov (United States)

    Simarmata, Verawaty; Pandia, Setiaty; Mawengkang, Herman

    2018-01-01

    In daily activities, hospitals, as one of the important health care unit, generate both medical solid waste and non-medical solid waste. The occurrence of medical solid waste could be from the results of treatment activities, such as, in the treatment room for a hospital inpatient, general clinic, a dental clinic, a mother and child clinic, laboratories and pharmacies. Most of the medical solid waste contains infectious and hazardous materials. Therefore it should be managed properly, otherwise it could be a source of new infectious for the community around the hospital as well as for health workers themselves. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. One of the efforts that need to be done in improving the quality of the environment is to undertake waste management activities, because with proper waste management is the most important in order to achieve an optimal degree of human health. Health development in Indonesian aims to achieve a future in which the Indonesian people live in a healthy environment, its people behave clean and healthy, able to reach quality health services, fair and equitable, so as to have optimal health status, health development paradigm anchored to the healthy. The healthy condition of the individual and society can be influenced by the environment. Poor environmental quality is a cause of various health problems. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. This paper proposes a model for managing the medical solid waste in hospitals in Medan city, in order to create healthy environment around hospitals.

  2. A taxonomy of nursing care organization models in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'Amour, Danielle; Tchouaket, Eric; Rivard, Michèle; Clarke, Sean; Blais, Régis

    2012-08-28

    Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the

  3. A taxonomy of nursing care organization models in hospitals

    Science.gov (United States)

    2012-01-01

    Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice

  4. Key performance indicators in hospital based on balanced scorecard model

    Directory of Open Access Journals (Sweden)

    Hamed Rahimi

    2017-01-01

    Full Text Available Introduction: Performance measurement is receiving increasing verification all over the world. Nowadays in a lot of organizations, irrespective of their type or size, performance evaluation is the main concern and a key issue for top administrators. The purpose of this study is to organize suitable key performance indicators (KPIs for hospitals’ performance evaluation based on the balanced scorecard (BSC. Method: This is a mixed method study. In order to identify the hospital’s performance indicators (HPI, first related literature was reviewed and then the experts’ panel and Delphi method were used. In this study, two rounds were needed for the desired level of consensus. The experts rated the importance of the indicators, on a five-point Likert scale. In the consensus calculation, the consensus percentage was calculated by classifying the values 1-3 as not important (0 and 4-5 to (1 as important. Simple additive weighting technique was used to rank the indicators and select hospital’s KPIs. The data were analyzed by Excel 2010 software. Results: About 218 indicators were obtained from a review of selected literature. Through internal expert panel, 77 indicators were selected. Finally, 22 were selected for KPIs of hospitals. Ten indicators were selected in internal process perspective and 5, 4, and 3 indicators in finance, learning and growth, and customer, respectively. Conclusion: This model can be a useful tool for evaluating and comparing the performance of hospitals. However, this model is flexible and can be adjusted according to differences in the target hospitals. This study can be beneficial for hospital administrators and it can help them to change their perspective about performance evaluation.

  5. Multiple regression and beyond an introduction to multiple regression and structural equation modeling

    CERN Document Server

    Keith, Timothy Z

    2014-01-01

    Multiple Regression and Beyond offers a conceptually oriented introduction to multiple regression (MR) analysis and structural equation modeling (SEM), along with analyses that flow naturally from those methods. By focusing on the concepts and purposes of MR and related methods, rather than the derivation and calculation of formulae, this book introduces material to students more clearly, and in a less threatening way. In addition to illuminating content necessary for coursework, the accessibility of this approach means students are more likely to be able to conduct research using MR or SEM--and more likely to use the methods wisely. Covers both MR and SEM, while explaining their relevance to one another Also includes path analysis, confirmatory factor analysis, and latent growth modeling Figures and tables throughout provide examples and illustrate key concepts and techniques For additional resources, please visit: http://tzkeith.com/.

  6. A collaborative scheduling model for the supply-hub with multiple suppliers and multiple manufacturers.

    Science.gov (United States)

    Li, Guo; Lv, Fei; Guan, Xu

    2014-01-01

    This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

  7. A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

    Directory of Open Access Journals (Sweden)

    Guo Li

    2014-01-01

    Full Text Available This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

  8. A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

    Science.gov (United States)

    Lv, Fei; Guan, Xu

    2014-01-01

    This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment. PMID:24892104

  9. Double-multiple streamtube model for Darrieus in turbines

    Science.gov (United States)

    Paraschivoiu, I.

    1981-01-01

    An analytical model is proposed for calculating the rotor performance and aerodynamic blade forces for Darrieus wind turbines with curved blades. The method of analysis uses a multiple-streamtube model, divided into two parts: one modeling the upstream half-cycle of the rotor and the other, the downstream half-cycle. The upwind and downwind components of the induced velocities at each level of the rotor were obtained using the principle of two actuator disks in tandem. Variation of the induced velocities in the two parts of the rotor produces larger forces in the upstream zone and smaller forces in the downstream zone. Comparisons of the overall rotor performance with previous methods and field test data show the important improvement obtained with the present model. The calculations were made using the computer code CARDAA developed at IREQ. The double-multiple streamtube model presented has two major advantages: it requires a much shorter computer time than the three-dimensional vortex model and is more accurate than multiple-streamtube model in predicting the aerodynamic blade loads.

  10. Multiple commodities in statistical microeconomics: Model and market

    Science.gov (United States)

    Baaquie, Belal E.; Yu, Miao; Du, Xin

    2016-11-01

    A statistical generalization of microeconomics has been made in Baaquie (2013). In Baaquie et al. (2015), the market behavior of single commodities was analyzed and it was shown that market data provides strong support for the statistical microeconomic description of commodity prices. The case of multiple commodities is studied and a parsimonious generalization of the single commodity model is made for the multiple commodities case. Market data shows that the generalization can accurately model the simultaneous correlation functions of up to four commodities. To accurately model five or more commodities, further terms have to be included in the model. This study shows that the statistical microeconomics approach is a comprehensive and complete formulation of microeconomics, and which is independent to the mainstream formulation of microeconomics.

  11. Risk Prediction Models for Other Cancers or Multiple Sites

    Science.gov (United States)

    Developing statistical models that estimate the probability of developing other multiple cancers over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  12. An extension of the multiple-trapping model

    International Nuclear Information System (INIS)

    Shkilev, V. P.

    2012-01-01

    The hopping charge transport in disordered semiconductors is considered. Using the concept of the transport energy level, macroscopic equations are derived that extend a multiple-trapping model to the case of semiconductors with both energy and spatial disorders. It is shown that, although both types of disorder can cause dispersive transport, the frequency dependence of conductivity is determined exclusively by the spatial disorder.

  13. Selecting Tools to Model Integer and Binomial Multiplication

    Science.gov (United States)

    Pratt, Sarah Smitherman; Eddy, Colleen M.

    2017-01-01

    Mathematics teachers frequently provide concrete manipulatives to students during instruction; however, the rationale for using certain manipulatives in conjunction with concepts may not be explored. This article focuses on area models that are currently used in classrooms to provide concrete examples of integer and binomial multiplication. The…

  14. Modeling single versus multiple systems in implicit and explicit memory.

    Science.gov (United States)

    Starns, Jeffrey J; Ratcliff, Roger; McKoon, Gail

    2012-04-01

    It is currently controversial whether priming on implicit tasks and discrimination on explicit recognition tests are supported by a single memory system or by multiple, independent systems. In a Psychological Review article, Berry and colleagues used mathematical modeling to address this question and provide compelling evidence against the independent-systems approach. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase.

    Science.gov (United States)

    Benning, Amirta; Dixon-Woods, Mary; Nwulu, Ugochi; Ghaleb, Maisoon; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Kotecha, Amit; Derrington, M Clare; Lilford, Richard

    2011-02-03

    To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting NHS hospitals in England. Nine hospitals participating in SPI2 and nine matched control hospitals. The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. One of the scores (organisational climate) showed a significant (P = 0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P = 0.010) and 12 hour (2.4, 1.1 to 5.0; P = 0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P

  16. Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase

    Science.gov (United States)

    Benning, Amirta; Dixon-Woods, Mary; Nwulu, Ugochi; Ghaleb, Maisoon; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Kotecha, Amit; Derrington, M Clare

    2011-01-01

    Objective To independently evaluate the impact of the second phase of the Health Foundation’s Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients’ satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting NHS hospitals in England. Participants Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal

  17. Green communication: The enabler to multiple business models

    DEFF Research Database (Denmark)

    Lindgren, Peter; Clemmensen, Suberia; Taran, Yariv

    2010-01-01

    Companies stand at the forefront of a new business model reality with new potentials - that will change their basic understanding and practice of running their business models radically. One of the drivers to this change is green communication, its strong relation to green business models and its...... possibility to enable lower energy consumption. This paper shows how green communication enables innovation of green business models and multiple business models running simultaneously in different markets to different customers.......Companies stand at the forefront of a new business model reality with new potentials - that will change their basic understanding and practice of running their business models radically. One of the drivers to this change is green communication, its strong relation to green business models and its...

  18. Infinite Multiple Membership Relational Modeling for Complex Networks

    DEFF Research Database (Denmark)

    Mørup, Morten; Schmidt, Mikkel Nørgaard; Hansen, Lars Kai

    Learning latent structure in complex networks has become an important problem fueled by many types of networked data originating from practically all fields of science. In this paper, we propose a new non-parametric Bayesian multiplemembership latent feature model for networks. Contrary to existing...... multiplemembership models that scale quadratically in the number of vertices the proposedmodel scales linearly in the number of links admittingmultiple-membership analysis in large scale networks. We demonstrate a connection between the single membership relational model and multiple membership models and show...

  19. PFI redux? Assessing a new model for financing hospitals.

    Science.gov (United States)

    Hellowell, Mark

    2013-11-01

    There is a growing need for investments in hospital facilities to improve the efficiency and quality of health services. In recent years, publicly financed hospital organisations in many countries have utilised private finance arrangements, variously called private finance initiatives (PFIs), public-private partnerships (PPPs) or P3s, to address their capital requirements. However, such projects have become more difficult to implement since the onset of the global financial crisis, which has led to a reduction in the supply of debt capital and an increase in its price. In December 2012, the government of the United Kingdom outlined a comprehensive set of reforms to the private finance model in order to revive this important source of capital for hospital investments. This article provides a critical assessment of the 'Private Finance 2' reforms, focusing on their likely impact on the supply and cost of capital. It concludes that constraints in supply are likely to continue, in part due to regulatory constraints facing both commercial banks and institutional investors, while the cost of capital is likely to increase, at least in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Multiple intra-hospital transports during relocation to a new critical care unit.

    Science.gov (United States)

    O'Leary, R-A; Conrick-Martin, I; O'Loughlin, C; Curran, M-R; Marsh, B

    2017-11-01

    Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.

  1. Exploring types of focused factories in hospital care: a multiple case study.

    NARCIS (Netherlands)

    Bredenhoff, E.; Bredenhoff, Eelco; van Lent, W.A.M.; van Harten, Willem H.

    2010-01-01

    Background: Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations. Our aim was to explore the

  2. Multiple arterial grafts in coronary artery bypass grafting, Sohag University Hospital's initial experience

    Directory of Open Access Journals (Sweden)

    A.A.A. Elsayed

    2017-12-01

    Conclusions: Using multiple arterial grafts did not add a significant risk or time to the classic CABG. With accumulating evidence about better patency rate in arterial grafts, MAR is recommended especially in younger patients undergoing CABG.

  3. Testing the "Work Ability House" Model in hospital workers.

    Science.gov (United States)

    Martinez, Maria Carmen; Latorre, Maria do Rosário Dias de Oliveira; Fischer, Frida Marina

    2016-01-01

    To test the Work Ability House model, verifying the hierarchy of proposed dimensions, among a group of hospital workers. A cohort study (2009-2011) was conducted with a sample of 599 workers from a hospital in the city of São Paulo. A questionnaire including sociodemographics, lifestyle and working conditions was used. The Brazilian versions of Job Stress Scale, Effort-Reward Imbalance, Work-Related Activities That May Contribute To Job-Related Pain and/or Injury, and the Work Ability Index (WAI) were also used. A hierarchical logistic regression analysis was performed: the independent variables were allocated into levels according to the dimensions of the theoretical model in order to evaluate the factors associated with work ability. Variables associated with impairment of work ability in each dimension were as follows: (a) sociodemographics: age work injuries (p = 0.029), (c) professional competence: low educational level (p = 0.008), (d) values : intensified in overcommitment (p work: intensification of effort-reward imbalance (p = 0.009) and high demands (p = 0.040). The results confirmed the dimensions proposed for the Work Ability House model, indicating that it is valid as a representation of a multidimensional construct of multifactorial determination and can be used in the management of work ability.

  4. A queueing theory based model for business continuity in hospitals.

    Science.gov (United States)

    Miniati, R; Cecconi, G; Dori, F; Frosini, F; Iadanza, E; Biffi Gentili, G; Niccolini, F; Gusinu, R

    2013-01-01

    Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.

  5. Vehicle coordinated transportation dispatching model base on multiple crisis locations

    Science.gov (United States)

    Tian, Ran; Li, Shanwei; Yang, Guoying

    2018-05-01

    Many disastrous events are often caused after unconventional emergencies occur, and the requirements of disasters are often different. It is difficult for a single emergency resource center to satisfy such requirements at the same time. Therefore, how to coordinate the emergency resources stored by multiple emergency resource centers to various disaster sites requires the coordinated transportation of emergency vehicles. In this paper, according to the problem of emergency logistics coordination scheduling, based on the related constraints of emergency logistics transportation, an emergency resource scheduling model based on multiple disasters is established.

  6. Multiple Surrogate Modeling for Wire-Wrapped Fuel Assembly Optimization

    International Nuclear Information System (INIS)

    Raza, Wasim; Kim, Kwang-Yong

    2007-01-01

    In this work, shape optimization of seven pin wire wrapped fuel assembly has been carried out in conjunction with RANS analysis in order to evaluate the performances of surrogate models. Previously, Ahmad and Kim performed the flow and heat transfer analysis based on the three-dimensional RANS analysis. But numerical optimization has not been applied to the design of wire-wrapped fuel assembly, yet. Surrogate models are being widely used in multidisciplinary optimization. Queipo et al. reviewed various surrogates based models used in aerospace applications. Goel et al. developed weighted average surrogate model based on response surface approximation (RSA), radial basis neural network (RBNN) and Krigging (KRG) models. In addition to the three basic models, RSA, RBNN and KRG, the multiple surrogate model, PBA also has been employed. Two geometric design variables and a multi-objective function with a weighting factor have been considered for this problem

  7. A model for diagnosing and explaining multiple disorders.

    Science.gov (United States)

    Jamieson, P W

    1991-08-01

    The ability to diagnose multiple interacting disorders and explain them in a coherent causal framework has only partially been achieved in medical expert systems. This paper proposes a causal model for diagnosing and explaining multiple disorders whose key elements are: physician-directed hypotheses generation, object-oriented knowledge representation, and novel explanation heuristics. The heuristics modify and link the explanations to make the physician aware of diagnostic complexities. A computer program incorporating the model currently is in use for diagnosing peripheral nerve and muscle disorders. The program successfully diagnoses and explains interactions between diseases in terms of underlying pathophysiologic concepts. The model offers a new architecture for medical domains where reasoning from first principles is difficult but explanation of disease interactions is crucial for the system's operation.

  8. MFAM: Multiple Frequency Adaptive Model-Based Indoor Localization Method.

    Science.gov (United States)

    Tuta, Jure; Juric, Matjaz B

    2018-03-24

    This paper presents MFAM (Multiple Frequency Adaptive Model-based localization method), a novel model-based indoor localization method that is capable of using multiple wireless signal frequencies simultaneously. It utilizes indoor architectural model and physical properties of wireless signal propagation through objects and space. The motivation for developing multiple frequency localization method lies in the future Wi-Fi standards (e.g., 802.11ah) and the growing number of various wireless signals present in the buildings (e.g., Wi-Fi, Bluetooth, ZigBee, etc.). Current indoor localization methods mostly rely on a single wireless signal type and often require many devices to achieve the necessary accuracy. MFAM utilizes multiple wireless signal types and improves the localization accuracy over the usage of a single frequency. It continuously monitors signal propagation through space and adapts the model according to the changes indoors. Using multiple signal sources lowers the required number of access points for a specific signal type while utilizing signals, already present in the indoors. Due to the unavailability of the 802.11ah hardware, we have evaluated proposed method with similar signals; we have used 2.4 GHz Wi-Fi and 868 MHz HomeMatic home automation signals. We have performed the evaluation in a modern two-bedroom apartment and measured mean localization error 2.0 to 2.3 m and median error of 2.0 to 2.2 m. Based on our evaluation results, using two different signals improves the localization accuracy by 18% in comparison to 2.4 GHz Wi-Fi-only approach. Additional signals would improve the accuracy even further. We have shown that MFAM provides better accuracy than competing methods, while having several advantages for real-world usage.

  9. MFAM: Multiple Frequency Adaptive Model-Based Indoor Localization Method

    Directory of Open Access Journals (Sweden)

    Jure Tuta

    2018-03-01

    Full Text Available This paper presents MFAM (Multiple Frequency Adaptive Model-based localization method, a novel model-based indoor localization method that is capable of using multiple wireless signal frequencies simultaneously. It utilizes indoor architectural model and physical properties of wireless signal propagation through objects and space. The motivation for developing multiple frequency localization method lies in the future Wi-Fi standards (e.g., 802.11ah and the growing number of various wireless signals present in the buildings (e.g., Wi-Fi, Bluetooth, ZigBee, etc.. Current indoor localization methods mostly rely on a single wireless signal type and often require many devices to achieve the necessary accuracy. MFAM utilizes multiple wireless signal types and improves the localization accuracy over the usage of a single frequency. It continuously monitors signal propagation through space and adapts the model according to the changes indoors. Using multiple signal sources lowers the required number of access points for a specific signal type while utilizing signals, already present in the indoors. Due to the unavailability of the 802.11ah hardware, we have evaluated proposed method with similar signals; we have used 2.4 GHz Wi-Fi and 868 MHz HomeMatic home automation signals. We have performed the evaluation in a modern two-bedroom apartment and measured mean localization error 2.0 to 2.3 m and median error of 2.0 to 2.2 m. Based on our evaluation results, using two different signals improves the localization accuracy by 18% in comparison to 2.4 GHz Wi-Fi-only approach. Additional signals would improve the accuracy even further. We have shown that MFAM provides better accuracy than competing methods, while having several advantages for real-world usage.

  10. Hospital nurses' wellbeing at work: a theoretical model.

    Science.gov (United States)

    Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi

    2015-09-01

    To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.

  11. A PDP model of the simultaneous perception of multiple objects

    Science.gov (United States)

    Henderson, Cynthia M.; McClelland, James L.

    2011-06-01

    Illusory conjunctions in normal and simultanagnosic subjects are two instances where the visual features of multiple objects are incorrectly 'bound' together. A connectionist model explores how multiple objects could be perceived correctly in normal subjects given sufficient time, but could give rise to illusory conjunctions with damage or time pressure. In this model, perception of two objects benefits from lateral connections between hidden layers modelling aspects of the ventral and dorsal visual pathways. As with simultanagnosia, simulations of dorsal lesions impair multi-object recognition. In contrast, a large ventral lesion has minimal effect on dorsal functioning, akin to dissociations between simple object manipulation (retained in visual form agnosia and semantic dementia) and object discrimination (impaired in these disorders) [Hodges, J.R., Bozeat, S., Lambon Ralph, M.A., Patterson, K., and Spatt, J. (2000), 'The Role of Conceptual Knowledge: Evidence from Semantic Dementia', Brain, 123, 1913-1925; Milner, A.D., and Goodale, M.A. (2006), The Visual Brain in Action (2nd ed.), New York: Oxford]. It is hoped that the functioning of this model might suggest potential processes underlying dorsal and ventral contributions to the correct perception of multiple objects.

  12. Supersymmetric U(1)' model with multiple dark matters

    International Nuclear Information System (INIS)

    Hur, Taeil; Lee, Hye-Sung; Nasri, Salah

    2008-01-01

    We consider a scenario where a supersymmetric model has multiple dark matter particles. Adding a U(1) ' gauge symmetry is a well-motivated extension of the minimal supersymmetric standard model (MSSM). It can cure the problems of the MSSM such as the μ problem or the proton decay problem with high-dimensional lepton number and baryon number violating operators which R parity allows. An extra parity (U parity) may arise as a residual discrete symmetry after U(1) ' gauge symmetry is spontaneously broken. The lightest U-parity particle (LUP) is stable under the new parity becoming a new dark matter candidate. Up to three massive particles can be stable in the presence of the R parity and the U parity. We numerically illustrate that multiple stable particles in our model can satisfy both constraints from the relic density and the direct detection, thus providing a specific scenario where a supersymmetric model has well-motivated multiple dark matters consistent with experimental constraints. The scenario provides new possibilities in the present and upcoming dark matter searches in the direct detection and collider experiments

  13. Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.

    Directory of Open Access Journals (Sweden)

    Pia Abel zur Wiesch

    2014-06-01

    Full Text Available The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of resistance. However, theoretical and clinical studies came to different conclusions regarding the usefulness of rotating first-line therapy (cycling. Here, we performed a quantitative pathogen-specific meta-analysis of clinical studies comparing cycling to standard practice. We searched PubMed and Google Scholar and identified 46 clinical studies addressing the effect of cycling on nosocomial infections, of which 11 met our selection criteria. We employed a method for multivariate meta-analysis using incidence rates as endpoints and find that cycling reduced the incidence rate/1000 patient days of both total infections by 4.95 [9.43-0.48] and resistant infections by 7.2 [14.00-0.44]. This positive effect was observed in most pathogens despite a large variance between individual species. Our findings remain robust in uni- and multivariate metaregressions. We used theoretical models that reflect various infections and hospital settings to compare cycling to random assignment to different drugs (mixing. We make the realistic assumption that therapy is changed when first line treatment is ineffective, which we call "adjustable cycling/mixing". In concordance with earlier theoretical studies, we find that in strict regimens, cycling is detrimental. However, in adjustable regimens single resistance is suppressed and cycling is successful in most settings. Both a meta-regression and our theoretical model indicate that "adjustable cycling" is especially useful to suppress emergence of multiple resistance. While our model predicts that cycling periods of one month perform well, we expect that too long cycling periods are detrimental. Our results suggest that

  14. Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

    Science.gov (United States)

    Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

    2018-06-01

    First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

  15. Challenges in LCA modelling of multiple loops for aluminium cans

    DEFF Research Database (Denmark)

    Niero, Monia; Olsen, Stig Irving

    considered the case of closed-loop recycling for aluminium cans, where body and lid are different alloys, and discussed the abovementioned challenge. The Life Cycle Inventory (LCI) modelling of aluminium processes is traditionally based on a pure aluminium flow, therefore neglecting the presence of alloying...... elements. We included the effect of alloying elements on the LCA modelling of aluminium can recycling. First, we performed a mass balance of the main alloying elements (Mn, Fe, Si, Cu) in aluminium can recycling at increasing levels of recycling rate. The analysis distinguished between different aluminium...... packaging scrap sources (i.e. used beverage can and mixed aluminium packaging) to understand the limiting factors for multiple loop aluminium can recycling. Secondly, we performed a comparative LCA of aluminium can production and recycling in multiple loops considering the two aluminium packaging scrap...

  16. Dealing with Multiple Solutions in Structural Vector Autoregressive Models.

    Science.gov (United States)

    Beltz, Adriene M; Molenaar, Peter C M

    2016-01-01

    Structural vector autoregressive models (VARs) hold great potential for psychological science, particularly for time series data analysis. They capture the magnitude, direction of influence, and temporal (lagged and contemporaneous) nature of relations among variables. Unified structural equation modeling (uSEM) is an optimal structural VAR instantiation, according to large-scale simulation studies, and it is implemented within an SEM framework. However, little is known about the uniqueness of uSEM results. Thus, the goal of this study was to investigate whether multiple solutions result from uSEM analysis and, if so, to demonstrate ways to select an optimal solution. This was accomplished with two simulated data sets, an empirical data set concerning children's dyadic play, and modifications to the group iterative multiple model estimation (GIMME) program, which implements uSEMs with group- and individual-level relations in a data-driven manner. Results revealed multiple solutions when there were large contemporaneous relations among variables. Results also verified several ways to select the correct solution when the complete solution set was generated, such as the use of cross-validation, maximum standardized residuals, and information criteria. This work has immediate and direct implications for the analysis of time series data and for the inferences drawn from those data concerning human behavior.

  17. Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

    Science.gov (United States)

    Zhao, Fang; Hämäläinen, Juha; Chen, Yu-Ting

    2017-01-01

    With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

  18. Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

    Science.gov (United States)

    E-Morris, Marlene; Caldwell, Barbara; Mencher, Kathleen J; Grogan, Kimberly; Judge-Gorny, Margaret; Patterson, Zelda; Christopher, Terrian; Smith, Russell C; McQuaide, Teresa

    2010-01-01

    The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

  19. A simulation model of hospital management based on cost accounting analysis according to disease.

    Science.gov (United States)

    Tanaka, Koji; Sato, Junzo; Guo, Jinqiu; Takada, Akira; Yoshihara, Hiroyuki

    2004-12-01

    Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

  20. Automatic Generation of 3D Building Models with Multiple Roofs

    Institute of Scientific and Technical Information of China (English)

    Kenichi Sugihara; Yoshitugu Hayashi

    2008-01-01

    Based on building footprints (building polygons) on digital maps, we are proposing the GIS and CG integrated system that automatically generates 3D building models with multiple roofs. Most building polygons' edges meet at right angles (orthogonal polygon). The integrated system partitions orthogonal building polygons into a set of rectangles and places rectangular roofs and box-shaped building bodies on these rectangles. In order to partition an orthogonal polygon, we proposed a useful polygon expression in deciding from which vertex a dividing line is drawn. In this paper, we propose a new scheme for partitioning building polygons and show the process of creating 3D roof models.

  1. A tactical supply chain planning model with multiple flexibility options

    DEFF Research Database (Denmark)

    Esmaeilikia, Masoud; Fahimnia, Behnam; Sarkis, Joeseph

    2016-01-01

    Supply chain flexibility is widely recognized as an approach to manage uncertainty. Uncertainty in the supply chain may arise from a number of sources such as demand and supply interruptions and lead time variability. A tactical supply chain planning model with multiple flexibility options...... incorporated in sourcing, manufacturing and logistics functions can be used for the analysis of flexibility adjustment in an existing supply chain. This paper develops such a tactical supply chain planning model incorporating a realistic range of flexibility options. A novel solution method is designed...

  2. Hierarchical Multiple Markov Chain Model for Unsupervised Texture Segmentation

    Czech Academy of Sciences Publication Activity Database

    Scarpa, G.; Gaetano, R.; Haindl, Michal; Zerubia, J.

    2009-01-01

    Roč. 18, č. 8 (2009), s. 1830-1843 ISSN 1057-7149 R&D Projects: GA ČR GA102/08/0593 EU Projects: European Commission(XE) 507752 - MUSCLE Institutional research plan: CEZ:AV0Z10750506 Keywords : Classification * texture analysis * segmentation * hierarchical image models * Markov process Subject RIV: BD - Theory of Information Impact factor: 2.848, year: 2009 http://library.utia.cas.cz/separaty/2009/RO/haindl-hierarchical multiple markov chain model for unsupervised texture segmentation.pdf

  3. The work engagement of nurses in multiple hospital sectors in Saudi Arabia: a comparative study.

    Science.gov (United States)

    Aboshaiqah, Ahmad E; Hamadi, Hanadi Y; Salem, Olfat A; Zakari, Nazik M A

    2016-05-01

    To examine the differences in work engagement among nurses in Saudi Arabia and its relationship with personal characteristics across different hospital affiliations. Quality care requires an adequate supply of engaged nurses who are dedicated, energised and absorbed in their work. In the nursing profession, work engagement is of considerable importance, owing to the shortage of nurses and the continuing reduction in healthcare costs. An analytic comparative cross-sectional design was used. Eight hospitals from three provinces and different affiliation types participated in the study. The Utrecht work engagement scale (UWES) was used to measure 980 nurses' work engagement. The findings indicate that nurses' total engagement scores were closer to the higher end of the Likert scale. The findings indicate generally high levels of work engagement, particularly regarding the element of dedication. Furthermore, the study shows significant differences in nurses' engagement among the various work settings and in nurses' age and experience. A number of nurses' personal characteristics have independent influences on their work engagement. Nurse leaders should acknowledge that a statement of professional nursing scope of practice is a necessity to encourage and fulfil engagement. © 2016 John Wiley & Sons Ltd.

  4. Feedback structure based entropy approach for multiple-model estimation

    Institute of Scientific and Technical Information of China (English)

    Shen-tu Han; Xue Anke; Guo Yunfei

    2013-01-01

    The variable-structure multiple-model (VSMM) approach, one of the multiple-model (MM) methods, is a popular and effective approach in handling problems with mode uncertainties. The model sequence set adaptation (MSA) is the key to design a better VSMM. However, MSA methods in the literature have big room to improve both theoretically and practically. To this end, we propose a feedback structure based entropy approach that could find the model sequence sets with the smallest size under certain conditions. The filtered data are fed back in real time and can be used by the minimum entropy (ME) based VSMM algorithms, i.e., MEVSMM. Firstly, the full Markov chains are used to achieve optimal solutions. Secondly, the myopic method together with particle filter (PF) and the challenge match algorithm are also used to achieve sub-optimal solutions, a trade-off between practicability and optimality. The numerical results show that the proposed algorithm provides not only refined model sets but also a good robustness margin and very high accuracy.

  5. Modelling of diffuse solar fraction with multiple predictors

    Energy Technology Data Exchange (ETDEWEB)

    Ridley, Barbara; Boland, John [Centre for Industrial and Applied Mathematics, University of South Australia, Mawson Lakes Boulevard, Mawson Lakes, SA 5095 (Australia); Lauret, Philippe [Laboratoire de Physique du Batiment et des Systemes, University of La Reunion, Reunion (France)

    2010-02-15

    For some locations both global and diffuse solar radiation are measured. However, for many locations, only global radiation is measured, or inferred from satellite data. For modelling solar energy applications, the amount of radiation on a tilted surface is needed. Since only the direct component on a tilted surface can be calculated from direct on some other plane using trigonometry, we need to have diffuse radiation on the horizontal plane available. There are regression relationships for estimating the diffuse on a tilted surface from diffuse on the horizontal. Models for estimating the diffuse on the horizontal from horizontal global that have been developed in Europe or North America have proved to be inadequate for Australia. Boland et al. developed a validated model for Australian conditions. Boland et al. detailed our recent advances in developing the theoretical framework for the use of the logistic function instead of piecewise linear or simple nonlinear functions and was the first step in identifying the means for developing a generic model for estimating diffuse from global and other predictors. We have developed a multiple predictor model, which is much simpler than previous models, and uses hourly clearness index, daily clearness index, solar altitude, apparent solar time and a measure of persistence of global radiation level as predictors. This model performs marginally better than currently used models for locations in the Northern Hemisphere and substantially better for Southern Hemisphere locations. We suggest it can be used as a universal model. (author)

  6. Endodontic flare-ups: comparison of incidence between single and multiple visits procedures in patients attending a Nigerian teaching hospital.

    Science.gov (United States)

    Oginni, Ao; Udoye, C I

    2004-12-01

    The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

  7. Rapidity correlations at fixed multiplicity in cluster emission models

    CERN Document Server

    Berger, M C

    1975-01-01

    Rapidity correlations in the central region among hadrons produced in proton-proton collisions of fixed final state multiplicity n at NAL and ISR energies are investigated in a two-step framework in which clusters of hadrons are emitted essentially independently, via a multiperipheral-like model, and decay isotropically. For n>or approximately=/sup 1///sub 2/(n), these semi-inclusive distributions are controlled by the reaction mechanism which dominates production in the central region. Thus, data offer cleaner insight into the properties of this mechanism than can be obtained from fully inclusive spectra. A method of experimental analysis is suggested to facilitate the extraction of new dynamical information. It is shown that the n independence of the magnitude of semi-inclusive correlation functions reflects directly the structure of the internal cluster multiplicity distribution. This conclusion is independent of certain assumptions concerning the form of the single cluster density in rapidity space. (23 r...

  8. Design of e-Science platform for biomedical imaging research cross multiple academic institutions and hospitals

    Science.gov (United States)

    Zhang, Jianguo; Zhang, Kai; Yang, Yuanyuan; Ling, Tonghui; Wang, Tusheng; Wang, Mingqing; Hu, Haibo; Xu, Xuemin

    2012-02-01

    More and more image informatics researchers and engineers are considering to re-construct imaging and informatics infrastructure or to build new framework to enable multiple disciplines of medical researchers, clinical physicians and biomedical engineers working together in a secured, efficient, and transparent cooperative environment. In this presentation, we show an outline and our preliminary design work of building an e-Science platform for biomedical imaging and informatics research and application in Shanghai. We will present our consideration and strategy on designing this platform, and preliminary results. We also will discuss some challenges and solutions in building this platform.

  9. Multiplicative Attribute Graph Model of Real-World Networks

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myunghwan [Stanford Univ., CA (United States); Leskovec, Jure [Stanford Univ., CA (United States)

    2010-10-20

    Large scale real-world network data, such as social networks, Internet andWeb graphs, is ubiquitous in a variety of scientific domains. The study of such social and information networks commonly finds patterns and explain their emergence through tractable models. In most networks, especially in social networks, nodes also have a rich set of attributes (e.g., age, gender) associatedwith them. However, most of the existing network models focus only on modeling the network structure while ignoring the features of nodes in the network. Here we present a class of network models that we refer to as the Multiplicative Attribute Graphs (MAG), which naturally captures the interactions between the network structure and node attributes. We consider a model where each node has a vector of categorical features associated with it. The probability of an edge between a pair of nodes then depends on the product of individual attributeattribute similarities. The model yields itself to mathematical analysis as well as fit to real data. We derive thresholds for the connectivity, the emergence of the giant connected component, and show that the model gives rise to graphs with a constant diameter. Moreover, we analyze the degree distribution to show that the model can produce networks with either lognormal or power-law degree distribution depending on certain conditions.

  10. Prediction of Clinical Deterioration in Hospitalized Adult Patients with Hematologic Malignancies Using a Neural Network Model.

    Directory of Open Access Journals (Sweden)

    Scott B Hu

    Full Text Available Clinical deterioration (ICU transfer and cardiac arrest occurs during approximately 5-10% of hospital admissions. Existing prediction models have a high false positive rate, leading to multiple false alarms and alarm fatigue. We used routine vital signs and laboratory values obtained from the electronic medical record (EMR along with a machine learning algorithm called a neural network to develop a prediction model that would increase the predictive accuracy and decrease false alarm rates.Retrospective cohort study.The hematologic malignancy unit in an academic medical center in the United States.Adult patients admitted to the hematologic malignancy unit from 2009 to 2010.None.Vital signs and laboratory values were obtained from the electronic medical record system and then used as predictors (features. A neural network was used to build a model to predict clinical deterioration events (ICU transfer and cardiac arrest. The performance of the neural network model was compared to the VitalPac Early Warning Score (ViEWS. Five hundred sixty five consecutive total admissions were available with 43 admissions resulting in clinical deterioration. Using simulation, the neural network outperformed the ViEWS model with a positive predictive value of 82% compared to 24%, respectively.We developed and tested a neural network-based prediction model for clinical deterioration in patients hospitalized in the hematologic malignancy unit. Our neural network model outperformed an existing model, substantially increasing the positive predictive value, allowing the clinician to be confident in the alarm raised. This system can be readily implemented in a real-time fashion in existing EMR systems.

  11. Dynamic coordinated control laws in multiple agent models

    International Nuclear Information System (INIS)

    Morgan, David S.; Schwartz, Ira B.

    2005-01-01

    We present an active control scheme of a kinetic model of swarming. It has been shown previously that the global control scheme for the model, presented in [Systems Control Lett. 52 (2004) 25], gives rise to spontaneous collective organization of agents into a unified coherent swarm, via steering controls and utilizing long-range attractive and short-range repulsive interactions. We extend these results by presenting control laws whereby a single swarm is broken into independently functioning subswarm clusters. The transition between one coordinated swarm and multiple clustered subswarms is managed simply with a homotopy parameter. Additionally, we present as an alternate formulation, a local control law for the same model, which implements dynamic barrier avoidance behavior, and in which swarm coherence emerges spontaneously

  12. Laplace transform analysis of a multiplicative asset transfer model

    Science.gov (United States)

    Sokolov, Andrey; Melatos, Andrew; Kieu, Tien

    2010-07-01

    We analyze a simple asset transfer model in which the transfer amount is a fixed fraction f of the giver’s wealth. The model is analyzed in a new way by Laplace transforming the master equation, solving it analytically and numerically for the steady-state distribution, and exploring the solutions for various values of f∈(0,1). The Laplace transform analysis is superior to agent-based simulations as it does not depend on the number of agents, enabling us to study entropy and inequality in regimes that are costly to address with simulations. We demonstrate that Boltzmann entropy is not a suitable (e.g. non-monotonic) measure of disorder in a multiplicative asset transfer system and suggest an asymmetric stochastic process that is equivalent to the asset transfer model.

  13. Comparison of Hospital standards with ISO principles and presentation appropriate model of Hospital standard development

    Directory of Open Access Journals (Sweden)

    bahram Delgoshai

    2005-02-01

    Conclusion: Writing method of evaluation items in »B hand out« has significant difference with what is done in ISO audit. Research findings showed that in spite of leaping that »B hand out« developing had in national. There are serious lacks in hospital compelete evaluaton so that consider a hospitals system, means and content beacause of lack of enough experiment in standard development based on ISO principles.

  14. Modeling Spatial Dependence of Rainfall Extremes Across Multiple Durations

    Science.gov (United States)

    Le, Phuong Dong; Leonard, Michael; Westra, Seth

    2018-03-01

    Determining the probability of a flood event in a catchment given that another flood has occurred in a nearby catchment is useful in the design of infrastructure such as road networks that have multiple river crossings. These conditional flood probabilities can be estimated by calculating conditional probabilities of extreme rainfall and then transforming rainfall to runoff through a hydrologic model. Each catchment's hydrological response times are unlikely to be the same, so in order to estimate these conditional probabilities one must consider the dependence of extreme rainfall both across space and across critical storm durations. To represent these types of dependence, this study proposes a new approach for combining extreme rainfall across different durations within a spatial extreme value model using max-stable process theory. This is achieved in a stepwise manner. The first step defines a set of common parameters for the marginal distributions across multiple durations. The parameters are then spatially interpolated to develop a spatial field. Storm-level dependence is represented through the max-stable process for rainfall extremes across different durations. The dependence model shows a reasonable fit between the observed pairwise extremal coefficients and the theoretical pairwise extremal coefficient function across all durations. The study demonstrates how the approach can be applied to develop conditional maps of the return period and return level across different durations.

  15. Protein Structure Classification and Loop Modeling Using Multiple Ramachandran Distributions

    KAUST Repository

    Najibi, Seyed Morteza

    2017-02-08

    Recently, the study of protein structures using angular representations has attracted much attention among structural biologists. The main challenge is how to efficiently model the continuous conformational space of the protein structures based on the differences and similarities between different Ramachandran plots. Despite the presence of statistical methods for modeling angular data of proteins, there is still a substantial need for more sophisticated and faster statistical tools to model the large-scale circular datasets. To address this need, we have developed a nonparametric method for collective estimation of multiple bivariate density functions for a collection of populations of protein backbone angles. The proposed method takes into account the circular nature of the angular data using trigonometric spline which is more efficient compared to existing methods. This collective density estimation approach is widely applicable when there is a need to estimate multiple density functions from different populations with common features. Moreover, the coefficients of adaptive basis expansion for the fitted densities provide a low-dimensional representation that is useful for visualization, clustering, and classification of the densities. The proposed method provides a novel and unique perspective to two important and challenging problems in protein structure research: structure-based protein classification and angular-sampling-based protein loop structure prediction.

  16. A multiple relevance feedback strategy with positive and negative models.

    Directory of Open Access Journals (Sweden)

    Yunlong Ma

    Full Text Available A commonly used strategy to improve search accuracy is through feedback techniques. Most existing work on feedback relies on positive information, and has been extensively studied in information retrieval. However, when a query topic is difficult and the results from the first-pass retrieval are very poor, it is impossible to extract enough useful terms from a few positive documents. Therefore, the positive feedback strategy is incapable to improve retrieval in this situation. Contrarily, there is a relatively large number of negative documents in the top of the result list, and it has been confirmed that negative feedback strategy is an important and useful way for adapting this scenario by several recent studies. In this paper, we consider a scenario when the search results are so poor that there are at most three relevant documents in the top twenty documents. Then, we conduct a novel study of multiple strategies for relevance feedback using both positive and negative examples from the first-pass retrieval to improve retrieval accuracy for such difficult queries. Experimental results on these TREC collections show that the proposed language model based multiple model feedback method which is generally more effective than both the baseline method and the methods using only positive or negative model.

  17. Protein Structure Classification and Loop Modeling Using Multiple Ramachandran Distributions

    KAUST Repository

    Najibi, Seyed Morteza; Maadooliat, Mehdi; Zhou, Lan; Huang, Jianhua Z.; Gao, Xin

    2017-01-01

    Recently, the study of protein structures using angular representations has attracted much attention among structural biologists. The main challenge is how to efficiently model the continuous conformational space of the protein structures based on the differences and similarities between different Ramachandran plots. Despite the presence of statistical methods for modeling angular data of proteins, there is still a substantial need for more sophisticated and faster statistical tools to model the large-scale circular datasets. To address this need, we have developed a nonparametric method for collective estimation of multiple bivariate density functions for a collection of populations of protein backbone angles. The proposed method takes into account the circular nature of the angular data using trigonometric spline which is more efficient compared to existing methods. This collective density estimation approach is widely applicable when there is a need to estimate multiple density functions from different populations with common features. Moreover, the coefficients of adaptive basis expansion for the fitted densities provide a low-dimensional representation that is useful for visualization, clustering, and classification of the densities. The proposed method provides a novel and unique perspective to two important and challenging problems in protein structure research: structure-based protein classification and angular-sampling-based protein loop structure prediction.

  18. Many-electron model for multiple ionization in atomic collisions

    International Nuclear Information System (INIS)

    Archubi, C D; Montanari, C C; Miraglia, J E

    2007-01-01

    We have developed a many-electron model for multiple ionization of heavy atoms bombarded by bare ions. It is based on the transport equation for an ion in an inhomogeneous electronic density. Ionization probabilities are obtained by employing the shell-to-shell local plasma approximation with the Levine and Louie dielectric function to take into account the binding energy of each shell. Post-collisional contributions due to Auger-like processes are taken into account by employing recent photoemission data. Results for single-to-quadruple ionization of Ne, Ar, Kr and Xe by protons are presented showing a very good agreement with experimental data

  19. Many-electron model for multiple ionization in atomic collisions

    Energy Technology Data Exchange (ETDEWEB)

    Archubi, C D [Instituto de AstronomIa y Fisica del Espacio, Casilla de Correo 67, Sucursal 28 (C1428EGA) Buenos Aires (Argentina); Montanari, C C [Instituto de AstronomIa y Fisica del Espacio, Casilla de Correo 67, Sucursal 28 (C1428EGA) Buenos Aires (Argentina); Miraglia, J E [Instituto de AstronomIa y Fisica del Espacio, Casilla de Correo 67, Sucursal 28 (C1428EGA) Buenos Aires (Argentina)

    2007-03-14

    We have developed a many-electron model for multiple ionization of heavy atoms bombarded by bare ions. It is based on the transport equation for an ion in an inhomogeneous electronic density. Ionization probabilities are obtained by employing the shell-to-shell local plasma approximation with the Levine and Louie dielectric function to take into account the binding energy of each shell. Post-collisional contributions due to Auger-like processes are taken into account by employing recent photoemission data. Results for single-to-quadruple ionization of Ne, Ar, Kr and Xe by protons are presented showing a very good agreement with experimental data.

  20. Natural history of multiple sclerosis from the Indian perspective: Experience from a tertiary care hospital.

    Science.gov (United States)

    Jena, Subhransu S; Alexander, Mathew; Aaron, Sanjith; Mathew, Vivek; Thomas, Maya Mary; Patil, Anil K; Sivadasan, Ajith; Muthusamy, Karthik; Mani, Sunithi; Rebekah, J Grace

    2015-01-01

    Multiple sclerosis (MS) has a spectrum of heterogeneity, as seen in western and eastern hemispheres, in the clinical features, topography of involvement and differences in natural history. To study the clinical spectrum, imaging, and electrophysiological as well as cerebrospinal fluid (CSF) characteristics and correlate them with outcome. Retrospective analysis of MS patients during a period of 20 years. Cases were selected according to recent McDonald's criteria (2010), They were managed in the Department of Neurology, Christian Medical College, Vellore. Chi-square and Fisher's exact tests were used for categorical variables. Multiple binary logistic regressions were done to assess significance. Kaplan-Meier curves were drawn to estimate the time to irreversible disability. A total of 157 patients with female preponderance (55%) were included. The inter quartile range duration of follow-up was 9.1 (8.2, 11) years for 114 patients, who were included for final outcome analysis. Relapsing remitting MS (RRMS) (54.1%) was the most common type of MS seen. RRMS had a significantly better outcome (odds ratio: 0.12, 95% confidence interval: 0.02-0.57, P = 0.008) compared to progressive form of MS (primary progressive, secondary progressive). The Expanded Disability Status Scale score of patients at presentation and at final follow-up was 4.4 ± 1.31 and 4.1 ± 2.31, respectively. During the first presentation, polysymptomatic manifestations like motor and sphincteric involvement, incomplete recovery from the first attack; and, during the disease course, bowel, bladder, cerebellar and pyramidal affliction, predicted a worse outcome. A high incidence of optico-spinal presentation, predominance of RRMS and a low yield on cerebrospinal fluid (CSF) studies are the major findings of our study. A notable feature was the analysis of prognostic markers of disability.

  1. Multiple transfused thalassemia major: Ocular manifestations in a hospital-based population

    Directory of Open Access Journals (Sweden)

    Taneja Rashi

    2010-01-01

    Full Text Available Purpose: To study the ocular manifestations in multiple transfused beta-thalassemia major patients and assess the ocular side-effects of iron chelating agents. Materials and Methods: In this prospective observational study, 45 multiple transfused beta-thalassemia major children between six months and 21 years of age were enrolled and assigned groups according to the treatment regimens suggested. Group A received only blood transfusions, Group B blood transfusions with subcutaneous desferrioxamine, Group C blood transfusions with desferrioxamine and oral deferriprone and Group D blood transfusions with deferriprone. Ocular status at the time of enrolment was documented. Subjects were observed quarterly for one year for changes in ocular status arising due to the disease process and due to iron chelation therapy. Children with hemoglobinopathies other than beta-thalassemia major, congenital ocular anomalies and anemia due to other causes were excluded. Results: Ocular involvement was observed in 58% of patients. Lenticular opacities were the most common ocular finding (44%, followed by decreased visual acuity (33%. An increased occurrence of ocular changes was observed with increase of serum ferritin and serum iron levels as well as with higher number of blood transfusions received. Desferrioxamine seemed to have a protective influence on retinal pigment epithelium (RPE mottling. Occurrence of lenticular opacities and RPE degeneration correlated positively with use of desferrioxamine and deferriprone respectively. Follow-up of patients for one year did not reveal any change in ocular status. Conclusion: Regular ocular examinations can aid in preventing, delaying or ameliorating the ocular complications of thalassemia.

  2. Model selection in Bayesian segmentation of multiple DNA alignments.

    Science.gov (United States)

    Oldmeadow, Christopher; Keith, Jonathan M

    2011-03-01

    The analysis of multiple sequence alignments is allowing researchers to glean valuable insights into evolution, as well as identify genomic regions that may be functional, or discover novel classes of functional elements. Understanding the distribution of conservation levels that constitutes the evolutionary landscape is crucial to distinguishing functional regions from non-functional. Recent evidence suggests that a binary classification of evolutionary rates is inappropriate for this purpose and finds only highly conserved functional elements. Given that the distribution of evolutionary rates is multi-modal, determining the number of modes is of paramount concern. Through simulation, we evaluate the performance of a number of information criterion approaches derived from MCMC simulations in determining the dimension of a model. We utilize a deviance information criterion (DIC) approximation that is more robust than the approximations from other information criteria, and show our information criteria approximations do not produce superfluous modes when estimating conservation distributions under a variety of circumstances. We analyse the distribution of conservation for a multiple alignment comprising four primate species and mouse, and repeat this on two additional multiple alignments of similar species. We find evidence of six distinct classes of evolutionary rates that appear to be robust to the species used. Source code and data are available at http://dl.dropbox.com/u/477240/changept.zip.

  3. A multiple-location model for natural gas forward curves

    International Nuclear Information System (INIS)

    Buffington, J.C.

    1999-06-01

    This thesis presents an approach for financial modelling of natural gas in which connections between locations are incorporated and the complexities of forward curves in natural gas are considered. Apart from electricity, natural gas is the most volatile commodity traded. Its price is often dependent on the weather and price shocks can be felt across several geographic locations. This modelling approach incorporates multiple risk factors that correspond to various locations. One of the objectives was to determine if the model could be used for closed-form option prices. It was suggested that an adequate model for natural gas must consider 3 statistical properties: volatility term structure, backwardation and contango, and stochastic basis. Data from gas forward prices at Chicago, NYMEX and AECO were empirically tested to better understand these 3 statistical properties at each location and to verify if the proposed model truly incorporates these properties. In addition, this study examined the time series property of the difference of two locations (the basis) and determines that these empirical properties are consistent with the model properties. Closed-form option solutions were also developed for call options of forward contracts and call options on forward basis. The options were calibrated and compared to other models. The proposed model is capable of pricing options, but the prices derived did not pass the test of economic reasonableness. However, the model was able to capture the effect of transportation as well as aspects of seasonality which is a benefit over other existing models. It was determined that modifications will be needed regarding the estimation of the convenience yields. 57 refs., 2 tabs., 7 figs., 1 append

  4. Product-market differentiation: a strategic planning model for community hospitals.

    Science.gov (United States)

    Milch, R A

    1980-01-01

    Community hospitals would seem to have every reason to identify and capitalize on their product-market strengths. The strategic marketing/planning model provides a framework for rational analysis of the community hospital dilemma and for developing sensible solutions to the complex problems of accelerating hospital price-inflation.

  5. Multiplicative point process as a model of trading activity

    Science.gov (United States)

    Gontis, V.; Kaulakys, B.

    2004-11-01

    Signals consisting of a sequence of pulses show that inherent origin of the 1/ f noise is a Brownian fluctuation of the average interevent time between subsequent pulses of the pulse sequence. In this paper, we generalize the model of interevent time to reproduce a variety of self-affine time series exhibiting power spectral density S( f) scaling as a power of the frequency f. Furthermore, we analyze the relation between the power-law correlations and the origin of the power-law probability distribution of the signal intensity. We introduce a stochastic multiplicative model for the time intervals between point events and analyze the statistical properties of the signal analytically and numerically. Such model system exhibits power-law spectral density S( f)∼1/ fβ for various values of β, including β= {1}/{2}, 1 and {3}/{2}. Explicit expressions for the power spectra in the low-frequency limit and for the distribution density of the interevent time are obtained. The counting statistics of the events is analyzed analytically and numerically, as well. The specific interest of our analysis is related with the financial markets, where long-range correlations of price fluctuations largely depend on the number of transactions. We analyze the spectral density and counting statistics of the number of transactions. The model reproduces spectral properties of the real markets and explains the mechanism of power-law distribution of trading activity. The study provides evidence that the statistical properties of the financial markets are enclosed in the statistics of the time interval between trades. A multiplicative point process serves as a consistent model generating this statistics.

  6. Guideline validation in multiple trauma care through business process modeling.

    Science.gov (United States)

    Stausberg, Jürgen; Bilir, Hüseyin; Waydhas, Christian; Ruchholtz, Steffen

    2003-07-01

    Clinical guidelines can improve the quality of care in multiple trauma. In our Department of Trauma Surgery a specific guideline is available paper-based as a set of flowcharts. This format is appropriate for the use by experienced physicians but insufficient for electronic support of learning, workflow and process optimization. A formal and logically consistent version represented with a standardized meta-model is necessary for automatic processing. In our project we transferred the paper-based into an electronic format and analyzed the structure with respect to formal errors. Several errors were detected in seven error categories. The errors were corrected to reach a formally and logically consistent process model. In a second step the clinical content of the guideline was revised interactively using a process-modeling tool. Our study reveals that guideline development should be assisted by process modeling tools, which check the content in comparison to a meta-model. The meta-model itself could support the domain experts in formulating their knowledge systematically. To assure sustainability of guideline development a representation independent of specific applications or specific provider is necessary. Then, clinical guidelines could be used for eLearning, process optimization and workflow management additionally.

  7. Rank-based model selection for multiple ions quantum tomography

    International Nuclear Information System (INIS)

    Guţă, Mădălin; Kypraios, Theodore; Dryden, Ian

    2012-01-01

    The statistical analysis of measurement data has become a key component of many quantum engineering experiments. As standard full state tomography becomes unfeasible for large dimensional quantum systems, one needs to exploit prior information and the ‘sparsity’ properties of the experimental state in order to reduce the dimensionality of the estimation problem. In this paper we propose model selection as a general principle for finding the simplest, or most parsimonious explanation of the data, by fitting different models and choosing the estimator with the best trade-off between likelihood fit and model complexity. We apply two well established model selection methods—the Akaike information criterion (AIC) and the Bayesian information criterion (BIC)—two models consisting of states of fixed rank and datasets such as are currently produced in multiple ions experiments. We test the performance of AIC and BIC on randomly chosen low rank states of four ions, and study the dependence of the selected rank with the number of measurement repetitions for one ion states. We then apply the methods to real data from a four ions experiment aimed at creating a Smolin state of rank 4. By applying the two methods together with the Pearson χ 2 test we conclude that the data can be suitably described with a model whose rank is between 7 and 9. Additionally we find that the mean square error of the maximum likelihood estimator for pure states is close to that of the optimal over all possible measurements. (paper)

  8. Assessment of operative times of multiple surgical specialties in a public university hospital.

    Science.gov (United States)

    Costa, Altair da Silva

    2017-01-01

    To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urg

  9. Clinical, laboratory, and demographic determinants of hospitalization due to dengue in 7613 patients: A retrospective study based on hierarchical models.

    Science.gov (United States)

    da Silva, Natal Santos; Undurraga, Eduardo A; da Silva Ferreira, Elis Regina; Estofolete, Cássia Fernanda; Nogueira, Maurício Lacerda

    2018-01-01

    In Brazil, the incidence of hospitalization due to dengue, as an indicator of severity, has drastically increased since 1998. The objective of our study was to identify risk factors associated with subsequent hospitalization related to dengue. We analyzed 7613 dengue confirmed via serology (ELISA), non-structural protein 1, or polymerase chain reaction amplification. We used a hierarchical framework to generate a multivariate logistic regression based on a variety of risk variables. This was followed by multiple statistical analyses to assess hierarchical model accuracy, variance, goodness of fit, and whether or not this model reliably represented the population. The final model, which included age, sex, ethnicity, previous dengue infection, hemorrhagic manifestations, plasma leakage, and organ failure, showed that all measured parameters, with the exception of previous dengue, were statistically significant. The presence of organ failure was associated with the highest risk of subsequent dengue hospitalization (OR=5·75; CI=3·53-9·37). Therefore, plasma leakage and organ failure were the main indicators of hospitalization due to dengue, although other variables of minor importance should also be considered to refer dengue patients to hospital treatment, which may lead to a reduction in avoidable deaths as well as costs related to dengue. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. A Hybrid Multiple Criteria Decision Making Model for Supplier Selection

    Directory of Open Access Journals (Sweden)

    Chung-Min Wu

    2013-01-01

    Full Text Available The sustainable supplier selection would be the vital part in the management of a sustainable supply chain. In this study, a hybrid multiple criteria decision making (MCDM model is applied to select optimal supplier. The fuzzy Delphi method, which can lead to better criteria selection, is used to modify criteria. Considering the interdependence among the selection criteria, analytic network process (ANP is then used to obtain their weights. To avoid calculation and additional pairwise comparisons of ANP, a technique for order preference by similarity to ideal solution (TOPSIS is used to rank the alternatives. The use of a combination of the fuzzy Delphi method, ANP, and TOPSIS, proposing an MCDM model for supplier selection, and applying these to a real case are the unique features of this study.

  11. Multiple Scattering Model for Optical Coherence Tomography with Rytov Approximation

    KAUST Repository

    Li, Muxingzi

    2017-04-24

    Optical Coherence Tomography (OCT) is a coherence-gated, micrometer-resolution imaging technique that focuses a broadband near-infrared laser beam to penetrate into optical scattering media, e.g. biological tissues. The OCT resolution is split into two parts, with the axial resolution defined by half the coherence length, and the depth-dependent lateral resolution determined by the beam geometry, which is well described by a Gaussian beam model. The depth dependence of lateral resolution directly results in the defocusing effect outside the confocal region and restricts current OCT probes to small numerical aperture (NA) at the expense of lateral resolution near the focus. Another limitation on OCT development is the presence of a mixture of speckles due to multiple scatterers within the coherence length, and other random noise. Motivated by the above two challenges, a multiple scattering model based on Rytov approximation and Gaussian beam optics is proposed for the OCT setup. Some previous papers have adopted the first Born approximation with the assumption of small perturbation of the incident field in inhomogeneous media. The Rytov method of the same order with smooth phase perturbation assumption benefits from a wider spatial range of validity. A deconvolution method for solving the inverse problem associated with the first Rytov approximation is developed, significantly reducing the defocusing effect through depth and therefore extending the feasible range of NA.

  12. Resveratrol Neuroprotection in a Chronic Mouse Model of Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Zoe eFonseca-Kelly

    2012-05-01

    Full Text Available Resveratrol is a naturally-occurring polyphenol that activates SIRT1, an NAD-dependent deacetylase. SRT501, a pharmaceutical formulation of resveratrol with enhanced systemic absorption, prevents neuronal loss without suppressing inflammation in mice with relapsing experimental autoimmune encephalomyelitis (EAE, a model of multiple sclerosis. In contrast, resveratrol has been reported to suppress inflammation in chronic EAE, although neuroprotective effects were not evaluated. The current studies examine potential neuroprotective and immunomodulatory effects of resveratrol in chronic EAE induced by immunization with myelin oligodendroglial glycoprotein peptide in C57/Bl6 mice. Effects of two distinct formulations of resveratrol administered daily orally were compared. Resveratrol delayed the onset of EAE compared to vehicle-treated EAE mice, but did not prevent or alter the phenotype of inflammation in spinal cords or optic nerves. Significant neuroprotective effects were observed, with higher numbers of retinal ganglion cells found in eyes of resveratrol-treated EAE mice with optic nerve inflammation. Results demonstrate that resveratrol prevents neuronal loss in this chronic demyelinating disease model, similar to its effects in relapsing EAE. Differences in immunosuppression compared with prior studies suggest that immunomodulatory effects may be limited and may depend on specific immunization parameters or timing of treatment. Importantly, neuroprotective effects can occur without immunosuppression, suggesting a potential additive benefit of resveratrol in combination with anti-inflammatory therapies for multiple sclerosis.

  13. Model for CO2 leakage including multiple geological layers and multiple leaky wells.

    Science.gov (United States)

    Nordbotten, Jan M; Kavetski, Dmitri; Celia, Michael A; Bachu, Stefan

    2009-02-01

    Geological storage of carbon dioxide (CO2) is likely to be an integral component of any realistic plan to reduce anthropogenic greenhouse gas emissions. In conjunction with large-scale deployment of carbon storage as a technology, there is an urgent need for tools which provide reliable and quick assessments of aquifer storage performance. Previously, abandoned wells from over a century of oil and gas exploration and production have been identified as critical potential leakage paths. The practical importance of abandoned wells is emphasized by the correlation of heavy CO2 emitters (typically associated with industrialized areas) to oil and gas producing regions in North America. Herein, we describe a novel framework for predicting the leakage from large numbers of abandoned wells, forming leakage paths connecting multiple subsurface permeable formations. The framework is designed to exploit analytical solutions to various components of the problem and, ultimately, leads to a grid-free approximation to CO2 and brine leakage rates, as well as fluid distributions. We apply our model in a comparison to an established numerical solverforthe underlying governing equations. Thereafter, we demonstrate the capabilities of the model on typical field data taken from the vicinity of Edmonton, Alberta. This data set consists of over 500 wells and 7 permeable formations. Results show the flexibility and utility of the solution methods, and highlight the role that analytical and semianalytical solutions can play in this important problem.

  14. A Multiple Indicators Multiple Causes (MIMIC) model of internal barriers to drug treatment in China.

    Science.gov (United States)

    Qi, Chang; Kelly, Brian C; Liao, Yanhui; He, Haoyu; Luo, Tao; Deng, Huiqiong; Liu, Tieqiao; Hao, Wei; Wang, Jichuan

    2015-03-01

    Although evidence exists for distinct barriers to drug abuse treatment (BDATs), investigations of their inter-relationships and the effect of individual characteristics on the barrier factors have been sparse, especially in China. A Multiple Indicators Multiple Causes (MIMIC) model is applied for this target. A sample of 262 drug users were recruited from three drug rehabilitation centers in Hunan Province, China. We applied a MIMIC approach to investigate the effect of gender, age, marital status, education, primary substance use, duration of primary drug use, and drug treatment experience on the internal barrier factors: absence of problem (AP), negative social support (NSS), fear of treatment (FT), and privacy concerns (PC). Drug users of various characteristics were found to report different internal barrier factors. Younger participants were more likely to report NSS (-0.19, p=0.038) and PC (-0.31, p<0.001). Compared to other drug users, ice users were more likely to report AP (0.44, p<0.001) and NSS (0.25, p=0.010). Drug treatment experiences related to AP (0.20, p=0.012). In addition, differential item functioning (DIF) occurred in three items when participant from groups with different duration of drug use, ice use, or marital status. Individual characteristics had significant effects on internal barriers to drug treatment. On this basis, BDAT perceived by different individuals could be assessed before tactics were utilized to successfully remove perceived barriers to drug treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Multiple-relaxation-time lattice Boltzmann model for compressible fluids

    International Nuclear Information System (INIS)

    Chen Feng; Xu Aiguo; Zhang Guangcai; Li Yingjun

    2011-01-01

    We present an energy-conserving multiple-relaxation-time finite difference lattice Boltzmann model for compressible flows. The collision step is first calculated in the moment space and then mapped back to the velocity space. The moment space and corresponding transformation matrix are constructed according to the group representation theory. Equilibria of the nonconserved moments are chosen according to the need of recovering compressible Navier-Stokes equations through the Chapman-Enskog expansion. Numerical experiments showed that compressible flows with strong shocks can be well simulated by the present model. The new model works for both low and high speeds compressible flows. It contains more physical information and has better numerical stability and accuracy than its single-relaxation-time version. - Highlights: → We present an energy-conserving MRT finite-difference LB model. → The moment space is constructed according to the group representation theory. → The new model works for both low and high speeds compressible flows. → It has better numerical stability and wider applicable range than its SRT version.

  16. Optimal Retail Price Model for Partial Consignment to Multiple Retailers

    Directory of Open Access Journals (Sweden)

    Po-Yu Chen

    2017-01-01

    Full Text Available This paper investigates the product pricing decision-making problem under a consignment stock policy in a two-level supply chain composed of one supplier and multiple retailers. The effects of the supplier’s wholesale prices and its partial inventory cost absorption of the retail prices of retailers with different market shares are investigated. In the partial product consignment model this paper proposes, the seller and the retailers each absorb part of the inventory costs. This model also provides general solutions for the complete product consignment and the traditional policy that adopts no product consignment. In other words, both the complete consignment and nonconsignment models are extensions of the proposed model (i.e., special cases. Research results indicated that the optimal retail price must be between 1/2 (50% and 2/3 (66.67% times the upper limit of the gross profit. This study also explored the results and influence of parameter variations on optimal retail price in the model.

  17. Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

    Directory of Open Access Journals (Sweden)

    Shadi Baniasadi

    Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

  18. Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

    Directory of Open Access Journals (Sweden)

    Shadi Baniasadi

    2013-02-01

    Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

  19. A methodology model for quality management in a general hospital.

    Science.gov (United States)

    Stern, Z; Naveh, E

    1997-01-01

    A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts.

  20. A latent class multiple constraint multiple discrete-continuous extreme value model of time use and goods consumption.

    Science.gov (United States)

    2016-06-01

    This paper develops a microeconomic theory-based multiple discrete continuous choice model that considers: (a) that both goods consumption and time allocations (to work and non-work activities) enter separately as decision variables in the utility fu...

  1. Using hidden Markov models to align multiple sequences.

    Science.gov (United States)

    Mount, David W

    2009-07-01

    A hidden Markov model (HMM) is a probabilistic model of a multiple sequence alignment (msa) of proteins. In the model, each column of symbols in the alignment is represented by a frequency distribution of the symbols (called a "state"), and insertions and deletions are represented by other states. One moves through the model along a particular path from state to state in a Markov chain (i.e., random choice of next move), trying to match a given sequence. The next matching symbol is chosen from each state, recording its probability (frequency) and also the probability of going to that state from a previous one (the transition probability). State and transition probabilities are multiplied to obtain a probability of the given sequence. The hidden nature of the HMM is due to the lack of information about the value of a specific state, which is instead represented by a probability distribution over all possible values. This article discusses the advantages and disadvantages of HMMs in msa and presents algorithms for calculating an HMM and the conditions for producing the best HMM.

  2. Analysis and application of opinion model with multiple topic interactions.

    Science.gov (United States)

    Xiong, Fei; Liu, Yun; Wang, Liang; Wang, Ximeng

    2017-08-01

    To reveal heterogeneous behaviors of opinion evolution in different scenarios, we propose an opinion model with topic interactions. Individual opinions and topic features are represented by a multidimensional vector. We measure an agent's action towards a specific topic by the product of opinion and topic feature. When pairs of agents interact for a topic, their actions are introduced to opinion updates with bounded confidence. Simulation results show that a transition from a disordered state to a consensus state occurs at a critical point of the tolerance threshold, which depends on the opinion dimension. The critical point increases as the dimension of opinions increases. Multiple topics promote opinion interactions and lead to the formation of macroscopic opinion clusters. In addition, more topics accelerate the evolutionary process and weaken the effect of network topology. We use two sets of large-scale real data to evaluate the model, and the results prove its effectiveness in characterizing a real evolutionary process. Our model achieves high performance in individual action prediction and even outperforms state-of-the-art methods. Meanwhile, our model has much smaller computational complexity. This paper provides a demonstration for possible practical applications of theoretical opinion dynamics.

  3. Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases.

    Science.gov (United States)

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

    2014-09-01

    The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease.

    Science.gov (United States)

    Chouinard, Maud-Christine; Robichaud-Ekstrand, Sylvie

    2007-02-01

    Several authors have questioned the transtheoretical model. Determining the predictive value of each cognitive-behavioural element within this model could explain the multiple successes reported in smoking cessation programmes. The purpose of this study was to predict point-prevalent smoking abstinence at 2 and 6 months, using the constructs of the transtheoretical model, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. The study follows a predictive correlation design. Recently hospitalized patients (n=168) with cardiovascular disease were pooled from a randomized, controlled trial. Independent variables of the predictive transtheoretical model comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. Compared to smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-re-evaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy and stages of change at baseline were predictive of smoking abstinence after 6 months. Other variables found to be predictive of smoking abstinence at 6 months were an increase in self-efficacy; an increase in positive social support behaviour and a decrease of the pros within the decisional balance. The results partially support the predictive value of the transtheoretical model constructs in smoking cessation for cardiovascular disease patients.

  5. A cost management model for hospital food and nutrition in a public hospital.

    Science.gov (United States)

    Neriz, Liliana; Núñez, Alicia; Ramis, Francisco

    2014-11-13

    In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

  6. Direction of Effects in Multiple Linear Regression Models.

    Science.gov (United States)

    Wiedermann, Wolfgang; von Eye, Alexander

    2015-01-01

    Previous studies analyzed asymmetric properties of the Pearson correlation coefficient using higher than second order moments. These asymmetric properties can be used to determine the direction of dependence in a linear regression setting (i.e., establish which of two variables is more likely to be on the outcome side) within the framework of cross-sectional observational data. Extant approaches are restricted to the bivariate regression case. The present contribution extends the direction of dependence methodology to a multiple linear regression setting by analyzing distributional properties of residuals of competing multiple regression models. It is shown that, under certain conditions, the third central moments of estimated regression residuals can be used to decide upon direction of effects. In addition, three different approaches for statistical inference are discussed: a combined D'Agostino normality test, a skewness difference test, and a bootstrap difference test. Type I error and power of the procedures are assessed using Monte Carlo simulations, and an empirical example is provided for illustrative purposes. In the discussion, issues concerning the quality of psychological data, possible extensions of the proposed methods to the fourth central moment of regression residuals, and potential applications are addressed.

  7. Investigating multiple solutions in the constrained minimal supersymmetric standard model

    Energy Technology Data Exchange (ETDEWEB)

    Allanach, B.C. [DAMTP, CMS, University of Cambridge,Wilberforce Road, Cambridge, CB3 0HA (United Kingdom); George, Damien P. [DAMTP, CMS, University of Cambridge,Wilberforce Road, Cambridge, CB3 0HA (United Kingdom); Cavendish Laboratory, University of Cambridge,JJ Thomson Avenue, Cambridge, CB3 0HE (United Kingdom); Nachman, Benjamin [SLAC, Stanford University,2575 Sand Hill Rd, Menlo Park, CA 94025 (United States)

    2014-02-07

    Recent work has shown that the Constrained Minimal Supersymmetric Standard Model (CMSSM) can possess several distinct solutions for certain values of its parameters. The extra solutions were not previously found by public supersymmetric spectrum generators because fixed point iteration (the algorithm used by the generators) is unstable in the neighbourhood of these solutions. The existence of the additional solutions calls into question the robustness of exclusion limits derived from collider experiments and cosmological observations upon the CMSSM, because limits were only placed on one of the solutions. Here, we map the CMSSM by exploring its multi-dimensional parameter space using the shooting method, which is not subject to the stability issues which can plague fixed point iteration. We are able to find multiple solutions where in all previous literature only one was found. The multiple solutions are of two distinct classes. One class, close to the border of bad electroweak symmetry breaking, is disfavoured by LEP2 searches for neutralinos and charginos. The other class has sparticles that are heavy enough to evade the LEP2 bounds. Chargino masses may differ by up to around 10% between the different solutions, whereas other sparticle masses differ at the sub-percent level. The prediction for the dark matter relic density can vary by a hundred percent or more between the different solutions, so analyses employing the dark matter constraint are incomplete without their inclusion.

  8. Characterising and modelling regolith stratigraphy using multiple geophysical techniques

    Science.gov (United States)

    Thomas, M.; Cremasco, D.; Fotheringham, T.; Hatch, M. A.; Triantifillis, J.; Wilford, J.

    2013-12-01

    Regolith is the weathered, typically mineral-rich layer from fresh bedrock to land surface. It encompasses soil (A, E and B horizons) that has undergone pedogenesis. Below is the weathered C horizon that retains at least some of the original rocky fabric and structure. At the base of this is the lower regolith boundary of continuous hard bedrock (the R horizon). Regolith may be absent, e.g. at rocky outcrops, or may be many 10's of metres deep. Comparatively little is known about regolith, and critical questions remain regarding composition and characteristics - especially deeper where the challenge of collecting reliable data increases with depth. In Australia research is underway to characterise and map regolith using consistent methods at scales ranging from local (e.g. hillslope) to continental scales. These efforts are driven by many research needs, including Critical Zone modelling and simulation. Pilot research in South Australia using digitally-based environmental correlation techniques modelled the depth to bedrock to 9 m for an upland area of 128 000 ha. One finding was the inability to reliably model local scale depth variations over horizontal distances of 2 - 3 m and vertical distances of 1 - 2 m. The need to better characterise variations in regolith to strengthen models at these fine scales was discussed. Addressing this need, we describe high intensity, ground-based multi-sensor geophysical profiling of three hillslope transects in different regolith-landscape settings to characterise fine resolution (i.e. a number of frequencies; multiple frequency, multiple coil electromagnetic induction; and high resolution resistivity. These were accompanied by georeferenced, closely spaced deep cores to 9 m - or to core refusal. The intact cores were sub-sampled to standard depths and analysed for regolith properties to compile core datasets consisting of: water content; texture; electrical conductivity; and weathered state. After preprocessing (filtering, geo

  9. Development Customer Knowledge Management (Ckm) Models in Purbalingga Hospitality Using Soft Systems Methodology (Ssm)

    OpenAIRE

    Chasanah, Nur; Sensuse, Dana Indra; Lusa, Jonathan Sofian

    2014-01-01

    Development of the tourism sector is part of the national development efforts that are being implemented in Indonesia. This research was conducted with the customer to make an overview of knowledge management models to address the existing problems in hospitality in the hospitality Purbalingga as supporting tourism Purbalingga. The model depicts a series of problem-solving activities that result in the hospitality, especially in Purbalingga. This research was action research with methods of S...

  10. Interaction of multiple biomimetic antimicrobial polymers with model bacterial membranes

    Energy Technology Data Exchange (ETDEWEB)

    Baul, Upayan, E-mail: upayanb@imsc.res.in; Vemparala, Satyavani, E-mail: vani@imsc.res.in [The Institute of Mathematical Sciences, C.I.T. Campus, Taramani, Chennai 600113 (India); Kuroda, Kenichi, E-mail: kkuroda@umich.edu [Department of Biologic and Materials Sciences, University of Michigan School of Dentistry, Ann Arbor, Michigan 48109 (United States)

    2014-08-28

    Using atomistic molecular dynamics simulations, interaction of multiple synthetic random copolymers based on methacrylates on prototypical bacterial membranes is investigated. The simulations show that the cationic polymers form a micellar aggregate in water phase and the aggregate, when interacting with the bacterial membrane, induces clustering of oppositely charged anionic lipid molecules to form clusters and enhances ordering of lipid chains. The model bacterial membrane, consequently, develops lateral inhomogeneity in membrane thickness profile compared to polymer-free system. The individual polymers in the aggregate are released into the bacterial membrane in a phased manner and the simulations suggest that the most probable location of the partitioned polymers is near the 1-palmitoyl-2-oleoyl-phosphatidylglycerol (POPG) clusters. The partitioned polymers preferentially adopt facially amphiphilic conformations at lipid-water interface, despite lacking intrinsic secondary structures such as α-helix or β-sheet found in naturally occurring antimicrobial peptides.

  11. BUSINESS MODEL IN THE HOSPITALITY INDUSTRY, FROM TRADITIONAL TO OPEN INNOVATION

    Directory of Open Access Journals (Sweden)

    Mihaela DIACONU

    2017-07-01

    Full Text Available The paper highlights the importance of information and communication technology in valorising the behavior of the tourism consumer by including it in new business models.The business model is considered a form of innovation to gain value for all stakeholders in the hospitality industry. On the basis of the very rich specialty literature, the paper presents the particularities of the model of hospitality industry, both the traditional model and the innovative business model.

  12. The intergenerational multiple deficit model and the case of dyslexia

    Directory of Open Access Journals (Sweden)

    Elsje evan Bergen

    2014-06-01

    Full Text Available Which children go on to develop dyslexia? Since dyslexia has a multifactorial aetiology, this question can be restated as: What are the factors that put children at high risk for developing dyslexia? It is argued that a useful theoretical framework to address this question is Pennington’s (2006 multiple deficit model (MDM. This model replaces models that attribute dyslexia to a single underlying cause. Subsequently, the generalist genes hypothesis for learning (disabilities (Plomin & Kovas, 2005 is described and integrated with the MDM. Finally, findings are presented from a longitudinal study with children at family risk for dyslexia. Such studies can contribute to testing and specifying the MDM. In this study, risk factors at both the child and family level were investigated. This led to the proposed intergenerational MDM, in which both parents confer liability via intertwined genetic and environmental pathways. Future scientific directions are discussed to investigate parent-offspring resemblance and transmission patterns, which will shed new light on disorder aetiology.

  13. An Advanced N -body Model for Interacting Multiple Stellar Systems

    Energy Technology Data Exchange (ETDEWEB)

    Brož, Miroslav [Astronomical Institute of the Charles University, Faculty of Mathematics and Physics, V Holešovičkách 2, CZ-18000 Praha 8 (Czech Republic)

    2017-06-01

    We construct an advanced model for interacting multiple stellar systems in which we compute all trajectories with a numerical N -body integrator, namely the Bulirsch–Stoer from the SWIFT package. We can then derive various observables: astrometric positions, radial velocities, minima timings (TTVs), eclipse durations, interferometric visibilities, closure phases, synthetic spectra, spectral energy distribution, and even complete light curves. We use a modified version of the Wilson–Devinney code for the latter, in which the instantaneous true phase and inclination of the eclipsing binary are governed by the N -body integration. If all of these types of observations are at one’s disposal, a joint χ {sup 2} metric and an optimization algorithm (a simplex or simulated annealing) allow one to search for a global minimum and construct very robust models of stellar systems. At the same time, our N -body model is free from artifacts that may arise if mutual gravitational interactions among all components are not self-consistently accounted for. Finally, we present a number of examples showing dynamical effects that can be studied with our code and we discuss how systematic errors may affect the results (and how to prevent this from happening).

  14. Negative binomial models for abundance estimation of multiple closed populations

    Science.gov (United States)

    Boyce, Mark S.; MacKenzie, Darry I.; Manly, Bryan F.J.; Haroldson, Mark A.; Moody, David W.

    2001-01-01

    Counts of uniquely identified individuals in a population offer opportunities to estimate abundance. However, for various reasons such counts may be burdened by heterogeneity in the probability of being detected. Theoretical arguments and empirical evidence demonstrate that the negative binomial distribution (NBD) is a useful characterization for counts from biological populations with heterogeneity. We propose a method that focuses on estimating multiple populations by simultaneously using a suite of models derived from the NBD. We used this approach to estimate the number of female grizzly bears (Ursus arctos) with cubs-of-the-year in the Yellowstone ecosystem, for each year, 1986-1998. Akaike's Information Criteria (AIC) indicated that a negative binomial model with a constant level of heterogeneity across all years was best for characterizing the sighting frequencies of female grizzly bears. A lack-of-fit test indicated the model adequately described the collected data. Bootstrap techniques were used to estimate standard errors and 95% confidence intervals. We provide a Monte Carlo technique, which confirms that the Yellowstone ecosystem grizzly bear population increased during the period 1986-1998.

  15. A diagnostic tree model for polytomous responses with multiple strategies.

    Science.gov (United States)

    Ma, Wenchao

    2018-04-23

    Constructed-response items have been shown to be appropriate for cognitively diagnostic assessments because students' problem-solving procedures can be observed, providing direct evidence for making inferences about their proficiency. However, multiple strategies used by students make item scoring and psychometric analyses challenging. This study introduces the so-called two-digit scoring scheme into diagnostic assessments to record both students' partial credits and their strategies. This study also proposes a diagnostic tree model (DTM) by integrating the cognitive diagnosis models with the tree model to analyse the items scored using the two-digit rubrics. Both convergent and divergent tree structures are considered to accommodate various scoring rules. The MMLE/EM algorithm is used for item parameter estimation of the DTM, and has been shown to provide good parameter recovery under varied conditions in a simulation study. A set of data from TIMSS 2007 mathematics assessment is analysed to illustrate the use of the two-digit scoring scheme and the DTM. © 2018 The British Psychological Society.

  16. A minimal model for multiple epidemics and immunity spreading.

    Directory of Open Access Journals (Sweden)

    Kim Sneppen

    Full Text Available Pathogens and parasites are ubiquitous in the living world, being limited only by availability of suitable hosts. The ability to transmit a particular disease depends on competing infections as well as on the status of host immunity. Multiple diseases compete for the same resource and their fate is coupled to each other. Such couplings have many facets, for example cross-immunization between related influenza strains, mutual inhibition by killing the host, or possible even a mutual catalytic effect if host immunity is impaired. We here introduce a minimal model for an unlimited number of unrelated pathogens whose interaction is simplified to simple mutual exclusion. The model incorporates an ongoing development of host immunity to past diseases, while leaving the system open for emergence of new diseases. The model exhibits a rich dynamical behavior with interacting infection waves, leaving broad trails of immunization in the host population. This obtained immunization pattern depends only on the system size and on the mutation rate that initiates new diseases.

  17. A minimal model for multiple epidemics and immunity spreading.

    Science.gov (United States)

    Sneppen, Kim; Trusina, Ala; Jensen, Mogens H; Bornholdt, Stefan

    2010-10-18

    Pathogens and parasites are ubiquitous in the living world, being limited only by availability of suitable hosts. The ability to transmit a particular disease depends on competing infections as well as on the status of host immunity. Multiple diseases compete for the same resource and their fate is coupled to each other. Such couplings have many facets, for example cross-immunization between related influenza strains, mutual inhibition by killing the host, or possible even a mutual catalytic effect if host immunity is impaired. We here introduce a minimal model for an unlimited number of unrelated pathogens whose interaction is simplified to simple mutual exclusion. The model incorporates an ongoing development of host immunity to past diseases, while leaving the system open for emergence of new diseases. The model exhibits a rich dynamical behavior with interacting infection waves, leaving broad trails of immunization in the host population. This obtained immunization pattern depends only on the system size and on the mutation rate that initiates new diseases.

  18. Modeling Pan Evaporation for Kuwait by Multiple Linear Regression

    Science.gov (United States)

    Almedeij, Jaber

    2012-01-01

    Evaporation is an important parameter for many projects related to hydrology and water resources systems. This paper constitutes the first study conducted in Kuwait to obtain empirical relations for the estimation of daily and monthly pan evaporation as functions of available meteorological data of temperature, relative humidity, and wind speed. The data used here for the modeling are daily measurements of substantial continuity coverage, within a period of 17 years between January 1993 and December 2009, which can be considered representative of the desert climate of the urban zone of the country. Multiple linear regression technique is used with a procedure of variable selection for fitting the best model forms. The correlations of evaporation with temperature and relative humidity are also transformed in order to linearize the existing curvilinear patterns of the data by using power and exponential functions, respectively. The evaporation models suggested with the best variable combinations were shown to produce results that are in a reasonable agreement with observation values. PMID:23226984

  19. Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals.

    Science.gov (United States)

    Hayden, Melanie G; Hughes, Samuel; Hahn, Edward J; Aryan, Henry E; Levy, Michael L; Jandial, Rahul

    2011-01-01

    A myriad of geopolitical and financial obstacles have kept modern neurosurgery from effectively reaching the citizens of the developing world. Targeted neurosurgical outreach by academic neurosurgeons to equip neurosurgical operating theaters and train local neurosurgeons is one method to efficiently and cost effectively improve sustainable care provided by international charity hospitals. The International Neurosurgical Children's Association (INCA) effectively improved the available neurosurgical care in the Maria Auxiliadora Hospital of Lima, Peru through the advancement of local specialist education and training. Neurosurgical equipment and training were provided for the local neurosurgeons by a mission team from the University of California at San Diego. At the end of 3 years, with one intensive week trip per year, the host neurosurgeons were proficiently and independently applying microsurgical techniques to previously performed operations, and performing newly learned operations such as neuroendoscopy and minimally invasive neurosurgery. Our experiences may serve as a successful template for the execution of other small scale, sustainable neurosurgery missions worldwide.

  20. Evaluating organizational change in health care: the patient-centered hospital model.

    Science.gov (United States)

    Fiorio, Carlo V; Gorli, Mara; Verzillo, Stefano

    2018-02-08

    An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both

  1. Decreasing Multicollinearity: A Method for Models with Multiplicative Functions.

    Science.gov (United States)

    Smith, Kent W.; Sasaki, M. S.

    1979-01-01

    A method is proposed for overcoming the problem of multicollinearity in multiple regression equations where multiplicative independent terms are entered. The method is not a ridge regression solution. (JKS)

  2. System health monitoring using multiple-model adaptive estimation techniques

    Science.gov (United States)

    Sifford, Stanley Ryan

    Monitoring system health for fault detection and diagnosis by tracking system parameters concurrently with state estimates is approached using a new multiple-model adaptive estimation (MMAE) method. This novel method is called GRid-based Adaptive Parameter Estimation (GRAPE). GRAPE expands existing MMAE methods by using new techniques to sample the parameter space. GRAPE expands on MMAE with the hypothesis that sample models can be applied and resampled without relying on a predefined set of models. GRAPE is initially implemented in a linear framework using Kalman filter models. A more generalized GRAPE formulation is presented using extended Kalman filter (EKF) models to represent nonlinear systems. GRAPE can handle both time invariant and time varying systems as it is designed to track parameter changes. Two techniques are presented to generate parameter samples for the parallel filter models. The first approach is called selected grid-based stratification (SGBS). SGBS divides the parameter space into equally spaced strata. The second approach uses Latin Hypercube Sampling (LHS) to determine the parameter locations and minimize the total number of required models. LHS is particularly useful when the parameter dimensions grow. Adding more parameters does not require the model count to increase for LHS. Each resample is independent of the prior sample set other than the location of the parameter estimate. SGBS and LHS can be used for both the initial sample and subsequent resamples. Furthermore, resamples are not required to use the same technique. Both techniques are demonstrated for both linear and nonlinear frameworks. The GRAPE framework further formalizes the parameter tracking process through a general approach for nonlinear systems. These additional methods allow GRAPE to either narrow the focus to converged values within a parameter range or expand the range in the appropriate direction to track the parameters outside the current parameter range boundary

  3. Shared mental models of integrated care: aligning multiple stakeholder perspectives.

    Science.gov (United States)

    Evans, Jenna M; Baker, G Ross

    2012-01-01

    Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter-organizational and inter-professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration. The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration-task, system-role, and integration-belief. The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory-based framework of psychological factors that may influence inter-organizational and inter-professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care. MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care. Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

  4. Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

    Science.gov (United States)

    Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine

    2017-03-01

    While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Eye Movement Abnormalities in Multiple Sclerosis: Pathogenesis, Modeling, and Treatment

    Directory of Open Access Journals (Sweden)

    Alessandro Serra

    2018-02-01

    Full Text Available Multiple sclerosis (MS commonly causes eye movement abnormalities that may have a significant impact on patients’ disability. Inflammatory demyelinating lesions, especially occurring in the posterior fossa, result in a wide range of disorders, spanning from acquired pendular nystagmus (APN to internuclear ophthalmoplegia (INO, among the most common. As the control of eye movements is well understood in terms of anatomical substrate and underlying physiological network, studying ocular motor abnormalities in MS provides a unique opportunity to gain insights into mechanisms of disease. Quantitative measurement and modeling of eye movement disorders, such as INO, may lead to a better understanding of common symptoms encountered in MS, such as Uhthoff’s phenomenon and fatigue. In turn, the pathophysiology of a range of eye movement abnormalities, such as APN, has been clarified based on correlation of experimental model with lesion localization by neuroimaging in MS. Eye movement disorders have the potential of being utilized as structural and functional biomarkers of early cognitive deficit, and possibly help in assessing disease status and progression, and to serve as platform and functional outcome to test novel therapeutic agents for MS. Knowledge of neuropharmacology applied to eye movement dysfunction has guided testing and use of a number of pharmacological agents to treat some eye movement disorders found in MS, such as APN and other forms of central nystagmus.

  6. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team.

    Science.gov (United States)

    Harrison, David A; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B; Gwinnutt, Carl; Nolan, Jerry P; Rowan, Kathryn M

    2014-08-01

    The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Risk models for two outcomes-return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge-were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC>20min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC>20min (c index 0.81 versus 0.72). Validated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  7. Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team☆

    Science.gov (United States)

    Harrison, David A.; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B.; Gwinnutt, Carl; Nolan, Jerry P.; Rowan, Kathryn M.

    2014-01-01

    Aim The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Methods Risk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20 min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. Results 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC > 20 min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC > 20 min (c index 0.81 versus 0.72). Conclusions Validated risk models for ROSC > 20 min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. PMID:24830872

  8. Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks.

    Science.gov (United States)

    Coiera, Enrico; Wang, Ying; Magrabi, Farah; Concha, Oscar Perez; Gallego, Blanca; Runciman, William

    2014-05-21

    Current prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models. Patients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria. There was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known 'weekend-effect' where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94). Risks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual's hospitalization. Combining disease specific models with such time varying- estimates appears to

  9. Geography of hospital admissions for multiple sclerosis in England and comparison with the geography of hospital admissions for infectious mononucleosis: a descriptive study

    Science.gov (United States)

    Ramagopalan, Sreeram V; Hoang, Uy; Seagroatt, Valerie; Handel, Adam; Ebers, George C; Giovannoni, Gavin

    2011-01-01

    Objective It is well recognised that variation in the geographical distribution of multiple sclerosis (MS) exists. Early studies in England have shown the disease to have been more common in the North than the South. However, this could be an artefact of inaccurate diagnosis and ascertainment, and recent data on MS prevalence are lacking. In the present study, data were analysed to provide a more contemporary map of the distribution of MS in England and, as infectious mononucleosis (IM) has been shown to be associated with the risk of MS, the geographical distribution of IM with that of MS was compared. Methods Analysis of linked statistical abstracts of hospital data for England between 1999 and 2005. Results There were 56 681 MS patients. The admission rate for MS was higher in females (22/105; 95% CI 21.8 to 22.3) than males (10.4/105; 95% CI 10.2 to 10.5). The highest admission rate for MS was seen for residents of Cumbria and Lancashire (North of England) (20.1/105; 95% CI 19.3 to 20.8) and the lowest admission rate was for North West London residents (South of England) (12.4/105; 95% CI 11.8 to 13.1). The geographical distributions of IM and MS were significantly correlated (weighted regression coefficient (r (w))=0.70, p<0.0001). Admission rates for MS were lowest in the area quintile with the highest level of deprivation and they were also lowest in the area quintile with the highest percentage of population born outside the UK. A significant association between northernliness and MS remained after adjustment for deprivation and UK birthplace. Conclusions The results show the continued existence of a latitude gradient for MS in England and show a correlation with the distribution of IM. The data have implications for healthcare provision, because lifetime costs of MS exceed £1 million per case in the UK, as well as for studies of disease causality and prevention. PMID:21212107

  10. Prioritizing public- private partnership models for public hospitals of iran based on performance indicators.

    Science.gov (United States)

    Gholamzadeh Nikjoo, Raana; Jabbari Beyrami, Hossein; Jannati, Ali; Asghari Jaafarabadi, Mohammad

    2012-01-01

    The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software's. In quality - effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial - efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri¬oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in¬dicator areas. This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.

  11. Mathematical Modeling of Loop Heat Pipes with Multiple Capillary Pumps and Multiple Condensers. Part 1; Stead State Stimulations

    Science.gov (United States)

    Hoang, Triem T.; OConnell, Tamara; Ku, Jentung

    2004-01-01

    Loop Heat Pipes (LHPs) have proven themselves as reliable and robust heat transport devices for spacecraft thermal control systems. So far, the LHPs in earth-orbit satellites perform very well as expected. Conventional LHPs usually consist of a single capillary pump for heat acquisition and a single condenser for heat rejection. Multiple pump/multiple condenser LHPs have shown to function very well in ground testing. Nevertheless, the test results of a dual pump/condenser LHP also revealed that the dual LHP behaved in a complicated manner due to the interaction between the pumps and condensers. Thus it is redundant to say that more research is needed before they are ready for 0-g deployment. One research area that perhaps compels immediate attention is the analytical modeling of LHPs, particularly the transient phenomena. Modeling a single pump/single condenser LHP is difficult enough. Only a handful of computer codes are available for both steady state and transient simulations of conventional LHPs. No previous effort was made to develop an analytical model (or even a complete theory) to predict the operational behavior of the multiple pump/multiple condenser LHP systems. The current research project offered a basic theory of the multiple pump/multiple condenser LHP operation. From it, a computer code was developed to predict the LHP saturation temperature in accordance with the system operating and environmental conditions.

  12. Covariance approximation for large multivariate spatial data sets with an application to multiple climate model errors

    KAUST Repository

    Sang, Huiyan; Jun, Mikyoung; Huang, Jianhua Z.

    2011-01-01

    This paper investigates the cross-correlations across multiple climate model errors. We build a Bayesian hierarchical model that accounts for the spatial dependence of individual models as well as cross-covariances across different climate models

  13. Modelling of coughed droplets in a hospital ward

    DEFF Research Database (Denmark)

    Sadrizadeh, Sasan; Nielsen, Peter Vilhelm

    2016-01-01

    Coughing and its importance for spreading respiratory infectious diseases has been confirmed in many previous studies. The dispersion process of respiratory droplets released by the coughing of a patient in a hospital ward was studied using computational fluid dynamics simulation. Two relatively ...

  14. Outcomes analysis of hospital management model in restricted budget conditions

    Directory of Open Access Journals (Sweden)

    Virsavia Vaseva

    2016-03-01

    Full Text Available Facing conditions of market economy and financial crisis, the head of any healthcare facility has to take adequate decisions about the cost-effective functioning of the hospital. Along with cost reduction, the main problem is how to maintain a high level of health services. The aim of our study was to analyse the quality of healthcare services after the implementation of control over expenses due to a reduction in the budgetary resources in Military Medical Academy (MMA, Sofia, Bulgaria. Data from the hospital information system and the Financial Department about the incomes and expenditures for patient treatment were used. We conducted a retrospective study on the main components of clinical indicators in 2013 to reveal the main problems in the hospital management. In 2014, control was imposed on the use of the most expensive medicines and consumables. Comparative analysis was made of the results of the medical services in MMA for 2013 and 2014. Our results showed that despite the limited budget in MMA over the last year, the policy of control over operational costs succeeded in maintaining the quality of healthcare services. While reducing the expenses for medicines, consumables and laboratory investigations by ∼26%, some quality criteria for healthcare services were observed to be improved by ∼9%. Financial crisis and budget reduction urge healthcare economists to create adequate economical instruments to assist the normal functioning of hospital facilities. Our analysis showed that when a right policy is chosen, better results may be achieved with fewer resources.

  15. Stabilization of multiple rib fractures in a canine model.

    Science.gov (United States)

    Huang, Ke-Nan; Xu, Zhi-Fei; Sun, Ju-Xian; Ding, Xin-Yu; Wu, Bin; Li, Wei; Qin, Xiong; Tang, Hua

    2014-12-01

    Operative stabilization is frequently used in the clinical treatment of multiple rib fractures (MRF); however, no ideal material exists for use in this fixation. This study investigates a newly developed biodegradable plate system for the stabilization of MRF. Silk fiber-reinforced polycaprolactone (SF/PCL) plates were developed for rib fracture stabilization and studied using a canine flail chest model. Adult mongrel dogs were divided into three groups: one group received the SF/PCL plates, one group received standard clinical steel plates, and the final group did not undergo operative fracture stabilization (n = 6 for each group). Radiographic, mechanical, and histologic examination was performed to evaluate the effectiveness of the biodegradable material for the stabilization of the rib fractures. No nonunion and no infections were found when using SF-PCL plates. The fracture sites collapsed in the untreated control group, leading to obvious chest wall deformity not encountered in the two groups that underwent operative stabilization. Our experimental study shows that the SF/PCL plate has the biocompatibility and mechanical strength suitable for fixation of MRF and is potentially ideal for the treatment of these injuries. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Multiplicative multifractal modeling and discrimination of human neuronal activity

    International Nuclear Information System (INIS)

    Zheng Yi; Gao Jianbo; Sanchez, Justin C.; Principe, Jose C.; Okun, Michael S.

    2005-01-01

    Understanding neuronal firing patterns is one of the most important problems in theoretical neuroscience. It is also very important for clinical neurosurgery. In this Letter, we introduce a computational procedure to examine whether neuronal firing recordings could be characterized by cascade multiplicative multifractals. By analyzing raw recording data as well as generated spike train data from 3 patients collected in two brain areas, the globus pallidus externa (GPe) and the globus pallidus interna (GPi), we show that the neural firings are consistent with a multifractal process over certain time scale range (t 1 ,t 2 ), where t 1 is argued to be not smaller than the mean inter-spike-interval of neuronal firings, while t 2 may be related to the time that neuronal signals propagate in the major neural branching structures pertinent to GPi and GPe. The generalized dimension spectrum D q effectively differentiates the two brain areas, both intra- and inter-patients. For distinguishing between GPe and GPi, it is further shown that the cascade model is more effective than the methods recently examined by Schiff et al. as well as the Fano factor analysis. Therefore, the methodology may be useful in developing computer aided tools to help clinicians perform precision neurosurgery in the operating room

  17. A Fuzzy Logic Framework for Integrating Multiple Learned Models

    Energy Technology Data Exchange (ETDEWEB)

    Hartog, Bobi Kai Den [Univ. of Nebraska, Lincoln, NE (United States)

    1999-03-01

    The Artificial Intelligence field of Integrating Multiple Learned Models (IMLM) explores ways to combine results from sets of trained programs. Aroclor Interpretation is an ill-conditioned problem in which trained programs must operate in scenarios outside their training ranges because it is intractable to train them completely. Consequently, they fail in ways related to the scenarios. We developed a general-purpose IMLM solution, the Combiner, and applied it to Aroclor Interpretation. The Combiner's first step, Scenario Identification (M), learns rules from very sparse, synthetic training data consisting of results from a suite of trained programs called Methods. S1 produces fuzzy belief weights for each scenario by approximately matching the rules. The Combiner's second step, Aroclor Presence Detection (AP), classifies each of three Aroclors as present or absent in a sample. The third step, Aroclor Quantification (AQ), produces quantitative values for the concentration of each Aroclor in a sample. AP and AQ use automatically learned empirical biases for each of the Methods in each scenario. Through fuzzy logic, AP and AQ combine scenario weights, automatically learned biases for each of the Methods in each scenario, and Methods' results to determine results for a sample.

  18. Multiple models guide strategies for agricultural nutrient reductions

    Science.gov (United States)

    Scavia, Donald; Kalcic, Margaret; Muenich, Rebecca Logsdon; Read, Jennifer; Aloysius, Noel; Bertani, Isabella; Boles, Chelsie; Confesor, Remegio; DePinto, Joseph; Gildow, Marie; Martin, Jay; Redder, Todd; Robertson, Dale M.; Sowa, Scott P.; Wang, Yu-Chen; Yen, Haw

    2017-01-01

    In response to degraded water quality, federal policy makers in the US and Canada called for a 40% reduction in phosphorus (P) loads to Lake Erie, and state and provincial policy makers in the Great Lakes region set a load-reduction target for the year 2025. Here, we configured five separate SWAT (US Department of Agriculture's Soil and Water Assessment Tool) models to assess load reduction strategies for the agriculturally dominated Maumee River watershed, the largest P source contributing to toxic algal blooms in Lake Erie. Although several potential pathways may achieve the target loads, our results show that any successful pathway will require large-scale implementation of multiple practices. For example, one successful pathway involved targeting 50% of row cropland that has the highest P loss in the watershed with a combination of three practices: subsurface application of P fertilizers, planting cereal rye as a winter cover crop, and installing buffer strips. Achieving these levels of implementation will require local, state/provincial, and federal agencies to collaborate with the private sector to set shared implementation goals and to demand innovation and honest assessments of water quality-related programs, policies, and partnerships.

  19. Calcium Intervention Ameliorates Experimental Model of Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Dariush Haghmorad

    2014-05-01

    Full Text Available Objective: Multiple sclerosis (MS is the most common inflammatory disease of the CNS. Experimental autoimmune encephalomyelitis (EAE is a widely used model for MS. In the present research, our aim was to test the therapeutic efficacy of Calcium (Ca in an experimental model of MS. Methods: In this study the experiment was done on C57BL/6 mice. EAE was induced using 200 μg of the MOG35-55 peptide emulsified in CFA and injected subcutaneously on day 0 over two flank areas. In addition, 250 ng of pertussis toxin was injected on days 0 and 2. In the treatment group, 30 mg/kg Ca was administered intraperitoneally four times at regular 48 hour intervals. The mice were sacrificed 21 days after EAE induction and blood samples were taken from their hearts. The brains of mice were removed for histological analysis and their isolated splenocytes were cultured. Results: Our results showed that treatment with Ca caused a significant reduction in the severity of the EAE. Histological analysis indicated that there was no plaque in brain sections of Ca treated group of mice whereas 4 ± 1 plaques were detected in brain sections of controls. The density of mononuclear infiltration in the CNS of Ca treated mice was lower than in controls. The serum level of Nitric Oxide in the treatment group was lower than in the control group but was not significant. Moreover, the levels of IFN-γ in cell culture supernatant of splenocytes in treated mice were significantly lower than in the control group. Conclusion: The data indicates that Ca intervention can effectively attenuate EAE progression.

  20. Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

    Directory of Open Access Journals (Sweden)

    Gregory Jackson Tung

    2017-09-01

    Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

  1. A ¤flexible additive multiplicative hazard model

    DEFF Research Database (Denmark)

    Martinussen, T.; Scheike, T. H.

    2002-01-01

    Aalen's additive model; Counting process; Cox regression; Hazard model; Proportional excess harzard model; Time-varying effect......Aalen's additive model; Counting process; Cox regression; Hazard model; Proportional excess harzard model; Time-varying effect...

  2. The Answering Process for Multiple-Choice Questions in Collaborative Learning: A Mathematical Learning Model Analysis

    Science.gov (United States)

    Nakamura, Yasuyuki; Nishi, Shinnosuke; Muramatsu, Yuta; Yasutake, Koichi; Yamakawa, Osamu; Tagawa, Takahiro

    2014-01-01

    In this paper, we introduce a mathematical model for collaborative learning and the answering process for multiple-choice questions. The collaborative learning model is inspired by the Ising spin model and the model for answering multiple-choice questions is based on their difficulty level. An intensive simulation study predicts the possibility of…

  3. An evaluation of systemic reforms of public hospitals: the Sanming model in China.

    Science.gov (United States)

    Fu, Hongqiao; Li, Ling; Li, Mingqiang; Yang, Chunyu; Hsiao, William

    2017-10-01

    Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Higher Education Program Curricula Models in Tourism and Hospitality Education: A Review of the Literature

    Science.gov (United States)

    Scotland, Miriam

    2006-01-01

    The relevancy of program curricula in tourism and hospitality education has been called into question by key stakeholders in light of ongoing changes in the multifaceted tourism and hospitality industry. Various program models have been identified. Program content and quality of student preparedness have been debated. Balance and areas of emphasis…

  5. Performance Evaluation of Sadoghi Hospital Based on «EFQM» Organizational Excellence Model

    Directory of Open Access Journals (Sweden)

    A Sanayeei

    2013-04-01

    Full Text Available Introduction: Realm of health care that organizations have faced in recent years has been described with high level of dynamism and development. To survive in such conditions, performance evaluation can have an effective role in satisfying proper quality for services. This study aimed to evaluate the performance of Shahid Sadoghi Yazd hospital through EFQM approach. Methods: This was a descriptive cross-sectional study. Data collection instrument was EFQM organization Excellence Model questionnaire which was completed by all the managers. The research data was gathered from a sample of 302 patients, staff, personnel and medical staff working in different parts of the hospital. Random stratified samples were selected and descriptive statistics were utilized in order to analyze the data. Results: The results revealed that Shahid Sadoughi hospital acquired 185.41 points out of the total 500 points considered in the model EFQM. In other words, the rating reflects the fact that regarding the defined desired position, the hospital has not achieved the desired rating. Conclusion: Since the hospital performance is posited in a low-middle class, much more attention is required in regard to therapeutic management in this hospital. Therefore, codifying an efficient and effective program to improve the hospital performance is necessary. Furthermore, it seems that EFQM model can be considered as a comprehensive model for performance evaluation in hospitals.

  6. The Application of Collaborative Business Intelligence Technology in the Hospital SPD Logistics Management Model

    Science.gov (United States)

    LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei

    2017-01-01

    Background: We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. Methods: We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. Results: For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Conclusion: Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers. PMID:28828316

  7. The Application of Collaborative Business Intelligence Technology in the Hospital SPD Logistics Management Model.

    Science.gov (United States)

    Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei

    2017-06-01

    We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers.

  8. Exclusive description of multiple production on nuclei in the additive quark model. Multiplicity distributions in interactions with heavy nuclei

    International Nuclear Information System (INIS)

    Levchenko, B.B.; Nikolaev, N.N.

    1985-01-01

    In the framework of the additive quark model of multiple production on nuclei we calculate the multiplicity distributions of secondary particles and the correlations between secondary particles in πA and pA interactions with heavy nuclei. We show that intranuclear cascades are responsible for up to 50% of the nuclear increase of the multiplicity of fast particles. We analyze the sensitivity of the multiplicities and their correlations to the choice of the quark-hadronization function. We show that with good accuracy the yield of relativistic secondary particles from heavy and intermediate nuclei depends only on the number N/sub p/ of protons knocked out of the nucleus, and not on the mass number of the nucleus (N/sub p/ scaling)

  9. Comparative study between a QCD inspired model and a multiple diffraction model

    International Nuclear Information System (INIS)

    Luna, E.G.S.; Martini, A.F.; Menon, M.J.

    2003-01-01

    A comparative study between a QCD Inspired Model (QCDIM) and a Multiple Diffraction Model (MDM) is presented, with focus on the results for pp differential cross section at √s = 52.8 GeV. It is shown that the MDM predictions are in agreement with experimental data, except for the dip region and that the QCDIM describes only the diffraction peak region. Interpretations in terms of the corresponding eikonals are also discussed. (author)

  10. Optimization of hospital ward resources with patient relocation using Markov chain modeling

    DEFF Research Database (Denmark)

    Andersen, Anders Reenberg; Nielsen, Bo Friis; Reinhardt, Line Blander

    2017-01-01

    available to the hospital. Patient flow is modeled using a homogeneous continuous-time Markov chain and optimization is conducted using a local search heuristic. Our model accounts for patient relocation, which has not been done analytically in literature with similar scope. The study objective is to ensure...... are distributed. Furthermore, our heuristic is found to efficiently derive the optimal solution. Applying our model to the hospital case, we found that relocation of daily arrivals can be reduced by 11.7% by re-distributing beds that are already available to the hospital....

  11. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

    Directory of Open Access Journals (Sweden)

    Maxine Johnson

    2017-01-01

    Full Text Available Abstract Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16 and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events. Three staff focus groups (total n = 21 and three service user focus groups (total n = 23 explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service

  12. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

    Science.gov (United States)

    Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

    2017-01-24

    Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research

  13. [Refractory heart failure. Models of hospital, ambulatory, and home management].

    Science.gov (United States)

    Oliva, Fabrizio; Alunni, Gianfranco

    2002-08-01

    Chronic heart failure is an enormous and growing public health problem and is reaching epidemic proportions. Its economic impact is dramatic; two thirds of expenses are for hospitalizations and relatively little is being spent for medications and outpatient visits. Most of the hospitalizations, deaths and costs are incurred by a relatively small minority of patients who may be described as having "complex", "advanced", "refractory" or "end-stage" heart failure; however, in essence they are patients who have severe symptoms and/or recurrent hospitalizations and/or emergency department visits despite maximal oral therapy. Many of the recommendations regarding the management of these patients are based more on experience than on evidence from controlled trials. This, because such patients require an individualized therapy which limits their inclusion in large trials and because support is less easily available when testing specific strategies than when testing specific agents. Improving the treatment of this group of patients by optimizing their medical regimen, aggressive monitoring and providing early intervention to avert heart failure can reduce their morbidity, mortality and costs of care. Refractory heart failure is not a single disease and it is extremely unlikely that all patients should be treated in a similar manner; before selecting the appropriate therapy, the clinician must categorize and profile the patient. The first step should be a re-evaluation of the previous treatment because many patients are treated suboptimally. It is also important to identify reversible or precipitating factors. For patients with advanced heart failure, the initial goal of therapy is to improve symptoms; the next goal is to maintain the improvement and to prevent later deterioration. The appropriate treatment plan will reflect the presence of comorbidities, the patients' history regarding previous responses to therapy, their own expectations with regard to daily life. The most

  14. Problem solving based learning model with multiple representations to improve student's mental modelling ability on physics

    Science.gov (United States)

    Haili, Hasnawati; Maknun, Johar; Siahaan, Parsaoran

    2017-08-01

    Physics is a lessons that related to students' daily experience. Therefore, before the students studying in class formally, actually they have already have a visualization and prior knowledge about natural phenomenon and could wide it themselves. The learning process in class should be aimed to detect, process, construct, and use students' mental model. So, students' mental model agree with and builds in the right concept. The previous study held in MAN 1 Muna informs that in learning process the teacher did not pay attention students' mental model. As a consequence, the learning process has not tried to build students' mental modelling ability (MMA). The purpose of this study is to describe the improvement of students' MMA as a effect of problem solving based learning model with multiple representations approach. This study is pre experimental design with one group pre post. It is conducted in XI IPA MAN 1 Muna 2016/2017. Data collection uses problem solving test concept the kinetic theory of gasses and interview to get students' MMA. The result of this study is clarification students' MMA which is categorized in 3 category; High Mental Modelling Ability (H-MMA) for 7Mental Modelling Ability (M-MMA) for 3Mental Modelling Ability (L-MMA) for 0 ≤ x ≤ 3 score. The result shows that problem solving based learning model with multiple representations approach can be an alternative to be applied in improving students' MMA.

  15. A Conceptual Model for Analysing Management Development in the UK Hospitality Industry

    Science.gov (United States)

    Watson, Sandra

    2007-01-01

    This paper presents a conceptual, contingent model of management development. It explains the nature of the UK hospitality industry and its potential influence on MD practices, prior to exploring dimensions and relationships in the model. The embryonic model is presented as a model that can enhance our understanding of the complexities of the…

  16. Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology.

    Science.gov (United States)

    Chambers, Georgina M; Hoang, Van Phuong; Lee, Evelyn; Hansen, Michele; Sullivan, Elizabeth A; Bower, Carol; Chapman, Michael

    2014-11-01

    The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood. To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births. A retrospective population cohort study using individually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008. Multiple-gestation delivery and ART conception. Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs. Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons. Compared with singletons, multiple-birth infants consume significantly more hospital

  17. Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

    Science.gov (United States)

    Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

    2009-07-01

    The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

  18. Numerical modelling of multiple scattering between two elastical particles

    DEFF Research Database (Denmark)

    Bjørnø, Irina; Jensen, Leif Bjørnø

    1998-01-01

    in suspension have been studied extensively since Foldy's formulation of his theory for isotropic scattering by randomly distributed scatterers. However, a number of important problems related to multiple scattering are still far from finding their solutions. A particular, but still unsolved, problem......Multiple acoustical signal interactions with sediment particles in the vicinity of the seabed may significantly change the course of sediment concentration profiles determined by inversion from acoustical backscattering measurements. The scattering properties of high concentrations of sediments...... is the question of proximity thresholds for influence of multiple scattering in terms of particle properties like volume fraction, average distance between particles or other related parameters. A few available experimental data indicate a significance of multiple scattering in suspensions where the concentration...

  19. 231 Using Multiple Regression Analysis in Modelling the Role of ...

    African Journals Online (AJOL)

    User

    of Internal Revenue, Tourism Bureau and hotel records. The multiple regression .... additional guest facilities such as restaurant, a swimming pool or child care and social function ... and provide good quality service to the public. Conclusion.

  20. Modeling a Single SEP Event from Multiple Vantage Points Using the iPATH Model

    Science.gov (United States)

    Hu, Junxiang; Li, Gang; Fu, Shuai; Zank, Gary; Ao, Xianzhi

    2018-02-01

    Using the recently extended 2D improved Particle Acceleration and Transport in the Heliosphere (iPATH) model, we model an example gradual solar energetic particle event as observed at multiple locations. Protons and ions that are energized via the diffusive shock acceleration mechanism are followed at a 2D coronal mass ejection-driven shock where the shock geometry varies across the shock front. The subsequent transport of energetic particles, including cross-field diffusion, is modeled by a Monte Carlo code that is based on a stochastic differential equation method. Time intensity profiles and particle spectra at multiple locations and different radial distances, separated in longitudes, are presented. The results shown here are relevant to the upcoming Parker Solar Probe mission.

  1. Methods and Models for Capacity and Patient Flow Analysis in Hospital Sector

    DEFF Research Database (Denmark)

    Kozlowski, Dawid

    at a private hospital in Denmark or at a hospital abroad if the public healthcare system is unable to provide treatment within the stated maximum waiting time guarantee. A queue modelling approach is used to analyse the potential negative consequences of the policy on the utilization of public hospital......This thesis is concerned about the novel applications of operations research methods for capacity and flow analysis within hospital sector. The first part of the thesis presents a detailed Discrete-Event Simulation (DES) model that has been developed as an analytical tool designed to facilitate...... by an improved patient flow. The specially developed structure of the model facilitates its reuse at different units, with no advanced modelling skills required in day-to-day use. This feature amplifies the usefulness of DES in conducting comprehensive patient flow analyses at any department with emergency...

  2. An Additive-Multiplicative Cox-Aalen Regression Model

    DEFF Research Database (Denmark)

    Scheike, Thomas H.; Zhang, Mei-Jie

    2002-01-01

    Aalen model; additive risk model; counting processes; Cox regression; survival analysis; time-varying effects......Aalen model; additive risk model; counting processes; Cox regression; survival analysis; time-varying effects...

  3. Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis.

    Science.gov (United States)

    Gutema, Girma; Håkonsen, Helle; Engidawork, Ephrem; Toverud, Else-Lydia

    2018-05-03

    This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show

  4. Modeling an integrated hospital management planning problem using integer optimization approach

    Science.gov (United States)

    Sitepu, Suryati; Mawengkang, Herman; Irvan

    2017-09-01

    Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

  5. Models of governance in multihospital systems. Implications for hospital and system-level decision-making.

    Science.gov (United States)

    Morlock, L L; Alexander, J A

    1986-12-01

    This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In

  6. A Predictive Model for Readmissions Among Medicare Patients in a California Hospital.

    Science.gov (United States)

    Duncan, Ian; Huynh, Nhan

    2017-11-17

    Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables). Specifically, the logistic regression is applied to 2 populations: a general population including all patients and the specific group of patients targeted by the CMS penalty (characterized as ages 65 or older with select conditions). The 2 resulting logistic regression models have a higher sensitivity rate compared to the sensitivity of the LACE index. The C statistic values of the model applied to both populations demonstrate moderate levels of predictive power. The authors also build an economic model to demonstrate the potential financial impact of the use of the model for targeting high-risk patients in a sample hospital and demonstrate that, on balance, whether the hospital gains or loses from reducing readmissions depends on its margin and the extent of its readmission penalties.

  7. Tools and Models for Integrating Multiple Cellular Networks

    Energy Technology Data Exchange (ETDEWEB)

    Gerstein, Mark [Yale Univ., New Haven, CT (United States). Gerstein Lab.

    2015-11-06

    In this grant, we have systematically investigated the integrated networks, which are responsible for the coordination of activity between metabolic pathways in prokaryotes. We have developed several computational tools to analyze the topology of the integrated networks consisting of metabolic, regulatory, and physical interaction networks. The tools are all open-source, and they are available to download from Github, and can be incorporated in the Knowledgebase. Here, we summarize our work as follow. Understanding the topology of the integrated networks is the first step toward understanding its dynamics and evolution. For Aim 1 of this grant, we have developed a novel algorithm to determine and measure the hierarchical structure of transcriptional regulatory networks [1]. The hierarchy captures the direction of information flow in the network. The algorithm is generally applicable to regulatory networks in prokaryotes, yeast and higher organisms. Integrated datasets are extremely beneficial in understanding the biology of a system in a compact manner due to the conflation of multiple layers of information. Therefore for Aim 2 of this grant, we have developed several tools and carried out analysis for integrating system-wide genomic information. To make use of the structural data, we have developed DynaSIN for protein-protein interactions networks with various dynamical interfaces [2]. We then examined the association between network topology with phenotypic effects such as gene essentiality. In particular, we have organized E. coli and S. cerevisiae transcriptional regulatory networks into hierarchies. We then correlated gene phenotypic effects by tinkering with different layers to elucidate which layers were more tolerant to perturbations [3]. In the context of evolution, we also developed a workflow to guide the comparison between different types of biological networks across various species using the concept of rewiring [4], and Furthermore, we have developed

  8. Lyssavirus infection: 'low dose, multiple exposure' in the mouse model.

    Science.gov (United States)

    Banyard, Ashley C; Healy, Derek M; Brookes, Sharon M; Voller, Katja; Hicks, Daniel J; Núñez, Alejandro; Fooks, Anthony R

    2014-03-06

    The European bat lyssaviruses (EBLV-1 and EBLV-2) are zoonotic pathogens present within bat populations across Europe. The maintenance and transmission of lyssaviruses within bat colonies is poorly understood. Cases of repeated isolation of lyssaviruses from bat roosts have raised questions regarding the maintenance and intraspecies transmissibility of these viruses within colonies. Furthermore, the significance of seropositive bats in colonies remains unclear. Due to the protected nature of European bat species, and hence restrictions to working with the natural host for lyssaviruses, this study analysed the outcome following repeat inoculation of low doses of lyssaviruses in a murine model. A standardized dose of virus, EBLV-1, EBLV-2 or a 'street strain' of rabies (RABV), was administered via a peripheral route to attempt to mimic what is hypothesized as natural infection. Each mouse (n=10/virus/group/dilution) received four inoculations, two doses in each footpad over a period of four months, alternating footpad with each inoculation. Mice were tail bled between inoculations to evaluate antibody responses to infection. Mice succumbed to infection after each inoculation with 26.6% of mice developing clinical disease following the initial exposure across all dilutions (RABV, 32.5% (n=13/40); EBLV-1, 35% (n=13/40); EBLV-2, 12.5% (n=5/40)). Interestingly, the lowest dose caused clinical disease in some mice upon first exposure ((RABV, 20% (n=2/10) after first inoculation; RABV, 12.5% (n=1/8) after second inoculation; EBLV-2, 10% (n=1/10) after primary inoculation). Furthermore, five mice developed clinical disease following the second exposure to live virus (RABV, n=1; EBLV-1, n=1; EBLV-2, n=3) although histopathological examination indicated that the primary inoculation was the most probably cause of death due to levels of inflammation and virus antigen distribution observed. All the remaining mice (RABV, n=26; EBLV-1, n=26; EBLV-2, n=29) survived the tertiary and

  9. Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

    Directory of Open Access Journals (Sweden)

    Eleanor M Winpenny

    2016-11-01

    Full Text Available Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs, nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

  10. Rapid installation of numerical models in multiple parent codes

    Energy Technology Data Exchange (ETDEWEB)

    Brannon, R.M.; Wong, M.K.

    1996-10-01

    A set of``model interface guidelines``, called MIG, is offered as a means to more rapidly install numerical models (such as stress-strain laws) into any parent code (hydrocode, finite element code, etc.) without having to modify the model subroutines. The model developer (who creates the model package in compliance with the guidelines) specifies the model`s input and storage requirements in a standardized way. For portability, database management (such as saving user inputs and field variables) is handled by the parent code. To date, NUG has proved viable in beta installations of several diverse models in vectorized and parallel codes written in different computer languages. A NUG-compliant model can be installed in different codes without modifying the model`s subroutines. By maintaining one model for many codes, MIG facilitates code-to-code comparisons and reduces duplication of effort potentially reducing the cost of installing and sharing models.

  11. Prevalence and Characterization of Integrons in Multidrug Resistant Acinetobacter baumannii in Eastern China: A Multiple-Hospital Study

    Directory of Open Access Journals (Sweden)

    Jing Chen

    2015-08-01

    Full Text Available Objective: The aim of this multiple-hospital study was to investigate the prevalence of integrons in multidrug-resistant Acinetobacter baumannii (MDRAB in Eastern China, and characterize the integron-integrase genes, so as to provide evidence for the management and appropriate antibiotic use of MDRAB infections. Methods: A total of 425 clinical isolates of A. baumannii were collected from 16 tertiary hospitals in 11 cities of four provinces (Fujian, Jiangsu, Zhejiang and Shandong from January 2009 to June 2012. The susceptibility of A. baumannii isolates to ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, ceftriaxone, cefepime, aztreonam, meropenem, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, sulfamethoxazole/trimenthoprim, minocycline and imipenem was tested, and integrons and their gene cassettes were characterized in these isolates using PCR assay. In addition, integron-positive A. baumannii isolates were genotyped using pulsed-field gel electrophoresis (PFGE assay, and intI1 gene cassette was sequenced. Results: intI1 gene was carried in 69.6% of total A. baumannii isolates, while intI2 and intI3 genes were not detected. The prevalence of resistance to ampicillin/sulbactam, piperacillin/tazobactam, ceftazidime, ceftriaxone, cefepime, aztreonam, imipenem, meropenem, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin and sulfamethoxazole/trimenthoprim was significantly higher in integron-positive A. baumannii isolates than in negative isolates (all p values <0.05, while no significant difference was observed in the prevalence of minocycline resistance (p > 0.05. PFGE assay revealed 27 PFGE genotypes and 4 predominant genotypes, P1, P4, P7 and P19. The PFGE genotype P1 contained 13 extensive-drug resistant and 89 non-extensive-drug resistant A. baumannii isolates, while the genotype P4 contained 34 extensive-drug resistant and 67 non-extensive-drug resistant isolates, appearing a significant

  12. Impact of emotional competence on supportive care needs, anxiety and depression symptoms of cancer patients: a multiple mediation model.

    Science.gov (United States)

    Baudry, A-S; Lelorain, S; Mahieuxe, M; Christophe, V

    2018-01-01

    The aim of this study was to test the effect of intrapersonal and interpersonal emotional competence on cancer patients' supportive care needs, as mediated by anxiety and depression symptoms. Cross-sectional design: 137 cancer patients (42% breast or ovarian cancer, 58% gastrointestinal cancer) in 4 French hospitals completed the Profile of Emotional Competence (PEC), the Hospital Anxiety and Depression Scale (HADS), and the Supportive Care Needs Survey Short Form (SCNS-SF). Bootstrap methods with PROCESS Macro were used to test multiple mediation models. Emotional competence presented a direct or indirect beneficial effect on the satisfaction of supportive care needs, anxiety and depression symptoms. As expected, anxiety and depression symptoms had also strong positive correlations with unmet needs. All multiple mediation models were significant, except for physical needs: intrapersonal and interpersonal emotional competence impacted anxiety and depression symptoms, which in turn impacted psychological, sexual, care/support, and information needs. These innovative results show the important effect of patients' emotional competence on their supportive care need satisfaction, as mediated by anxiety and depression. Consequently, patients with high emotional competence may require less psychosocial input from medical clinicians. Thus, emotional competence may be integrated into health models and psychosocial interventions to improve patient adjustment. Further investigation is, however, needed to know which are the most beneficial specific emotional competences and at what point of the cancer pathway.

  13. Stochastic modeling of pitting corrosion: A new model for initiation and growth of multiple corrosion pits

    International Nuclear Information System (INIS)

    Valor, A.; Caleyo, F.; Alfonso, L.; Rivas, D.; Hallen, J.M.

    2007-01-01

    In this work, a new stochastic model capable of simulating pitting corrosion is developed and validated. Pitting corrosion is modeled as the combination of two stochastic processes: pit initiation and pit growth. Pit generation is modeled as a nonhomogeneous Poisson process, in which induction time for pit initiation is simulated as the realization of a Weibull process. In this way, the exponential and Weibull distributions can be considered as the possible distributions for pit initiation time. Pit growth is simulated using a nonhomogeneous Markov process. Extreme value statistics is used to find the distribution of maximum pit depths resulting from the combination of the initiation and growth processes for multiple pits. The proposed model is validated using several published experiments on pitting corrosion. It is capable of reproducing the experimental observations with higher quality than the stochastic models available in the literature for pitting corrosion

  14. Stochastic modeling of pitting corrosion: A new model for initiation and growth of multiple corrosion pits

    Energy Technology Data Exchange (ETDEWEB)

    Valor, A. [Facultad de Fisica, Universidad de La Habana, San Lazaro y L, Vedado, 10400 Havana (Cuba); Caleyo, F. [Departamento de Ingenieria, Metalurgica, IPN-ESIQIE, UPALM Edif. 7, Zacatenco, Mexico DF 07738 (Mexico)]. E-mail: fcaleyo@gmail.com; Alfonso, L. [Departamento de Ingenieria, Metalurgica, IPN-ESIQIE, UPALM Edif. 7, Zacatenco, Mexico DF 07738 (Mexico); Rivas, D. [Departamento de Ingenieria, Metalurgica, IPN-ESIQIE, UPALM Edif. 7, Zacatenco, Mexico DF 07738 (Mexico); Hallen, J.M. [Departamento de Ingenieria, Metalurgica, IPN-ESIQIE, UPALM Edif. 7, Zacatenco, Mexico DF 07738 (Mexico)

    2007-02-15

    In this work, a new stochastic model capable of simulating pitting corrosion is developed and validated. Pitting corrosion is modeled as the combination of two stochastic processes: pit initiation and pit growth. Pit generation is modeled as a nonhomogeneous Poisson process, in which induction time for pit initiation is simulated as the realization of a Weibull process. In this way, the exponential and Weibull distributions can be considered as the possible distributions for pit initiation time. Pit growth is simulated using a nonhomogeneous Markov process. Extreme value statistics is used to find the distribution of maximum pit depths resulting from the combination of the initiation and growth processes for multiple pits. The proposed model is validated using several published experiments on pitting corrosion. It is capable of reproducing the experimental observations with higher quality than the stochastic models available in the literature for pitting corrosion.

  15. Prioritizing Public- Private Partnership Models for Public Hospitals of Iran Based on Performance Indicators

    Directory of Open Access Journals (Sweden)

    Mohammad Asghari Jaafarabadi

    2012-12-01

    Full Text Available Background: The present study was conducted to scrutinize Public- Private Partnership (PPP models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals.Methods: In this mixed (quantitative-qualitative study, systematic review and expert panel hasbeen done to identify varied models of PPP as well as performance indicators. In the second stepwe prioritized performance indicator and PPP models based on selected performance indicatorsby Analytical Hierarchy process (AHP technique. The data were analyzed by Excel 2007 andExpert Choice11 software’s.Results: In quality – effectiveness area, indicators like the rate of hospital infections(100%, hospital accidents prevalence rate (73%, pure rate of hospital mortality (63%, patientsatisfaction percentage (53%, in accessibility equity area indicators such as average inpatientwaiting time (100% and average outpatient waiting time (74%, and in financial – efficiency area,indicators including average length of stay (100%, bed occupation ratio (99%, specific incometo total cost ratio (97% have been chosen to be the most key performance indicators. In the prioritizationof the PPP models clinical outsourcing, management, privatization, BOO (build, own,operate and non-clinical outsourcing models, achieved high priority for various performance indicatorareas.Conclusion: This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.

  16. Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

    Science.gov (United States)

    Baxter, Pamela E; Hewko, Sarah J; Pfaff, Kathryn A; Cleghorn, Laura; Cunningham, Barbara J; Elston, Dawn; Cummings, Greta G

    2015-08-01

    Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study.

    Science.gov (United States)

    Sullivan, Jennifer L; Rivard, Peter E; Shin, Marlena H; Rosen, Amy K

    2016-09-01

    The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.

  18. An Additive-Multiplicative Restricted Mean Residual Life Model

    DEFF Research Database (Denmark)

    Mansourvar, Zahra; Martinussen, Torben; Scheike, Thomas H.

    2016-01-01

    mean residual life model to study the association between the restricted mean residual life function and potential regression covariates in the presence of right censoring. This model extends the proportional mean residual life model using an additive model as its covariate dependent baseline....... For the suggested model, some covariate effects are allowed to be time-varying. To estimate the model parameters, martingale estimating equations are developed, and the large sample properties of the resulting estimators are established. In addition, to assess the adequacy of the model, we investigate a goodness...

  19. Extending positive CLASS results across multiple instructors and multiple classes of Modeling Instruction

    Science.gov (United States)

    Brewe, Eric; Traxler, Adrienne; de la Garza, Jorge; Kramer, Laird H.

    2013-12-01

    We report on a multiyear study of student attitudes measured with the Colorado Learning Attitudes about Science Survey in calculus-based introductory physics taught with the Modeling Instruction curriculum. We find that five of six instructors and eight of nine sections using Modeling Instruction showed significantly improved attitudes from pre- to postcourse. Cohen’s d effect sizes range from 0.08 to 0.95 for individual instructors. The average effect was d=0.45, with a 95% confidence interval of (0.26-0.64). These results build on previously published results showing positive shifts in attitudes from Modeling Instruction classes. We interpret these data in light of other published positive attitudinal shifts and explore mechanistic explanations for similarities and differences with other published positive shifts.

  20. Extending positive CLASS results across multiple instructors and multiple classes of Modeling Instruction

    Directory of Open Access Journals (Sweden)

    Eric Brewe

    2013-10-01

    Full Text Available We report on a multiyear study of student attitudes measured with the Colorado Learning Attitudes about Science Survey in calculus-based introductory physics taught with the Modeling Instruction curriculum. We find that five of six instructors and eight of nine sections using Modeling Instruction showed significantly improved attitudes from pre- to postcourse. Cohen’s d effect sizes range from 0.08 to 0.95 for individual instructors. The average effect was d=0.45, with a 95% confidence interval of (0.26–0.64. These results build on previously published results showing positive shifts in attitudes from Modeling Instruction classes. We interpret these data in light of other published positive attitudinal shifts and explore mechanistic explanations for similarities and differences with other published positive shifts.

  1. A Generic Discrete-Event Simulation Model for Outpatient Clinics in a Large Public Hospital

    Directory of Open Access Journals (Sweden)

    Waressara Weerawat

    2013-01-01

    Full Text Available The orthopedic outpatient department (OPD ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES simulation. Key Performance Indicators (KPIs are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.

  2. Selection of asset investment models by hospitals: examination of influencing factors, using Switzerland as an example.

    Science.gov (United States)

    Eicher, Bernhard

    2016-10-01

    Hospitals are responsible for a remarkable part of the annual increase in healthcare expenditure. This article examines one of the major cost drivers, the expenditure for investment in hospital assets. The study, conducted in Switzerland, identifies factors that influence hospitals' investment decisions. A suggestion on how to categorize asset investment models is presented based on the life cycle of an asset, and its influencing factors defined based on transaction cost economics. The influence of five factors (human asset specificity, physical asset specificity, uncertainty, bargaining power, and privacy of ownership) on the selection of an asset investment model is examined using a two-step fuzzy-set Qualitative Comparative Analysis. The research shows that outsourcing-oriented asset investment models are particularly favored in the presence of two combinations of influencing factors: First, if technological uncertainty is high and both human asset specificity and bargaining power of a hospital are low. Second, if assets are very specific, technological uncertainty is high and there is a private hospital with low bargaining power, outsourcing-oriented asset investment models are favored too. Using Qualitative Comparative Analysis, it can be demonstrated that investment decisions of hospitals do not depend on isolated influencing factors but on a combination of factors. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Interstitial integrals in the multiple-scattering model

    International Nuclear Information System (INIS)

    Swanson, J.R.; Dill, D.

    1982-01-01

    We present an efficient method for the evaluation of integrals involving multiple-scattering wave functions over the interstitial region. Transformation of the multicenter interstitial wave functions to a single center representation followed by a geometric projection reduces the integrals to products of analytic angular integrals and numerical radial integrals. The projection function, which has the value 1 in the interstitial region and 0 elsewhere, has a closed-form partial-wave expansion. The method is tested by comparing its results with exact normalization and dipole integrals; the differences are 2% at worst and typically less than 1%. By providing an efficient means of calculating Coulomb integrals, the method allows treatment of electron correlations using a multiple scattering basis set

  4. A new spatial multiple discrete-continuous modeling approach to land use change analysis.

    Science.gov (United States)

    2013-09-01

    This report formulates a multiple discrete-continuous probit (MDCP) land-use model within a : spatially explicit economic structural framework for land-use change decisions. The spatial : MDCP model is capable of predicting both the type and intensit...

  5. Steam consumption minimization model in a multiple evaporation effect in a sugar plant

    International Nuclear Information System (INIS)

    Villada, Fernando; Valencia, Jaime A; Moreno, German; Murillo, J. Joaquin

    1992-01-01

    In this work, a mathematical model to minimize the steam consumption in a multiple effect evaporation system is shown. The model is based in the dynamic programming technique and the results are tested in a Colombian sugar mill

  6. New Hybrid Variational Recovery Model for Blurred Images with Multiplicative Noise

    DEFF Research Database (Denmark)

    Dong, Yiqiu; Zeng, Tieyong

    2013-01-01

    A new hybrid variational model for recovering blurred images in the presence of multiplicative noise is proposed. Inspired by previous work on multiplicative noise removal, an I-divergence technique is used to build a strictly convex model under a condition that ensures the uniqueness...

  7. Pursuing the method of multiple working hypotheses for hydrological modeling

    NARCIS (Netherlands)

    Clark, M.P.; Kavetski, D.; Fenicia, F.

    2011-01-01

    Ambiguities in the representation of environmental processes have manifested themselves in a plethora of hydrological models, differing in almost every aspect of their conceptualization and implementation. The current overabundance of models is symptomatic of an insufficient scientific understanding

  8. Multiple Models of Reality and How to Use Them

    NARCIS (Netherlands)

    Jamroga, W.J.; Blockeel, H.; Denecker, M.

    2002-01-01

    A virtual agent may obviously benefit from having an up-to-date model of her environment of activity. The model may include actual users' profiles, a dynamic environment characteristic or some assumptions being accepted by default. However, the agent doesn't have to stick to one model only, she can

  9. Evaluation models and criteria of the quality of hospital websites: a systematic review study

    OpenAIRE

    Jeddi, Fatemeh Rangraz; Gilasi, Hamidreza; Khademi, Sahar

    2017-01-01

    Introduction Hospital websites are important tools in establishing communication and exchanging information between patients and staff, and thus should enjoy an acceptable level of quality. The aim of this study was to identify proper models and criteria to evaluate the quality of hospital websites. Methods This research was a systematic review study. The international databases such as Science Direct, Google Scholar, PubMed, Proquest, Ovid, Elsevier, Springer, and EBSCO together with regiona...

  10. Statistical Modeling of the Trends Concerning the Number of Hospitals and Medical Centres in Romania

    Directory of Open Access Journals (Sweden)

    Gabriela OPAIT

    2017-04-01

    Full Text Available This study reveals the technique for to achive the shapes of the mathematical models which put in evidence the distributions of the values concerning the number of Hospitals, respectively Medical Centres, in our country, in the time horizon 2005-2014. In the same time, we can to observe the algorithm applied for to construct forecasts about the evolutions regarding the number of Hospitals and Medical Centres in Romania.

  11. A Review of the Modelling of Thermally Interacting Multiple Boreholes

    Directory of Open Access Journals (Sweden)

    Seama Koohi-Fayegh

    2013-06-01

    Full Text Available Much attention is now focused on utilizing ground heat pumps for heating and cooling buildings, as well as water heating, refrigeration and other thermal tasks. Modeling such systems is important for understanding, designing and optimizing their performance and characteristics. Several heat transfer models exist for ground heat exchangers. In this review article, challenges of modelling heat transfer in vertical heat exchangers are described, some analytical and numerical models are reviewed and compared, recent related developments are described and the importance of modelling these systems is discussed from a variety of aspects, such as sustainability of geothermal systems or their potential impacts on the ecosystems nearby.

  12. SPD-based Logistics Management Model of Medical Consumables in Hospitals

    Science.gov (United States)

    LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

    2016-01-01

    Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

  13. SPD-based Logistics Management Model of Medical Consumables in Hospitals.

    Science.gov (United States)

    Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

    2016-10-01

    With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

  14. A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

    Science.gov (United States)

    Kamis-Gould, Edna; And Others

    1991-01-01

    A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

  15. Multiple phase transitions in the generalized Curie-Weiss model

    International Nuclear Information System (INIS)

    Eisele, T.; Ellis, R.S.

    1988-01-01

    The generalized Curie-Weiss model is an extension of the classical Curie-Weiss model in which the quadratic interaction function of the mean spin value is replaced by a more general interaction function. It is shown that the generalized Curie-Weiss model can have a sequence of phase transitions at different critical temperatures. Both first-order and second-order phase transitions can occur, and explicit criteria for the two types are given. Three examples of generalized Curie-Weiss models are worked out in detail, including one example with infinitely many phase transitions. A number of results are derived using large-deviation techniques

  16. Towards Integration of CAx Systems and a Multiple-View Product Modeller in Mechanical Design

    Directory of Open Access Journals (Sweden)

    H. Song

    2005-01-01

    Full Text Available This paper deals with the development of an integration framework and its implementation for the connexion of CAx systems and multiple-view product modelling. The integration framework is presented regarding its conceptual level and the implementation level is described currently with the connexion of a functional modeller, a multiple-view product modeller, an optimisation module and a CAD system. The integration between the multiple-view product modeller and CATIA V5 based on the STEP standard is described in detail. Finally, the presented works are discussed and future research developments are suggested. 

  17. The association of birth model with resilience variables and birth experience: Home versus hospital birth.

    Science.gov (United States)

    Handelzalts, Jonathan E; Zacks, Arni; Levy, Sigal

    2016-05-01

    to study home, natural hospital, and medical hospital births, and the association of these birth models to resilience and birth experience. cross-section retrospective design. participants were recruited via an online survey system. Invitations to participate were posted in five different Internet forums for women on maternity leave, from September 2014 to August 2015. the sample comprised 381 post partum healthy women above the age of 20, during their maternity leave. Of the participants: 22% gave birth at home, 32% gave birth naturally in a hospital, and 46% of the participants had a medical birth at the hospital. life Orientation Test Revised (LOT-R), General Self-Efficacy Scale, Sense of Mastery Scale, Childbirth Experience Questionnaire (CEQ). women having had natural births, whether at home or at the hospital, significantly differed from women having had medical births in all aspects of the birth experience, even when controlling for age and optimism. Birth types contributed to between 14% and 24% of the explained variance of the various birth experience aspects. home and natural hospital births were associated with a better childbirth experience. Optimism was identified as a resilience factor, associated both with preference as well as with childbirth experience. physically healthy and resilient women could be encouraged to explore the prospect of home or natural hospital births as a means to have a more positive birth experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

    Directory of Open Access Journals (Sweden)

    Kleinschmidt Immo

    2006-10-01

    Full Text Available Abstract Background Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. Methods Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. Results and conclusion Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria

  19. When children with profound multiple disabilities are hospitalized: A cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care.

    Science.gov (United States)

    Seliner, Brigitte; Latal, Bea; Spirig, Rebecca

    2016-07-01

    We aimed to assess parental burden of care, satisfaction with family-centered care, and quality of life (HRQoL) of parents and their hospitalized children with profound intellectual and multiple disabilities (PIMD), and determine the relationship among these factors. A cross-sectional study using printed questionnaires and qualitative questions was undertaken at a Swiss University Children's Hospital. The 117 parents (98 mothers, 19 fathers) studied indicated a substantial impact on burden of care and parental health-related quality of life. Significant correlations with the hospitalized children's well-being were rs = .408 for burden of care and rs -.368 for quality of life. Qualitative results showed parents struggling to safeguard their children and worrying most about the children's well-being. Health professionals need to be aware of parental burden and that the perception of the children's well-being and the parents' efforts determine their support needs. Easing parents' burden and fostering confidence in the hospitalized children's well-being requires coordination of care provided by advanced nurse specialists, with an institutional framework that clarifies parental collaboration. © 2016, Wiley Periodicals, Inc.

  20. Multiple Model Adaptive Control Using Dual Youla-Kucera Factorisation

    DEFF Research Database (Denmark)

    Bendtsen, Jan Dimon; Trangbæk, Klaus

    2012-01-01

    We propose a multi-model adaptive control scheme for uncertain linear plants based on the concept of model unfalsification. The approach relies on examining the ability of a pre-computed set of plant-controller candidates and choosing the one that is best able to reproduce observed in- and output...

  1. Multiple operating models for data linkage: A privacy positive

    Directory of Open Access Journals (Sweden)

    Katrina Irvine

    2017-04-01

    Our data linkage centre will implement new operating models with cascading levels of data handling on behalf of custodians. Sharing or publication of empirical evidence on timeframes, efficiency and quality can provide useful inputs in the design of new operating models and assist with the development of stakeholder and public confidence.

  2. Relative efficiency of joint-model and full-conditional-specification multiple imputation when conditional models are compatible: The general location model.

    Science.gov (United States)

    Seaman, Shaun R; Hughes, Rachael A

    2018-06-01

    Estimating the parameters of a regression model of interest is complicated by missing data on the variables in that model. Multiple imputation is commonly used to handle these missing data. Joint model multiple imputation and full-conditional specification multiple imputation are known to yield imputed data with the same asymptotic distribution when the conditional models of full-conditional specification are compatible with that joint model. We show that this asymptotic equivalence of imputation distributions does not imply that joint model multiple imputation and full-conditional specification multiple imputation will also yield asymptotically equally efficient inference about the parameters of the model of interest, nor that they will be equally robust to misspecification of the joint model. When the conditional models used by full-conditional specification multiple imputation are linear, logistic and multinomial regressions, these are compatible with a restricted general location joint model. We show that multiple imputation using the restricted general location joint model can be substantially more asymptotically efficient than full-conditional specification multiple imputation, but this typically requires very strong associations between variables. When associations are weaker, the efficiency gain is small. Moreover, full-conditional specification multiple imputation is shown to be potentially much more robust than joint model multiple imputation using the restricted general location model to mispecification of that model when there is substantial missingness in the outcome variable.

  3. Developing models for the prediction of hospital healthcare waste generation rate.

    Science.gov (United States)

    Tesfahun, Esubalew; Kumie, Abera; Beyene, Abebe

    2016-01-01

    An increase in the number of health institutions, along with frequent use of disposable medical products, has contributed to the increase of healthcare waste generation rate. For proper handling of healthcare waste, it is crucial to predict the amount of waste generation beforehand. Predictive models can help to optimise healthcare waste management systems, set guidelines and evaluate the prevailing strategies for healthcare waste handling and disposal. However, there is no mathematical model developed for Ethiopian hospitals to predict healthcare waste generation rate. Therefore, the objective of this research was to develop models for the prediction of a healthcare waste generation rate. A longitudinal study design was used to generate long-term data on solid healthcare waste composition, generation rate and develop predictive models. The results revealed that the healthcare waste generation rate has a strong linear correlation with the number of inpatients (R(2) = 0.965), and a weak one with the number of outpatients (R(2) = 0.424). Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching and private). In these models, the number of inpatients and outpatients were revealed to be significant factors on the quantity of waste generated. The influence of the number of inpatients and outpatients treated varies at different hospitals. Therefore, different models were developed based on the types of hospitals. © The Author(s) 2015.

  4. Strategic plan modelling by hospital senior administration to integrate diversity management.

    Science.gov (United States)

    Newhouse, John J

    2010-11-01

    Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

  5. Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Saitoh Akiyoshi

    2010-04-01

    Full Text Available Abstract Background A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital. Methods Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ. Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records. Results Among 312 patients, 27 (8.7% and 52 (16.7% were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8% were recognized by physicians as having a mental disorder, but only three (11.1% were diagnosed as having a mood disorder. Only two patients with major depressive disorder (7.4% had been prescribed antidepressants. Even among those (n = 15 whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7% were prescribed an antidepressant. Conclusions Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring

  6. Knowledge representation to support reasoning based on multiple models

    Science.gov (United States)

    Gillam, April; Seidel, Jorge P.; Parker, Alice C.

    1990-01-01

    Model Based Reasoning is a powerful tool used to design and analyze systems, which are often composed of numerous interactive, interrelated subsystems. Models of the subsystems are written independently and may be used together while they are still under development. Thus the models are not static. They evolve as information becomes obsolete, as improved artifact descriptions are developed, and as system capabilities change. Researchers are using three methods to support knowledge/data base growth, to track the model evolution, and to handle knowledge from diverse domains. First, the representation methodology is based on having pools, or types, of knowledge from which each model is constructed. In addition information is explicit. This includes the interactions between components, the description of the artifact structure, and the constraints and limitations of the models. The third principle we have followed is the separation of the data and knowledge from the inferencing and equation solving mechanisms. This methodology is used in two distinct knowledge-based systems: one for the design of space systems and another for the synthesis of VLSI circuits. It has facilitated the growth and evolution of our models, made accountability of results explicit, and provided credibility for the user community. These capabilities have been implemented and are being used in actual design projects.

  7. Multiplicative quiver varieties and generalised Ruijsenaars-Schneider models

    Science.gov (United States)

    Chalykh, Oleg; Fairon, Maxime

    2017-11-01

    We study some classical integrable systems naturally associated with multiplicative quiver varieties for the (extended) cyclic quiver with m vertices. The phase space of our integrable systems is obtained by quasi-Hamiltonian reduction from the space of representations of the quiver. Three families of Poisson-commuting functions are constructed and written explicitly in suitable Darboux coordinates. The case m = 1 corresponds to the tadpole quiver and the Ruijsenaars-Schneider system and its variants, while for m > 1 we obtain new integrable systems that generalise the Ruijsenaars-Schneider system. These systems and their quantum versions also appeared recently in the context of supersymmetric gauge theory and cyclotomic DAHAs (Braverman et al. [32,34,35] and Kodera and Nakajima [36]), as well as in the context of the Macdonald theory (Chalykh and Etingof, 2013).

  8. Applications of Bayesian approach in modelling risk of malaria-related hospital mortality

    Directory of Open Access Journals (Sweden)

    Simbeye Jupiter S

    2008-02-01

    Full Text Available Abstract Background Malaria is a major public health problem in Malawi, however, quantifying its burden in a population is a challenge. Routine hospital data provide a proxy for measuring the incidence of severe malaria and for crudely estimating morbidity rates. Using such data, this paper proposes a method to describe trends, patterns and factors associated with in-hospital mortality attributed to the disease. Methods We develop semiparametric regression models which allow joint analysis of nonlinear effects of calendar time and continuous covariates, spatially structured variation, unstructured heterogeneity, and other fixed covariates. Modelling and inference use the fully Bayesian approach via Markov Chain Monte Carlo (MCMC simulation techniques. The methodology is applied to analyse data arising from paediatric wards in Zomba district, Malawi, between 2002 and 2003. Results and Conclusion We observe that the risk of dying in hospital is lower in the dry season, and for children who travel a distance of less than 5 kms to the hospital, but increases for those who are referred to the hospital. The results also indicate significant differences in both structured and unstructured spatial effects, and the health facility effects reveal considerable differences by type of facility or practice. More importantly, our approach shows non-linearities in the effect of metrical covariates on the probability of dying in hospital. The study emphasizes that the methodological framework used provides a useful tool for analysing the data at hand and of similar structure.

  9. Comparison of Sleep Latency and Number of SOREMPs in the Home and Hospital With a Modified Multiple Sleep Latency Test: A Randomized Crossover Study.

    Science.gov (United States)

    Beiske, Kornelia K; Sand, Trond; Rugland, Eyvind; Stavem, Knut

    2017-05-01

    Comparison of mean sleep latencies and number of sleep-onset rapid eye movement periods (SOREMPs) between modified multiple sleep latency test (MSLT) performed in the unattended home and in-hospital laboratory setting. A randomized crossover single-blinded design. Thirty-four subjects referred to MSLT for suspected hypersomnia or narcolepsy were included. Participants were randomized to perform modified MSLT in the unattended home or in the hospital first. Scores in the two settings were compared using Wilcoxon signed-rank test or exact McNemar test. Agreement between home and hospital categorized mean sleep latency and number of SOREMPs was assessed using simple kappa (κ) and proportion agreement. Agreement between home and hospital mean sleep latency was assessed using a Bland-Altman plot and an intraclass correlation coefficient. There was no difference between home and hospital assessment of mean sleep latency (P = 0.86). Two or more SOREMPs were found more frequently on modified MSLTs performed at home compared with those at the hospital (7 and 2, respectively; P = 0.025). Agreement was moderate for categorized sleep latency (κ = 0.53) and fair for categorized SOREMPs (κ = 0.39) in the 2 settings. Analysis of mean sleep latency using intraclass correlation coefficient showed a very good agreement between the two settings. Group mean sleep latency for home modified MSLTs seems to be reliable compared with that for the attended sleep-laboratory setting. Higher rate of SOREMP in the unattended home suggests that napping in a familiar environment facilitates the transition into REM sleep. Further studies are needed to assess the normal limit, sensitivity, and specificity for SOREMP at home before the clinical utility of home-based napping can be determined.

  10. The impacts of multiple stressors to model ecological structures

    International Nuclear Information System (INIS)

    Landis, W.G.; Kelly, S.A.; Markiewicz, A.J.; Matthews, R.A.; Matthews, G.B.

    1995-01-01

    The basis of the community conditioning hypothesis is that ecological structures are the result of their unique etiology. Systems that have been exposed to a variety of stressors should reflect this history. The authors how conducted a series of microcosm experiments that can compare the effects of multiple stressors upon community dynamics. The microcosm protocols are derived from the Standardized Aquatic Microcosm (SAM) and have Lemma and additional protozoan species. Two multiple stressor experiments have been conducted. In an extended length SAM (ELSAM), two of four treatments were dosed with the turbine fuel JP-8 one week into the experiment. Two treatments were later exposed to the heat stress, one that had received jet fuel and one that had not. Similarly, an ELSAM was conducted with the second stressor being the further addition of JP-8 replacing the heat shock. Biological, physical and chemical data were analyzed with multivariate techniques including nonmetric clustering and association analysis. Space-time worms and phase diagrams were also employed to ascertain the dynamic relationships of variables identified as important by the multivariate techniques. The experiments do not result in a simple additive linear response to the additional stressor. Examination of the relative population dynamics reveal alterations in trajectories that suggest treatment related effects. As in previous single stressor experiments, recovery does not occur even after extended experimental periods. The authors are now attempting to measure the resulting trajectories, changes in similarity vectors and overall dynamics. However, community conditioning does appear to be an important framework in understanding systems with a heterogeneous array of stressors

  11. Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan.

    Science.gov (United States)

    Miyata, Hiroaki; Hashimoto, Hideki; Horiguchi, Hiromasa; Fushimi, Kiyohide; Matsuda, Shinya

    2010-05-19

    Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index > or = 0.8; hospitals with c-index /=0.8 and were classified as the higher c-index group. A significantly higher proportion of hospitals in the lower c-index group were specialized hospitals and hospitals with convalescent wards. The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

  12. A heart model with multiple chambers for myocardial scintigraphy

    International Nuclear Information System (INIS)

    Pretschner, D.P.; Hundeshagen, H.

    1980-01-01

    A heart model is portrayed which consists from individual segments to be filled with activity. The mechanics allow to vary the position in order to generate different positions for evaluation of the scintigraphic systems performance. (orig.) [de

  13. Multiple Model Particle Filtering For Multi-Target Tracking

    National Research Council Canada - National Science Library

    Hero, Alfred; Kreucher, Chris; Kastella, Keith

    2004-01-01

    .... The details of this method have been presented elsewhere 1. One feature of real targets is that they are poorly described by a single kinematic model Target behavior may change dramatically i.e...

  14. Computational Modeling of Human Multiple-Task Performance

    National Research Council Canada - National Science Library

    Kieras, David E; Meyer, David

    2005-01-01

    This is the final report for a project that was a continuation of an earlier, long-term project on the development and validation of the EPIC cognitive architecture for modeling human cognition and performance...

  15. A Bose-Einstein model of particle multiplicity distributions

    Energy Technology Data Exchange (ETDEWEB)

    Mekjian, A.Z. [Department of Physics and Astronomy, Rutgers University, Piscataway, NJ 08854 (United States) and California Institute of Technology, Kellogg Radiation Lab., Pasadena, CA 91106 (United States) and MTA KFKI RMKI, 114 PO Box 49, H-1525 Budapest (Hungary)]. E-mail: amekjian@physics.rutgers.edu; Csoergoe, T. [MTA KFKI RMKI, 114 PO Box 49, H-1525 Budapest (Hungary); Hegyi, S. [MTA KFKI RMKI, 114 PO Box 49, H-1525 Budapest (Hungary)

    2007-03-01

    A model of particle production is developed based on a parallel with a theory of Bose-Einstein condensation and similarities with other critical phenomena such as critical opalescence. The role of a power law critical exponent {tau} and Levy index {alpha} are studied. Various features of this model are developed and compared with other commonly used models of particle production which are shown to differ by having different values for {tau}, {alpha}. While void scaling is a feature of this model, hierarchical structure is not a general property of it. The value of the exponent {tau}=2 is a transition point associated with void and hierarchical scaling features. An exponent {gamma} is introduced to describe enhanced fluctuations near a critical point. Experimentally determined properties of the void scaling function can be used to determine {tau}.

  16. A Bose-Einstein model of particle multiplicity distributions

    International Nuclear Information System (INIS)

    Mekjian, A.Z.; Csoergoe, T.; Hegyi, S.

    2007-01-01

    A model of particle production is developed based on a parallel with a theory of Bose-Einstein condensation and similarities with other critical phenomena such as critical opalescence. The role of a power law critical exponent τ and Levy index α are studied. Various features of this model are developed and compared with other commonly used models of particle production which are shown to differ by having different values for τ, α. While void scaling is a feature of this model, hierarchical structure is not a general property of it. The value of the exponent τ=2 is a transition point associated with void and hierarchical scaling features. An exponent γ is introduced to describe enhanced fluctuations near a critical point. Experimentally determined properties of the void scaling function can be used to determine τ

  17. A Bose Einstein model of particle multiplicity distributions

    Science.gov (United States)

    Mekjian, A. Z.; Csörgö, T.; Hegyi, S.

    2007-03-01

    A model of particle production is developed based on a parallel with a theory of Bose-Einstein condensation and similarities with other critical phenomena such as critical opalescence. The role of a power law critical exponent τ and Levy index α are studied. Various features of this model are developed and compared with other commonly used models of particle production which are shown to differ by having different values for τ, α. While void scaling is a feature of this model, hierarchical structure is not a general property of it. The value of the exponent τ=2 is a transition point associated with void and hierarchical scaling features. An exponent γ is introduced to describe enhanced fluctuations near a critical point. Experimentally determined properties of the void scaling function can be used to determine τ.

  18. Discrete modeling of multiple discontinuities in rock mass using XFEM

    OpenAIRE

    Das, Kamal C.; Ausas, Roberto Federico; Carol, Ignacio; Rodrigues, Eduardo; Sandeep, Sandra; Vargas, P. E.; Gonzalez, Nubia Aurora; Segura, Josep María; Lakshmikantha, Ramasesha Mookanahallipatna; Mello,, U.

    2017-01-01

    Modeling of discontinuities (fractures and fault surfaces) is of major importance to assess the geomechanical behavior of oil and gas reservoirs, especially for tight and unconventional reservoirs. Numerical analysis of discrete discontinuities traditionally has been studied using interface element concepts, however more recently there are attempts to use extended finite element method (XFEM). The development of an XFEM tool for geo-mechanical fractures/faults modeling has significant industr...

  19. The Effect of ISO 9001 and the EFQM Model on Improving Hospital Performance: A Systematic Review.

    Science.gov (United States)

    Yousefinezhadi, Taraneh; Mohamadi, Efat; Safari Palangi, Hossein; Akbari Sari, Ali

    2015-12-01

    This study aimed to explore the effect of the International Organization for Standardization (ISO) ISO 9001 standard and the European foundation for quality management (EFQM) model on improving hospital performance. PubMed, Embase and the Cochrane Library databases were searched. In addition, Elsevier and Springer were searched as main publishers in the field of health sciences. We included empirical studies with any design that had used ISO 9001 or the EFQM model to improve the quality of healthcare. Data were collected and tabulated into a data extraction sheet that was specifically designed for this study. The collected data included authors' names, country, year of publication, intervention, improvement aims, setting, length of program, study design, and outcomes. Seven out of the 121 studies that were retrieved met the inclusion criteria. Three studies assessed the EFQM model and four studies assessed the ISO 9001 standard. Use of the EFQM model increased the degree of patient satisfaction and the number of hospital admissions and reduced the average length of stay, the delay on the surgical waiting list, and the number of emergency re-admissions. ISO 9001 also increased the degree of patient satisfaction and patient safety, increased cost-effectiveness, improved the hospital admissions process, and reduced the percentage of unscheduled returns to the hospital. Generally, there is a lack of robust and high quality empirical evidence regarding the effects of ISO 9001 and the EFQM model on the quality care provided by and the performance of hospitals. However, the limited evidence shows that ISO 9001 and the EFQM model might improve hospital performance.

  20. Model-based monitoring of rotors with multiple coexisting faults

    International Nuclear Information System (INIS)

    Rossner, Markus

    2015-01-01

    Monitoring systems are applied to many rotors, but only few monitoring systems can separate coexisting errors and identify their quantity. This research project solves this problem using a combination of signal-based and model-based monitoring. The signal-based part performs a pre-selection of possible errors; these errors are further separated with model-based methods. This approach is demonstrated for the errors unbalance, bow, stator-fixed misalignment, rotor-fixed misalignment and roundness errors. For the model-based part, unambiguous error definitions and models are set up. The Ritz approach reduces the model order and therefore speeds up the diagnosis. Identification algorithms are developed for the different rotor faults. Hereto, reliable damage indicators and proper sub steps of the diagnosis have to be defined. For several monitoring problems, measuring both deflection and bearing force is very useful. The monitoring system is verified by experiments on an academic rotor test rig. The interpretation of the measurements requires much knowledge concerning the dynamics of the rotor. Due to the model-based approach, the system can separate errors with similar signal patterns and identify bow and roundness error online at operation speed. [de

  1. The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses.

    Science.gov (United States)

    Scott, Linda D; Hwang, Wei-Ting; Rogers, Ann E

    2006-02-01

    This study describes fatigue and stress among a random sample of full-time hospital staff nurses (n=393) who provide care for aging family members, compares the results to nurses with and without children younger than 18 years living at home, examines differences in sleep duration, and explores the effects on work performance by care giving status during a 4-week period. Little attention has been given to the effects of care giver well-being when individuals assume dual roles as family and professional care givers. Hospital staff nurses recorded daily information concerning their work hours, errors, sleep/wake patterns, perceptions of fatigue, alertness, and stress and periods of drowsiness and sleep episodes while on duty for 28 days. Fatigue and stress levels were significantly higher among nurses caring for both children and elders. However, nurses providing elder care at home were more fatigued, sleep-deprived, and likely to make errors at work. These findings underscore the importance of restorative sleep interventions and fatigue countermeasures for hospital staff nurses involved in dual care giving roles. Limiting overtime and applying circadian principles to hospital scheduling processes would ensure a more alert workforce, minimize health risks for nurses, and maximize the safety of those in their care.

  2. Exploring the Use of Multiple Analogical Models when Teaching and Learning Chemical Equilibrium

    Science.gov (United States)

    Harrison, Allan G.; De Jong, Onno

    2005-01-01

    This study describes the multiple analogical models used to introduce and teach Grade 12 chemical equilibrium. We examine the teacher's reasons for using models, explain each model's development during the lessons, and analyze the understandings students derived from the models. A case study approach was used and the data were drawn from the…

  3. Areas of Hospitality Management and Stakeholders in Recruitment and Selection Multiple Case Study: Estanplaza, Travel in and Transamérica.

    Directory of Open Access Journals (Sweden)

    Thiago Sbarai Santos Alves

    2014-06-01

    Full Text Available This research aims to analyze the relationships between recruitment and selection and its stakeholders, considering the areas of hospitality and its characteristics as influential factors to recruit and select new employees. The research approach was qualitative methodologies for the study of multiple cases, which contributed to the form of empirical research. For this investigation were selected by three chains together features that enabled a comparative analysis of the study, which were used for data collection, three sources of evidence: interviews, direct observations and documentation. The selected networks, Estanplaza Hotels, Hotels Transamerica and Travel Inn Hotels The overall goal was to understand the processes used in recruitment and selection set features the fields of hospitality. From this issue were established specific objectives: to observe the dynamics of recruitment and selection of chains; analyze the content related to the fields of hospitality in the tools used in the process of recruitment and selection, and meet stakeholders in this area. The research was conducted through interviews with managers of lodging facilities and with stakeholders in the area of recruitment and selection, based on a semistructured interview guide. Through this research, we found that some features of the fields of hospitality are considered in the process of recruitment and selection. Chains surveyed, however, point out that it is necessary to use tools and processes that enable this type of analysis.

  4. Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

    Science.gov (United States)

    Guo, Hainan; Zhao, Yang; Niu, Tie; Tsui, Kwok-Leung

    2017-01-01

    The Hospital Authority (HA) is a statutory body managing all the public hospitals and institutes in Hong Kong (HK). In recent decades, Hong Kong Hospital Authority (HKHA) has been making efforts to improve the healthcare services, but there still exist some problems like unfair resource allocation and poor management, as reported by the Hong Kong medical legislative committee. One critical consequence of these problems is low healthcare efficiency of hospitals, leading to low satisfaction among patients. Moreover, HKHA also suffers from the conflict between limited resource and growing demand. An effective evaluation of HA is important for resource planning and healthcare decision making. In this paper, we propose a two-phase method to evaluate HA efficiency for reducing healthcare expenditure and improving healthcare service. Specifically, in Phase I, we measure the HKHA efficiency changes from 2000 to 2013 by applying a novel DEA-Malmquist index with undesirable factors. In Phase II, we further explore the impact of some exogenous factors (e.g., population density) on HKHA efficiency by Tobit regression model. Empirical results show that there are significant differences between the efficiencies of different hospitals and clusters. In particular, it is found that the public hospital serving in a richer district has a relatively lower efficiency. To a certain extent, this reflects the socioeconomic reality in HK that people with better economic condition prefers receiving higher quality service from the private hospitals.

  5. Simple model for multiple-choice collective decision making.

    Science.gov (United States)

    Lee, Ching Hua; Lucas, Andrew

    2014-11-01

    We describe a simple model of heterogeneous, interacting agents making decisions between n≥2 discrete choices. For a special class of interactions, our model is the mean field description of random field Potts-like models and is effectively solved by finding the extrema of the average energy E per agent. In these cases, by studying the propagation of decision changes via avalanches, we argue that macroscopic dynamics is well captured by a gradient flow along E. We focus on the permutation symmetric case, where all n choices are (on average) the same, and spontaneous symmetry breaking (SSB) arises purely from cooperative social interactions. As examples, we show that bimodal heterogeneity naturally provides a mechanism for the spontaneous formation of hierarchies between decisions and that SSB is a preferred instability to discontinuous phase transitions between two symmetric points. Beyond the mean field limit, exponentially many stable equilibria emerge when we place this model on a graph of finite mean degree. We conclude with speculation on decision making with persistent collective oscillations. Throughout the paper, we emphasize analogies between methods of solution to our model and common intuition from diverse areas of physics, including statistical physics and electromagnetism.

  6. Chlorpyrifos PBPK/PD model for multiple routes of exposure.

    Science.gov (United States)

    Poet, Torka S; Timchalk, Charles; Hotchkiss, Jon A; Bartels, Michael J

    2014-10-01

    1. Chlorpyrifos (CPF) is an important pesticide used to control crop insects. Human Exposures to CPF will occur primarily through oral exposure to residues on foods. A physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD) model has been developed that describes the relationship between oral, dermal and inhalation doses of CPF and key events in the pathway for cholinergic effects. The model was built on a prior oral model that addressed age-related changes in metabolism and physiology. This multi-route model was developed in rats and humans to validate all scenarios in a parallelogram design. 2. Critical biological effects from CPF exposure require metabolic activation to CPF oxon, and small amounts of metabolism in tissues will potentially have a great effect on pharmacokinetics and pharmacodynamic outcomes. Metabolism (bioactivation and detoxification) was therefore added in diaphragm, brain, lung and skin compartments. Pharmacokinetic data are available for controlled human exposures via the oral and dermal routes and from oral and inhalation studies in rats. The validated model was then used to determine relative dermal versus inhalation uptake from human volunteers exposed to CPF in an indoor scenario.

  7. A measurement model of multiple intelligence profiles of management graduates

    Science.gov (United States)

    Krishnan, Heamalatha; Awang, Siti Rahmah

    2017-05-01

    In this study, developing a fit measurement model and identifying the best fitting items to represent Howard Gardner's nine intelligences namely, musical intelligence, bodily-kinaesthetic intelligence, mathematical/logical intelligence, visual/spatial intelligence, verbal/linguistic intelligence, interpersonal intelligence, intrapersonal intelligence, naturalist intelligence and spiritual intelligence are the main interest in order to enhance the opportunities of the management graduates for employability. In order to develop a fit measurement model, Structural Equation Modeling (SEM) was applied. A psychometric test which is the Ability Test in Employment (ATIEm) was used as the instrument to measure the existence of nine types of intelligence of 137 University Teknikal Malaysia Melaka (UTeM) management graduates for job placement purposes. The initial measurement model contains nine unobserved variables and each unobserved variable is measured by ten observed variables. Finally, the modified measurement model deemed to improve the Normed chi-square (NC) = 1.331; Incremental Fit Index (IFI) = 0.940 and Root Mean Square of Approximation (RMSEA) = 0.049 was developed. The findings showed that the UTeM management graduates possessed all nine intelligences either high or low. Musical intelligence, mathematical/logical intelligence, naturalist intelligence and spiritual intelligence contributed highest loadings on certain items. However, most of the intelligences such as bodily kinaesthetic intelligence, visual/spatial intelligence, verbal/linguistic intelligence interpersonal intelligence and intrapersonal intelligence possessed by UTeM management graduates are just at the borderline.

  8. Multiple bifurcations and periodic 'bubbling' in a delay population model

    International Nuclear Information System (INIS)

    Peng Mingshu

    2005-01-01

    In this paper, the flip bifurcation and periodic doubling bifurcations of a discrete population model without delay influence is firstly studied and the phenomenon of Feigenbaum's cascade of periodic doublings is also observed. Secondly, we explored the Neimark-Sacker bifurcation in the delay population model (two-dimension discrete dynamical systems) and the unique stable closed invariant curve which bifurcates from the nontrivial fixed point. Finally, a computer-assisted study for the delay population model is also delved into. Our computer simulation shows that the introduction of delay effect in a nonlinear difference equation derived from the logistic map leads to much richer dynamic behavior, such as stable node → stable focus → an lower-dimensional closed invariant curve (quasi-periodic solution, limit cycle) or/and stable periodic solutions → chaotic attractor by cascading bubbles (the combination of potential period doubling and reverse period-doubling) and the sudden change between two different attractors, etc

  9. Semantics of Temporal Models with Multiple Temporal Dimensions

    DEFF Research Database (Denmark)

    Kraft, Peter; Sørensen, Jens Otto

    ending up with lexical data models. In particular we look upon the representations by sets of normalised tables, by sets of 1NF tables and by sets of N1NF/nested tables. At each translation step we focus on how the temporal semantic is consistently maintained. In this way we recognise the requirements...... for representation of temporal properties in different models and the correspondence between the models. The results rely on the assumptions that the temporal dimensions are interdependent and ordered. Thus for example the valid periods of existences of a property in a mini world are dependent on the transaction...... periods in which the corresponding recordings are valid. This is not the normal way of looking at temporal dimensions and we give arguments supporting our assumption....

  10. Modeling of plates with multiple anisotropic layers and residual stress

    DEFF Research Database (Denmark)

    Engholm, Mathias; Pedersen, Thomas; Thomsen, Erik Vilain

    2016-01-01

    Usually the analytical approach for modeling of plates uses the single layer plate equation to obtain the deflection and does not take anisotropy and residual stress into account. Based on the stress–strain relation of each layer and balancing stress resultants and bending moments, a general...... multilayered anisotropic plate equation is developed for plates with an arbitrary number of layers. The exact deflection profile is calculated for a circular clamped plate of anisotropic materials with residual bi-axial stress.From the deflection shape the critical stress for buckling is calculated......, and an excellent agreement between the two models is seen with a relative difference of less than 2% for all calculations. The model was also used to extract the cell capacitance, the parasitic capacitance and the residual stress of a pressure sensor composed of a multilayered plate of silicon and silicon oxide...

  11. Improving financial performance by modeling and analysis of radiology procedure scheduling at a large community hospital.

    Science.gov (United States)

    Lu, Lingbo; Li, Jingshan; Gisler, Paula

    2011-06-01

    Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.

  12. Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients.

    Science.gov (United States)

    Aguiar, Fabio S; Almeida, Luciana L; Ruffino-Netto, Antonio; Kritski, Afranio Lineu; Mello, Fernanda Cq; Werneck, Guilherme L

    2012-08-07

    Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in

  13. Dynamic information architecture system (DIAS) : multiple model simulation management

    International Nuclear Information System (INIS)

    Simunich, K. L.; Sydelko, P.; Dolph, J.; Christiansen, J.

    2002-01-01

    Dynamic Information Architecture System (DIAS) is a flexible, extensible, object-based framework for developing and maintaining complex multidisciplinary simulations of a wide variety of application contexts. The modeling domain of a specific DIAS-based simulation is determined by (1) software Entity (domain-specific) objects that represent the real-world entities that comprise the problem space (atmosphere, watershed, human), and (2) simulation models and other data processing applications that express the dynamic behaviors of the domain entities. In DIAS, models communicate only with Entity objects, never with each other. Each Entity object has a number of Parameter and Aspect (of behavior) objects associated with it. The Parameter objects contain the state properties of the Entity object. The Aspect objects represent the behaviors of the Entity object and how it interacts with other objects. DIAS extends the ''Object'' paradigm by abstraction of the object's dynamic behaviors, separating the ''WHAT'' from the ''HOW.'' DIAS object class definitions contain an abstract description of the various aspects of the object's behavior (the WHAT), but no implementation details (the HOW). Separate DIAS models/applications carry the implementation of object behaviors (the HOW). Any model deemed appropriate, including existing legacy-type models written in other languages, can drive entity object behavior. The DIAS design promotes plug-and-play of alternative models, with minimal recoding of existing applications. The DIAS Context Builder object builds a constructs or scenario for the simulation, based on developer specification and user inputs. Because DIAS is a discrete event simulation system, there is a Simulation Manager object with which all events are processed. Any class that registers to receive events must implement an event handler (method) to process the event during execution. Event handlers can schedule other events; create or remove Entities from the

  14. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  15. Dynamic information architecture system (DIAS) : multiple model simulation management.

    Energy Technology Data Exchange (ETDEWEB)

    Simunich, K. L.; Sydelko, P.; Dolph, J.; Christiansen, J.

    2002-05-13

    Dynamic Information Architecture System (DIAS) is a flexible, extensible, object-based framework for developing and maintaining complex multidisciplinary simulations of a wide variety of application contexts. The modeling domain of a specific DIAS-based simulation is determined by (1) software Entity (domain-specific) objects that represent the real-world entities that comprise the problem space (atmosphere, watershed, human), and (2) simulation models and other data processing applications that express the dynamic behaviors of the domain entities. In DIAS, models communicate only with Entity objects, never with each other. Each Entity object has a number of Parameter and Aspect (of behavior) objects associated with it. The Parameter objects contain the state properties of the Entity object. The Aspect objects represent the behaviors of the Entity object and how it interacts with other objects. DIAS extends the ''Object'' paradigm by abstraction of the object's dynamic behaviors, separating the ''WHAT'' from the ''HOW.'' DIAS object class definitions contain an abstract description of the various aspects of the object's behavior (the WHAT), but no implementation details (the HOW). Separate DIAS models/applications carry the implementation of object behaviors (the HOW). Any model deemed appropriate, including existing legacy-type models written in other languages, can drive entity object behavior. The DIAS design promotes plug-and-play of alternative models, with minimal recoding of existing applications. The DIAS Context Builder object builds a constructs or scenario for the simulation, based on developer specification and user inputs. Because DIAS is a discrete event simulation system, there is a Simulation Manager object with which all events are processed. Any class that registers to receive events must implement an event handler (method) to process the event during execution. Event handlers

  16. Innovative supply chain optimization models with multiple uncertainty factors

    DEFF Research Database (Denmark)

    Choi, Tsan Ming; Govindan, Kannan; Li, Xiang

    2017-01-01

    Uncertainty is an inherent factor that affects all dimensions of supply chain activities. In today’s business environment, initiatives to deal with one specific type of uncertainty might not be effective since other types of uncertainty factors and disruptions may be present. These factors relate...... to supply chain competition and coordination. Thus, to achieve a more efficient and effective supply chain requires the deployment of innovative optimization models and novel methods. This preface provides a concise review of critical research issues regarding innovative supply chain optimization models...

  17. The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

    Science.gov (United States)

    Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

    2016-10-10

    Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

  18. Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.

    Science.gov (United States)

    Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

    2014-11-01

    Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working

  19. Network formation under heterogeneous costs: The multiple group model

    NARCIS (Netherlands)

    Kamphorst, J.J.A.; van der Laan, G.

    2007-01-01

    It is widely recognized that the shape of networks influences both individual and aggregate behavior. This raises the question which types of networks are likely to arise. In this paper we investigate a model of network formation, where players are divided into groups and the costs of a link between

  20. Framework for Modelling Multiple Input Complex Aggregations for Interactive Installations

    DEFF Research Database (Denmark)

    Padfield, Nicolas; Andreasen, Troels

    2012-01-01

    on fuzzy logic and provides a method for variably balancing interaction and user input with the intention of the artist or director. An experimental design is presented, demonstrating an intuitive interface for parametric modelling of a complex aggregation function. The aggregation function unifies...

  1. Multiple Linear Regression Model for Estimating the Price of a ...

    African Journals Online (AJOL)

    Ghana Mining Journal ... In the modeling, the Ordinary Least Squares (OLS) normality assumption which could introduce errors in the statistical analyses was dealt with by log transformation of the data, ensuring the data is normally ... The resultant MLRM is: Ŷi MLRM = (X'X)-1X'Y(xi') where X is the sample data matrix.

  2. A multiple-compartment model for biokinetics studies in plants

    International Nuclear Information System (INIS)

    Garcia, Fermin; Pietrobron, Flavio; Fonseca, Agnes M.F.; Mol, Anderson W.; Rodriguez, Oscar; Guzman, Fernando

    2001-01-01

    In the present work is used the system of linear equations based in the general Assimakopoulos's GMCM model , for the development of a new method that will determine the flow's parameters and transfer coefficients in plants. The need of mathematical models to quantify the penetration of a trace substance in animals and plants, has often been stressed in the literature. Usually, in radiological environment studies, it is used the mean value of contaminant concentrations on whole or edible part plant body, without taking in account vegetable physiology regularities. In this work concepts and mathematical formulation of a Vegetable Multi-compartment Model (VMCM), taking into account the plant's physiology regularities is presented. The model based in general ideas of the GMCM , and statistical Square Minimum Method STATFLUX is proposed to use in inverse sense: the experimental time dependence of concentration in each compartment, should be input, and the parameters should be determined from this data in a statistical approach. The case of Uranium metabolism is discussed. (author)

  3. Modeling of Optimal Power Generation using Multiple Kites

    NARCIS (Netherlands)

    Williams, P.; Lansdorp, B.; Ockels, W.J.

    2008-01-01

    Kite systems have the potential to revolutionize energy generation. Large scale systems are envisioned that can fly autonomously in “power generation” cycles which drive a ground-based generator. In order for such systems to produce power efficiently, good models of the system are required. This

  4. An individual-based model of transmission of resistant bacteria in a veterinary teaching hospital.

    Directory of Open Access Journals (Sweden)

    Neeraj Suthar

    Full Text Available Veterinary nosocomial infections caused by antibiotic resistant bacteria cause increased morbidity, higher cost and length of treatment and increased zoonotic risk because of the difficulty in treating them. In this study, an individual-based model was developed to investigate the effects of movements of canine patients among ten areas (transmission points within a veterinary teaching hospital, and the effects of these movements on transmission of antibiotic susceptible and resistant pathogens. The model simulates contamination of transmission points, healthcare workers, and patients as well as the effects of decontamination of transmission points, disinfection of healthcare workers, and antibiotic treatments of canine patients. The model was parameterized using data obtained from hospital records, information obtained by interviews with hospital staff, and the published literature. The model suggested that transmission resulting from contact with healthcare workers was common, and that certain transmission points (housing wards, diagnostics room, and the intensive care unit presented higher risk for transmission than others (lobby and surgery. Sensitivity analyses using a range of parameter values demonstrated that the risk of acquisition of colonization by resistant pathogens decreased with shorter patient hospital stays (P<0.0001, more frequent decontamination of transmission points and disinfection of healthcare workers (P<0.0001 and better compliance of healthcare workers with hygiene practices (P<0.0001. More frequent decontamination of heavily trafficked transmission points was especially effective at reducing transmission of the model pathogen.

  5. Development of a conceptual model of the role of hospital nurses in health promotion in Jordan.

    Science.gov (United States)

    Shoqirat, N

    2015-05-19

    International evidence reveals that hospital nurses have not been able to incorporate health promotion effectively into the framework of their care. This can be attributed to unclear conceptualizing of the barriers and facilitators to the role of nurses in health promotion. An integrative review was carried out to develop a conceptual model to assist hospital nurses in Jordan to understand how health promotion activities can be developed. Factors affecting the involvement of nurses in health promotion - ranging from limited knowledge about health promotion to the social image of nursing - can be structured into three levels: the micro (individual), meso (organizational) and macro (population). By understanding the interplay of factors between and within the levels, nurses and other health professionals can draw on the individual, social and organizational factors that influence nurses' role in health promotion. The proposed model can be considered as a springboard for developing health promotion activities related to hospitals in other Muslim-majority contexts.

  6. On the thermoluminescent interactive multiple-trap system (IMTS) model: is it a simple model?

    International Nuclear Information System (INIS)

    Gil T, M. I.; Perez C, L.; Cruz Z, E.; Furetta, C.; Roman L, J.

    2016-10-01

    In the thermally stimulated luminescence phenomenon, named thermoluminescence (Tl), the electrons and holes generated by the radiation-matter interaction can be trapped by the metastable levels in the band gap of the solid. Following, the electron can be thermally releases into the conduction band and a radiatively recombination with hole close to the recombination center occurred and the glow curve is emitted. However, the complex mechanism of trapping and thermally releases occurred in the band gap of solid. Some models, such as; first, second and general-order kinetics, have been well established to explain the behaviour of the glow curves and their defects recombination mechanism. In this work, expressions for and Interactive Multiple-Trap System model (IMTS) was obtained assuming: a set of discrete electron traps (active traps At), another set of thermally disconnected trap (TDT) and a recombination center (Rc) too. A numerical analysis based on the Levenberg-Marquardt method in conjunction with an implicit Rosenbrock method was taken into account to simulate the glow curve. The numerical method was tested through synthetic Tl glow curves for a wide range of trap parameters. The activation energy and kinetics order were determined using values from the General Order Kinetics (GOK) model as entry data to IMTS model. This model was tested using the experimental glow curves obtained from Ce or Eu-doped MgF 2 (LiF) polycrystals samples. Results shown that the IMTS model can predict more accurately the behavior of the Tl glow curves that those obtained by the GOK modified by Rasheedy and by the Mixed Order Kinetics model. (Author)

  7. On the thermoluminescent interactive multiple-trap system (IMTS) model: is it a simple model?

    Energy Technology Data Exchange (ETDEWEB)

    Gil T, M. I.; Perez C, L. [UNAM, Facultad de Quimica, Ciudad Universitaria, 04510 Ciudad de Mexico (Mexico); Cruz Z, E.; Furetta, C.; Roman L, J., E-mail: ecruz@nucleares.unam.mx [UNAM, Instituto de Ciencias Nucleares, Ciudad Universitaria, 04510 Ciudad de Mexico (Mexico)

    2016-10-15

    In the thermally stimulated luminescence phenomenon, named thermoluminescence (Tl), the electrons and holes generated by the radiation-matter interaction can be trapped by the metastable levels in the band gap of the solid. Following, the electron can be thermally releases into the conduction band and a radiatively recombination with hole close to the recombination center occurred and the glow curve is emitted. However, the complex mechanism of trapping and thermally releases occurred in the band gap of solid. Some models, such as; first, second and general-order kinetics, have been well established to explain the behaviour of the glow curves and their defects recombination mechanism. In this work, expressions for and Interactive Multiple-Trap System model (IMTS) was obtained assuming: a set of discrete electron traps (active traps At), another set of thermally disconnected trap (TDT) and a recombination center (Rc) too. A numerical analysis based on the Levenberg-Marquardt method in conjunction with an implicit Rosenbrock method was taken into account to simulate the glow curve. The numerical method was tested through synthetic Tl glow curves for a wide range of trap parameters. The activation energy and kinetics order were determined using values from the General Order Kinetics (GOK) model as entry data to IMTS model. This model was tested using the experimental glow curves obtained from Ce or Eu-doped MgF{sub 2}(LiF) polycrystals samples. Results shown that the IMTS model can predict more accurately the behavior of the Tl glow curves that those obtained by the GOK modified by Rasheedy and by the Mixed Order Kinetics model. (Author)

  8. MODELING OF TARGETED DRUG DELIVERY PART II. MULTIPLE DRUG ADMINISTRATION

    Directory of Open Access Journals (Sweden)

    A. V. Zaborovskiy

    2017-01-01

    Full Text Available In oncology practice, despite significant advances in early cancer detection, surgery, radiotherapy, laser therapy, targeted therapy, etc., chemotherapy is unlikely to lose its relevance in the near future. In this context, the development of new antitumor agents is one of the most important problems of cancer research. In spite of the importance of searching for new compounds with antitumor activity, the possibilities of the “old” agents have not been fully exhausted. Targeted delivery of antitumor agents can give them a “second life”. When developing new targeted drugs and their further introduction into clinical practice, the change in their pharmacodynamics and pharmacokinetics plays a special role. The paper describes a pharmacokinetic model of the targeted drug delivery. The conditions under which it is meaningful to search for a delivery vehicle for the active substance were described. Primary screening of antitumor agents was undertaken to modify them for the targeted delivery based on underlying assumptions of the model.

  9. Modeling of CMUTs with Multiple Anisotropic Layers and Residual Stress

    DEFF Research Database (Denmark)

    Engholm, Mathias; Thomsen, Erik Vilain

    2014-01-01

    Usually the analytical approach for modeling CMUTs uses the single layer plate equation to obtain the deflection and does not take anisotropy and residual stress into account. A highly accurate model is developed for analytical characterization of CMUTs taking an arbitrary number of layers...... and residual stress into account. Based on the stress-strain relation of each layer and balancing stress resultants and bending moments, a general multilayered anisotropic plate equation is developed for plates with an arbitrary number of layers. The exact deflection profile is calculated for a circular...... clamped plate of anisotropic materials with residual bi-axial stress. From the deflection shape the critical stress for buckling is calculated and by using the Rayleigh-Ritz method the natural frequency is estimated....

  10. Standard model fermion hierarchies with multiple Higgs doublets

    International Nuclear Information System (INIS)

    Solaguren-Beascoa Negre, Ana

    2016-01-01

    The hierarchies between the Standard Model (SM) fermion masses and mixing angles and the origin of neutrino masses are two of the biggest mysteries in particle physics. We extend the SM with new Higgs doublets to solve these issues. The lightest fermion masses and the mixing angles are generated through radiative effects, correctly reproducing the hierarchy pattern. Neutrino masses are generated in the see-saw mechanism.

  11. Optical model with multiple band couplings using soft rotator structure

    Science.gov (United States)

    Martyanov, Dmitry; Soukhovitskii, Efrem; Capote, Roberto; Quesada, Jose Manuel; Chiba, Satoshi

    2017-09-01

    A new dispersive coupled-channel optical model (DCCOM) is derived that describes nucleon scattering on 238U and 232Th targets using a soft-rotator-model (SRM) description of the collective levels of the target nucleus. SRM Hamiltonian parameters are adjusted to the observed collective levels of the target nucleus. SRM nuclear wave functions (mixed in K quantum number) have been used to calculate coupling matrix elements of the generalized optical model. Five rotational bands are coupled: the ground-state band, β-, γ-, non-axial- bands, and a negative parity band. Such coupling scheme includes almost all levels below 1.2 MeV of excitation energy of targets. The "effective" deformations that define inter-band couplings are derived from SRM Hamiltonian parameters. Conservation of nuclear volume is enforced by introducing a monopolar deformed potential leading to additional couplings between rotational bands. The present DCCOM describes the total cross section differences between 238U and 232Th targets within experimental uncertainty from 50 keV up to 200 MeV of neutron incident energy. SRM couplings and volume conservation allow a precise calculation of the compound-nucleus (CN) formation cross sections, which is significantly different from the one calculated with rigid-rotor potentials with any number of coupled levels.

  12. Modeling water demand when households have multiple sources of water

    Science.gov (United States)

    Coulibaly, Lassina; Jakus, Paul M.; Keith, John E.

    2014-07-01

    A significant portion of the world's population lives in areas where public water delivery systems are unreliable and/or deliver poor quality water. In response, people have developed important alternatives to publicly supplied water. To date, most water demand research has been based on single-equation models for a single source of water, with very few studies that have examined water demand from two sources of water (where all nonpublic system water sources have been aggregated into a single demand). This modeling approach leads to two outcomes. First, the demand models do not capture the full range of alternatives, so the true economic relationship among the alternatives is obscured. Second, and more seriously, economic theory predicts that demand for a good becomes more price-elastic as the number of close substitutes increases. If researchers artificially limit the number of alternatives studied to something less than the true number, the price elasticity estimate may be biased downward. This paper examines water demand in a region with near universal access to piped water, but where system reliability and quality is such that many alternative sources of water exist. In extending the demand analysis to four sources of water, we are able to (i) demonstrate why households choose the water sources they do, (ii) provide a richer description of the demand relationships among sources, and (iii) calculate own-price elasticity estimates that are more elastic than those generally found in the literature.

  13. An architecture model for multiple disease management information systems.

    Science.gov (United States)

    Chen, Lichin; Yu, Hui-Chu; Li, Hao-Chun; Wang, Yi-Van; Chen, Huang-Jen; Wang, I-Ching; Wang, Chiou-Shiang; Peng, Hui-Yu; Hsu, Yu-Ling; Chen, Chi-Huang; Chuang, Lee-Ming; Lee, Hung-Chang; Chung, Yufang; Lai, Feipei

    2013-04-01

    Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

  14. A Technique of Fuzzy C-Mean in Multiple Linear Regression Model toward Paddy Yield

    Science.gov (United States)

    Syazwan Wahab, Nur; Saifullah Rusiman, Mohd; Mohamad, Mahathir; Amira Azmi, Nur; Che Him, Norziha; Ghazali Kamardan, M.; Ali, Maselan

    2018-04-01

    In this paper, we propose a hybrid model which is a combination of multiple linear regression model and fuzzy c-means method. This research involved a relationship between 20 variates of the top soil that are analyzed prior to planting of paddy yields at standard fertilizer rates. Data used were from the multi-location trials for rice carried out by MARDI at major paddy granary in Peninsular Malaysia during the period from 2009 to 2012. Missing observations were estimated using mean estimation techniques. The data were analyzed using multiple linear regression model and a combination of multiple linear regression model and fuzzy c-means method. Analysis of normality and multicollinearity indicate that the data is normally scattered without multicollinearity among independent variables. Analysis of fuzzy c-means cluster the yield of paddy into two clusters before the multiple linear regression model can be used. The comparison between two method indicate that the hybrid of multiple linear regression model and fuzzy c-means method outperform the multiple linear regression model with lower value of mean square error.

  15. Reprodaetion of an animal model of multiple intestinal injuries mimicking "lethal triad" caused by severe penetrating abdominal trauma

    Directory of Open Access Journals (Sweden)

    Peng-fei WANG

    2011-03-01

    Full Text Available Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature,acidosis and coagulopathy.Methods Six female domestic outbred pigs were anesthetized,and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid.The animals were shot with a gun to create a severe penetrating abdominal trauma.Immediately after the shooting,50% of total blood volume(35ml/kg hemorrhage was drawn from the carotid artery in 20min.After a 40min shock period,4h of pre-hospital phase was mimicked by normal saline(NS resuscitation to maintain systolic blood pressure(SBP > 80mmHg or mean arterial pressure(MAP > 60mmHg.When SBP > 80mmHg or MAP > 60mmHg,no fluid infusion or additional bleeding was given.Hemodynamic parameters were recorded,and pathology of myocardium,lung,small intestine and liver was observed.Results There were multiple intestinal perforations(8-10 site injuries/pig leading to intra-abdominal contamination,mesenteric injury(1-2 site injuries/pig resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury.One pig died before the completion of the model establishment(at the end of pre-hospital resuscitation.The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals.Low temperature(33.3±0.5℃,acidosis(pH=7.242±0.064,and coagulopathy(protrombin time and activated partial thromboplasting time prolonged were observed after pre-hospital resuscitation.Pathology showed that myocardium,lung,small intestine and liver were severely injured.Conclusions A new model,simulating three stages of "traumatic hemorrhagic shock,pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution,has been successfully established.This model has good stability and high reproducibility.The survival animals can be

  16. Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model.

    Science.gov (United States)

    Melas, Christos D; Zampetakis, Leonidas A; Dimopoulou, Anastasia; Moustakis, Vassilis

    2011-08-01

    Recent empirical research has utilized the Technology Acceptance Model (TAM) to advance the understanding of doctors' and nurses' technology acceptance in the workplace. However, the majority of the reported studies are either qualitative in nature or use small convenience samples of medical staff. Additionally, in very few studies moderators are either used or assessed despite their importance in TAM based research. The present study focuses on the application of TAM in order to explain the intention to use clinical information systems, in a random sample of 604 medical staff (534 physicians) working in 14 hospitals in Greece. We introduce physicians' specialty as a moderator in TAM and test medical staff's information and communication technology (ICT) knowledge and ICT feature demands, as external variables. The results show that TAM predicts a substantial proportion of the intention to use clinical information systems. Findings make a contribution to the literature by replicating, explaining and advancing the TAM, whereas theory is benefited by the addition of external variables and medical specialty as a moderator. Recommendations for further research are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Occupational stress and psychopathology in health professionals: an explorative study with the multiple indicators multiple causes (MIMIC) model approach.

    Science.gov (United States)

    Iliceto, Paolo; Pompili, Maurizio; Spencer-Thomas, Sally; Ferracuti, Stefano; Erbuto, Denise; Lester, David; Candilera, Gabriella; Girardi, Paolo

    2013-03-01

    Occupational stress is a multivariate process involving sources of pressure, psycho-physiological distress, locus of control, work dissatisfaction, depression, anxiety, mental health disorders, hopelessness, and suicide ideation. Healthcare professionals are known for higher rates of occupational-related distress (burnout and compassion fatigue) and higher rates of suicide. The purpose of this study was to explain the relationships between occupational stress and some psychopathological dimensions in a sample of health professionals. We investigated 156 nurses and physicians, 62 males and 94 females, who were administered self-report questionnaires to assess occupational stress [occupational stress inventory (OSI)], temperament (temperament evaluation of Memphis, Pisa, Paris, and San Diego autoquestionnaire), and hopelessness (Beck hopelessness scale). The best Multiple Indicators Multiple Causes model with five OSI predictors yielded the following results: χ2(9) = 14.47 (p = 0.11); χ2/df = 1.60; comparative fit index = 0.99; root mean square error of approximation = 0.05. This model provided a good fit to the empirical data, showing a strong direct influence of casual variables such as work dissatisfaction, absence of type A behavior, and especially external locus of control, psychological and physiological distress on latent variable psychopathology. Occupational stress is in a complex relationship with temperament and hopelessness and also common among healthcare professionals.

  18. Deterministic integer multiple firing depending on initial state in Wang model

    Energy Technology Data Exchange (ETDEWEB)

    Xie Yong [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China)]. E-mail: yxie@mail.xjtu.edu.cn; Xu Jianxue [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China); Jiang Jun [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China)

    2006-12-15

    We investigate numerically dynamical behaviour of the Wang model, which describes the rhythmic activities of thalamic relay neurons. The model neuron exhibits Type I excitability from a global view, but Type II excitability from a local view. There exists a narrow range of bistability, in which a subthreshold oscillation and a suprathreshold firing behaviour coexist. A special firing pattern, integer multiple firing can be found in the certain part of the bistable range. The characteristic feature of such firing pattern is that the histogram of interspike intervals has a multipeaked structure, and the peaks are located at about integer multiples of a basic interspike interval. Since the Wang model is noise-free, the integer multiple firing is a deterministic firing pattern. The existence of bistability leads to the deterministic integer multiple firing depending on the initial state of the model neuron, i.e., the initial values of the state variables.

  19. Deterministic integer multiple firing depending on initial state in Wang model

    International Nuclear Information System (INIS)

    Xie Yong; Xu Jianxue; Jiang Jun

    2006-01-01

    We investigate numerically dynamical behaviour of the Wang model, which describes the rhythmic activities of thalamic relay neurons. The model neuron exhibits Type I excitability from a global view, but Type II excitability from a local view. There exists a narrow range of bistability, in which a subthreshold oscillation and a suprathreshold firing behaviour coexist. A special firing pattern, integer multiple firing can be found in the certain part of the bistable range. The characteristic feature of such firing pattern is that the histogram of interspike intervals has a multipeaked structure, and the peaks are located at about integer multiples of a basic interspike interval. Since the Wang model is noise-free, the integer multiple firing is a deterministic firing pattern. The existence of bistability leads to the deterministic integer multiple firing depending on the initial state of the model neuron, i.e., the initial values of the state variables

  20. SOME STATISTICAL ISSUES RELATED TO MULTIPLE LINEAR REGRESSION MODELING OF BEACH BACTERIA CONCENTRATIONS

    Science.gov (United States)

    As a fast and effective technique, the multiple linear regression (MLR) method has been widely used in modeling and prediction of beach bacteria concentrations. Among previous works on this subject, however, several issues were insufficiently or inconsistently addressed. Those is...

  1. A geospatial modelling approach to predict seagrass habitat recovery under multiple stressor regimes

    Science.gov (United States)

    Restoration of estuarine seagrass habitats requires a clear understanding of the modes of action of multiple interacting stressors including nutrients, climate change, coastal land-use change, and habitat modification. We have developed and demonstrated a geospatial modeling a...

  2. A minimal unified model of disease trajectories captures hallmarks of multiple sclerosis

    KAUST Repository

    Kannan, Venkateshan; Kiani, Narsis A.; Piehl, Fredrik; Tegner, Jesper

    2017-01-01

    Multiple Sclerosis (MS) is an autoimmune disease targeting the central nervous system (CNS) causing demyelination and neurodegeneration leading to accumulation of neurological disability. Here we present a minimal, computational model involving

  3. Shared Authentic Leadership in Research Teams: Testing a Multiple Mediation Model

    NARCIS (Netherlands)

    Günter, Hannes; Gardner, William L.; Davis McCauley, Kelly; Randolph-Seng, Brandon; P. Prahbu, Veena

    2017-01-01

    Research teams face complex leadership and coordination challenges. We propose shared authentic leadership (SAL) as a timely approach to addressing these challenges. Drawing from authentic and functional leadership theories, we posit a multiple mediation model that suggests three mechanisms whereby

  4. A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.

    Science.gov (United States)

    Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L

    2007-11-01

    This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

  5. An object-oriented approach to evaluating multiple spectral models

    International Nuclear Information System (INIS)

    Majoras, R.E.; Richardson, W.M.; Seymour, R.S.

    1995-01-01

    A versatile, spectroscopy analysis engine has been developed by using object-oriented design and analysis techniques coupled with an object-oriented language, C++. This engine provides the spectroscopist with the choice of several different peak shape models that are tailored to the type of spectroscopy being performed. It also allows ease of development in adapting the engine to other analytical methods requiring more complex peak fitting in the future. This results in a program that can currently be used across a wide range of spectroscopy applications and anticipates inclusion of future advances in the field. (author) 6 refs.; 1 fig

  6. Modeling the effects of influenza vaccination of health care workers in hospital departments

    NARCIS (Netherlands)

    van den Dool, C.; Bonten, M. J. M.; Hak, E.; Wallinga, J.

    2009-01-01

    Nowadays health care worker (HCW) vaccination is widely recommended. Although the benefits of this strategy have been demonstrated in long-term care settings, no studies have been performed in regular hospital departments. We adapt a previously developed model of influenza transmission in a

  7. An Empirical Study of Kirkpatrick's Evaluation Model in the Hospitality Industry

    Science.gov (United States)

    Chang, Ya-Hui Elegance

    2010-01-01

    This study examined Kirkpatrick's training evaluation model (Kirkpatrick & Kirkpatrick, 2006) by assessing a sales training program conducted at an organization in the hospitality industry. The study assessed the employees' training outcomes of knowledge and skills, job performance, and the impact of the training upon the organization. By…

  8. Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

    NARCIS (Netherlands)

    Voors, Adriaan A.; Ouwerkerk, Wouter; Zannad, Faiez; van Veldhuisen, Dirk J.; Samani, Nilesh J.; Ponikowski, Piotr; Ng, Leong L.; Metra, Marco; ter Maaten, Jozine M.; Lang, Chim C.; Hillege, Hans L.; van der Harst, Pim; Filippatos, Gerasimos; Dickstein, Kenneth; Cleland, John G.; Anker, Stefan D.; Zwinderman, Aeilko H.

    Introduction From a prospective multicentre multicountry clinical trial, we developed and validated risk models to predict prospective all-cause mortality and hospitalizations because of heart failure (HF) in patients with HF. Methods and results BIOSTAT-CHF is a research programme designed to

  9. Development and validation of multivariable models to predict mortality and hospitalization in patients with heart failure

    NARCIS (Netherlands)

    Voors, Adriaan A.; Ouwerkerk, Wouter; Zannad, Faiez; van Veldhuisen, Dirk J.; Samani, Nilesh J.; Ponikowski, Piotr; Ng, Leong L.; Metra, Marco; ter Maaten, Jozine M.; Lang, Chim C.; Hillege, Hans L.; van der Harst, Pim; Filippatos, Gerasimos; Dickstein, Kenneth; Cleland, John G.; Anker, Stefan D.; Zwinderman, Aeilko H.

    2017-01-01

    Introduction From a prospective multicentre multicountry clinical trial, we developed and validated risk models to predict prospective all-cause mortality and hospitalizations because of heart failure (HF) in patients with HF. Methods and results BIOSTAT-CHF is a research programme designed to

  10. A combined statistical model for multiple motifs search

    International Nuclear Information System (INIS)

    Gao Lifeng; Liu Xin; Guan Shan

    2008-01-01

    Transcription factor binding sites (TFBS) play key roles in genebior 6.8 wavelet expression and regulation. They are short sequence segments with definite structure and can be recognized by the corresponding transcription factors correctly. From the viewpoint of statistics, the candidates of TFBS should be quite different from the segments that are randomly combined together by nucleotide. This paper proposes a combined statistical model for finding over-represented short sequence segments in different kinds of data set. While the over-represented short sequence segment is described by position weight matrix, the nucleotide distribution at most sites of the segment should be far from the background nucleotide distribution. The central idea of this approach is to search for such kind of signals. This algorithm is tested on 3 data sets, including binding sites data set of cyclic AMP receptor protein in E.coli, PlantProm DB which is a non-redundant collection of proximal promoter sequences from different species, collection of the intergenic sequences of the whole genome of E.Coli. Even though the complexity of these three data sets is quite different, the results show that this model is rather general and sensible. (general)

  11. Verification of road databases using multiple road models

    Science.gov (United States)

    Ziems, Marcel; Rottensteiner, Franz; Heipke, Christian

    2017-08-01

    In this paper a new approach for automatic road database verification based on remote sensing images is presented. In contrast to existing methods, the applicability of the new approach is not restricted to specific road types, context areas or geographic regions. This is achieved by combining several state-of-the-art road detection and road verification approaches that work well under different circumstances. Each one serves as an independent module representing a unique road model and a specific processing strategy. All modules provide independent solutions for the verification problem of each road object stored in the database in form of two probability distributions, the first one for the state of a database object (correct or incorrect), and a second one for the state of the underlying road model (applicable or not applicable). In accordance with the Dempster-Shafer Theory, both distributions are mapped to a new state space comprising the classes correct, incorrect and unknown. Statistical reasoning is applied to obtain the optimal state of a road object. A comparison with state-of-the-art road detection approaches using benchmark datasets shows that in general the proposed approach provides results with larger completeness. Additional experiments reveal that based on the proposed method a highly reliable semi-automatic approach for road data base verification can be designed.

  12. A model for AGN variability on multiple time-scales

    Science.gov (United States)

    Sartori, Lia F.; Schawinski, Kevin; Trakhtenbrot, Benny; Caplar, Neven; Treister, Ezequiel; Koss, Michael J.; Urry, C. Megan; Zhang, C. E.

    2018-05-01

    We present a framework to link and describe active galactic nuclei (AGN) variability on a wide range of time-scales, from days to billions of years. In particular, we concentrate on the AGN variability features related to changes in black hole fuelling and accretion rate. In our framework, the variability features observed in different AGN at different time-scales may be explained as realisations of the same underlying statistical properties. In this context, we propose a model to simulate the evolution of AGN light curves with time based on the probability density function (PDF) and power spectral density (PSD) of the Eddington ratio (L/LEdd) distribution. Motivated by general galaxy population properties, we propose that the PDF may be inspired by the L/LEdd distribution function (ERDF), and that a single (or limited number of) ERDF+PSD set may explain all observed variability features. After outlining the framework and the model, we compile a set of variability measurements in terms of structure function (SF) and magnitude difference. We then combine the variability measurements on a SF plot ranging from days to Gyr. The proposed framework enables constraints on the underlying PSD and the ability to link AGN variability on different time-scales, therefore providing new insights into AGN variability and black hole growth phenomena.

  13. Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan

    Directory of Open Access Journals (Sweden)

    Fushimi Kiyohide

    2010-05-01

    Full Text Available Abstract Background Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. Method We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index ≥ 0.8; hospitals with c-index Results The model demonstrated excellent discrimination as indicated by the high average c-index and small standard deviation (c-index = 0.88 ± 0.04. Expected mortality rate of each hospital was highly correlated with observed mortality rate (r = 0.693, p Conclusion The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

  14. The empirical content of models with multiple equilibria in economies with social interactions

    OpenAIRE

    Alberto Bisin; Andrea Moro; Giorgio Topa

    2011-01-01

    We study a general class of models with social interactions that might display multiple equilibria. We propose an estimation procedure for these models and evaluate its efficiency and computational feasibility relative to different approaches taken to the curse of dimensionality implied by the multiplicity. Using data on smoking among teenagers, we implement the proposed estimation procedure to understand how group interactions affect health-related choices. We find that interaction effects a...

  15. MODEL PENSKORAN PARTIAL CREDIT PADA BUTIR MULTIPLE TRUE-FALSE BIDANG FISIKA

    OpenAIRE

    Wasis Wasis

    2013-01-01

    Tujuan penelitian ini menghasilkan model penskoran politomus untuk respons butir multiple true-false, sehingga dapat mengestimasi secara lebih akurat kemampuan di bidang fisika. Pengembangan penskoran menggunakan Four-D model dan diuji akurasinya melalui penelitian empiris dan simulasi. Penelitian empiris menggunakan 15 butir multiple true-false yang diambil dari soal UMPTN tahun 1996-2006 dan dikenakan pada 410 mahasiswa baru FMIPA Universitas Negeri Surabaya angkatan tahun 2007. Respons pes...

  16. Multiple attribute decision making model and application to food safety risk evaluation.

    Science.gov (United States)

    Ma, Lihua; Chen, Hong; Yan, Huizhe; Yang, Lifeng; Wu, Lifeng

    2017-01-01

    Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

  17. Testing effect of a drug using multiple nested models for the dose–response

    DEFF Research Database (Denmark)

    Baayen, C.; Hougaard, P.; Pipper, C. B.

    2015-01-01

    of the assumed dose–response model. Bretz et al. (2005, Biometrics 61, 738–748) suggested a combined approach, which selects one or more suitable models from a set of candidate models using a multiple comparison procedure. The method initially requires a priori estimates of any non-linear parameters...

  18. A Model of Distraction using new Architectural Mechanisms to Manage Multiple Goals

    NARCIS (Netherlands)

    Taatgen, Niels; Katidioti, Ioanna; Borst, Jelmer; van Vugt, Marieke; Taatgen, Niels; van Vugt, Marieke; Borst, Jelmer; Mehlhorn, Katja

    2015-01-01

    Cognitive models assume a one-to-one correspondence between task and goals. We argue that modeling a task by combining multiple goals has several advantages: a task can be constructed from components that are reused from other tasks, and it enables modeling thought processes that compete with or

  19. Music genre classification via likelihood fusion from multiple feature models

    Science.gov (United States)

    Shiu, Yu; Kuo, C.-C. J.

    2005-01-01

    Music genre provides an efficient way to index songs in a music database, and can be used as an effective means to retrieval music of a similar type, i.e. content-based music retrieval. A new two-stage scheme for music genre classification is proposed in this work. At the first stage, we examine a couple of different features, construct their corresponding parametric models (e.g. GMM and HMM) and compute their likelihood functions to yield soft classification results. In particular, the timbre, rhythm and temporal variation features are considered. Then, at the second stage, these soft classification results are integrated to result in a hard decision for final music genre classification. Experimental results are given to demonstrate the performance of the proposed scheme.

  20. Electronic Commerce Success Model: A Search for Multiple Criteria

    Directory of Open Access Journals (Sweden)

    Didi Achjari

    2004-01-01

    Full Text Available The current study attempts to develop and examine framework of e-commerce success. In order to obtain comprehensive and robust measures, the framework accomodates key factors that are identified in the literature concerning the success of electronic commerce. The structural model comprises of four exogenous variables (Internal Driver, Internal Impediment, External Driver and Exgternal Impediment and one endogenous variable (Electornic Commerce Success eith 24 observed variables. The study that was administered within large Australian companies using questionaire survey concluded that benefits for both internal organization and external parties from the use of e-commerce were the main factor tro predict perceived and/or expected success of electronic commerce.

  1. Uncertainty and Preference Modelling for Multiple Criteria Vehicle Evaluation

    Directory of Open Access Journals (Sweden)

    Qiuping Yang

    2010-12-01

    Full Text Available A general framework for vehicle assessment is proposed based on both mass survey information and the evidential reasoning (ER approach. Several methods for uncertainty and preference modeling are developed within the framework, including the measurement of uncertainty caused by missing information, the estimation of missing information in original surveys, the use of nonlinear functions for data mapping, and the use of nonlinear functions as utility function to combine distributed assessments into a single index. The results of the investigation show that various measures can be used to represent the different preferences of decision makers towards the same feedback from respondents. Based on the ER approach, credible and informative analysis can be conducted through the complete understanding of the assessment problem in question and the full exploration of available information.

  2. Forecasting asthma-related hospital admissions in London using negative binomial models.

    Science.gov (United States)

    Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

    2013-05-01

    Health forecasting can improve health service provision and individual patient outcomes. Environmental factors are known to impact chronic respiratory conditions such as asthma, but little is known about the extent to which these factors can be used for forecasting. Using weather, air quality and hospital asthma admissions, in London (2005-2006), two related negative binomial models were developed and compared with a naive seasonal model. In the first approach, predictive forecasting models were fitted with 7-day averages of each potential predictor, and then a subsequent multivariable model is constructed. In the second strategy, an exhaustive search of the best fitting models between possible combinations of lags (0-14 days) of all the environmental effects on asthma admission was conducted. Three models were considered: a base model (seasonal effects), contrasted with a 7-day average model and a selected lags model (weather and air quality effects). Season is the best predictor of asthma admissions. The 7-day average and seasonal models were trivial to implement. The selected lags model was computationally intensive, but of no real value over much more easily implemented models. Seasonal factors can predict daily hospital asthma admissions in London, and there is a little evidence that additional weather and air quality information would add to forecast accuracy.

  3. Application of multiple objective models to water resources planning and management

    International Nuclear Information System (INIS)

    North, R.M.

    1993-01-01

    Over the past 30 years, we have seen the birth and growth of multiple objective analysis from an idea without tools to one with useful applications. Models have been developed and applications have been researched to address the multiple purposes and objectives inherent in the development and management of water resources. A practical approach to multiple objective modelling incorporates macroeconomic-based policies and expectations in order to optimize the results from both engineering (structural) and management (non-structural) alternatives, while taking into account the economic and environmental trade-offs. (author). 27 refs, 4 figs, 3 tabs

  4. THE EFFECTS OF HOSPITAL QUALITY OF CARE ON PATIENT BELONGING: STRUCTURAL EQUALITY MODEL AND MEDIATION

    Directory of Open Access Journals (Sweden)

    Ali Rıza FİRUZAN

    2017-09-01

    Full Text Available The aim of the study is to measure the effects of perceived and expected service quality levels on patient loyalty. In total, 370 patients participated in this research. The Structural Equation Modeling (SEM method to test the causal relationship model. The corresponding model in the study emerged as acceptable fit with the model. The result of the study indicate that perceived service quality and patient loyalty are statistically significant and positively related to each other. Additionally, perceived service quality has found to be an important mediator between expected service quality and patient loyalty. After patients have treatment in corresponding hospital, they have been affected by service quality as mush as cost of medication. As patient satisfaction increases, their loyalty increases. It is suggested to hospital management that they might course of action to patients for improving Reliability and Assurance SERVQUAL factors

  5. High Prevalence of Multiple Drug Resistance among ESBLs-Producing Klebsiella pneumoniae Isolated from Hospitalized Patients in Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Zahra Tahanasab

    2017-02-01

    Full Text Available Background:   This study was to evaluate the prevalence of CTX-Mand TEM type ESBLs-producing K. pneumoniae and determination of MDR, XDR, and PDR phenotypes of these isolates as well as find out the genetic relationship and molecular typing of these isolates using phenotypic and genotypic methods.Methods:   Non-repetitive 96 K. pneumonia isolates were isolated from hospitalized patients in Al-Zahra hospital of Isfahan, Iran. The antibiotic susceptibility test was assessed for 20 antibiotics using Kirby-Bauer disk diffusion method. The frequency of ESBL-producing isolates was determined by phenotypic confirmatory test. All ESBLs-producing isolates were assessed for blaTEM and blaCTX-M genes using PCR method. Molecular typing was performed by enterobacterial repetitive intergenic consensus sequence-based PCR (ERIC-PCR.Results:  Among 96 isolates, 58 isolates (60.4% were ESBL-producers. In this study, 85.7% and 30.3% of ESBL-producing isolates showed MDR and XDR phenotypes, respectively. No PDR isolate was found. PCR amplification on ESBL-producing isolates showed that 47 (81% isolates were carried blaTEM gene, while blaCTX-M was detected in all isolates (100%. ERIC-PCR typing was characterized the high genetic similarity among ESBL-producing K. pneumonia isolates and revealed 32 band pattern for the isolates. Conclusion:  This study showed high prevalence of important ESBL genes (blaCTX-M and blaTEM genes among the K. pneumoniae isolated from in-patients. Constant following of ESBLs, also identification of their types, in bacteria isolated from hospitalized patients has an important clinical impact. It can provide valuable information for the choice of appropriate antibacterial therapy and decrease of antibiotic resistance.

  6. Treatment of a multiple sclerosis animal model by a novel nanodrop formulation of a natural antioxidant

    Directory of Open Access Journals (Sweden)

    Binyamin O

    2015-11-01

    Full Text Available Orli Binyamin,1,* Liraz Larush,2,* Kati Frid,1 Guy Keller,1 Yael Friedman-Levi,1 Haim Ovadia,1 Oded Abramsky,1 Shlomo Magdassi,2 Ruth Gabizon1 1Department of Neurology, The Agnes Ginges Center of Human Neurogenetics, Hadassah University Hospital, 2Casali Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel *These authors contributed equally to this work Abstract: Multiple sclerosis (MS is a chronic inflammatory disease of the central nervous system and is associated with demyelination, neurodegeneration, and sensitivity to oxidative stress. In this work, we administered a nanodroplet formulation of pomegranate seed oil (PSO, denominated Nano-PSO, to mice induced for experimental autoimmune encephalomyelitis (EAE, an established model of MS. PSO comprises high levels of punicic acid, a unique polyunsaturated fatty acid considered as one of the strongest natural antioxidants. We show here that while EAE-induced mice treated with natural PSO presented some reduction in disease burden, this beneficial effect increased significantly when EAE mice were treated with Nano-PSO of specific size nanodroplets at much lower concentrations of the oil. Pathological examinations revealed that Nano-PSO administration dramatically reduced demyelination and oxidation of lipids in the brains of the affected animals, which are hallmarks of this severe neurological disease. We propose that novel formulations of natural antioxidants such as Nano-PSO may be considered for the treatment of patients suffering from demyelinating diseases. On the mechanistic side, our results demonstrate that lipid oxidation may be a seminal feature in both demyelination and neurodegeneration. Keywords: nanodrops, PSO, EAE, oxidative stress, neurodegeneration

  7. Materials and nanosystems : interdisciplinary computational modeling at multiple scales

    International Nuclear Information System (INIS)

    Huber, S.E.

    2014-01-01

    Over the last five decades, computer simulation and numerical modeling have become valuable tools complementing the traditional pillars of science, experiment and theory. In this thesis, several applications of computer-based simulation and modeling shall be explored in order to address problems and open issues in chemical and molecular physics. Attention shall be paid especially to the different degrees of interrelatedness and multiscale-flavor, which may - at least to some extent - be regarded as inherent properties of computational chemistry. In order to do so, a variety of computational methods are used to study features of molecular systems which are of relevance in various branches of science and which correspond to different spatial and/or temporal scales. Proceeding from small to large measures, first, an application in astrochemistry, the investigation of spectroscopic and energetic aspects of carbonic acid isomers shall be discussed. In this respect, very accurate and hence at the same time computationally very demanding electronic structure methods like the coupled-cluster approach are employed. These studies are followed by the discussion of an application in the scope of plasma-wall interaction which is related to nuclear fusion research. There, the interactions of atoms and molecules with graphite surfaces are explored using density functional theory methods. The latter are computationally cheaper than coupled-cluster methods and thus allow the treatment of larger molecular systems, but yield less accuracy and especially reduced error control at the same time. The subsequently presented exploration of surface defects at low-index polar zinc oxide surfaces, which are of interest in materials science and surface science, is another surface science application. The necessity to treat even larger systems of several hundreds of atoms requires the use of approximate density functional theory methods. Thin gold nanowires consisting of several thousands of

  8. Hospitals and organizational models based on the intensity of treatment: the internist's point of view

    Directory of Open Access Journals (Sweden)

    Giuseppe Chesi

    2012-01-01

    Full Text Available IntroductionThe type of patients being treated in our hospitals has changed significantly. Today's patients are much older with more complicated, polypathological problems. As a result, hospital organization and management structures must also change, particularly in Internal Medicine. A widely discussed approach, organization according to “intensity of treatment,” could be an appropriate solution from an organizational viewpoint that would also satisfy these new demands.Materials and methodsWith the aid of a questionnaire sent to internists working in the hospitals of Italy's Emilia-Romagna region and the review of the relevant medical literature, we defined structural, organizational, technological, managerial, and staffing characteristics to better determine and classify this model. We analyzed questionnaire responses of 31 internists heading operative units in their hospitals, a relatively homogeneous subgroup with experience in organizing and managing healthcare as well as its clinical aspects.ResultsAnalysis of these questionnaires revealed important points concerning the model: 1 an accurate identification of the medical care on which to base the model; 2 a well-defined strategy for differentiated allocation of staff to structural and technological areas depending on the level of medical care provided in the area; 3 an accurate definition of the types and features of patients targeted by each level of medical care; 4 an early exchange (starting from the patient's arrival in the Emergency Department of information and medical knowledge among Emergency Department physicians and those present during the initial stages of hospitalization; 5 a precise definition of responsibilities in the different areas, operative and collaborative stages among different physicians and medical staff, the different disciplines involved in the process.ConclusionsAmong the physicians responsible for managing complex areas of Internal Medicine in Emilia

  9. A multiple shock model for common cause failures using discrete Markov chain

    International Nuclear Information System (INIS)

    Chung, Dae Wook; Kang, Chang Soon

    1992-01-01

    The most widely used models in common cause analysis are (single) shock models such as the BFR, and the MFR. But, single shock model can not treat the individual common cause separately and has some irrational assumptions. Multiple shock model for common cause failures is developed using Markov chain theory. This model treats each common cause shock as separately and sequently occuring event to implicate the change in failure probability distribution due to each common cause shock. The final failure probability distribution is evaluated and compared with that from the BFR model. The results show that multiple shock model which minimizes the assumptions in the BFR model is more realistic and conservative than the BFR model. The further work for application is the estimations of parameters such as common cause shock rate and component failure probability given a shock,p, through the data analysis

  10. [Children's medically complex diseases unit. A model required in all our hospitals].

    Science.gov (United States)

    Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

    2018-01-01

    The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Leptophobic Z' in models with multiple Higgs doublet fields

    Science.gov (United States)

    Chiang, Cheng-Wei; Nomura, Takaaki; Yagyu, Kei

    2015-05-01

    We study the collider phenomenology of the leptophobic Z' boson from an extra U(1)' gauge symmetry in models with N -Higgs doublet fields. We assume that the Z' boson at tree level has (i) no Z- Z' mixing, (ii) no interaction with the charged leptons, and (iii) no flavour-changing neutral current. Under such a setup, it is shown that in the N = 1 case, all the U(1)' charges of left-handed quark doublets and right-handed up- and down- type quarks are required to be the same, while in the N ≥ 3 case one can take different charges for the three types of quarks. The N = 2 case is not well-defined under the above three requirements. We study the processes ( V = γ , Z and W ±) with the leptonic decays of Z and W ± at the LHC. The most promising discovery channel or the most stringent constraint on the U(1)' gauge coupling constant comes from the Z'γ process below the threshold and from the process above the threshold. Assuming the collision energy of 8 TeV and integrated luminosity of 19.6 fb-1, we find that the constraint from the Z'γ search in the lower mass regime can be stronger than that from the UA2 experiment. In the N ≥ 3 case, we consider four benchmark points for the Z' couplings with quarks. If such a Z' is discovered, a careful comparison between the Z'γ and Z' W signals is crucial to reveal the nature of Z' couplings with quarks. We also present the discovery reach of the Z' boson at the 14-TeV LHC in both N = 1 and N ≥ 3 cases.

  12. Should researchers use single indicators, best indicators, or multiple indicators in structural equation models?

    Directory of Open Access Journals (Sweden)

    Hayduk Leslie A

    2012-10-01

    Full Text Available Abstract Background Structural equation modeling developed as a statistical melding of path analysis and factor analysis that obscured a fundamental tension between a factor preference for multiple indicators and path modeling’s openness to fewer indicators. Discussion Multiple indicators hamper theory by unnecessarily restricting the number of modeled latents. Using the few best indicators – possibly even the single best indicator of each latent – encourages development of theoretically sophisticated models. Additional latent variables permit stronger statistical control of potential confounders, and encourage detailed investigation of mediating causal mechanisms. Summary We recommend the use of the few best indicators. One or two indicators are often sufficient, but three indicators may occasionally be helpful. More than three indicators are rarely warranted because additional redundant indicators provide less research benefit than single indicators of additional latent variables. Scales created from multiple indicators can introduce additional problems, and are prone to being less desirable than either single or multiple indicators.

  13. Flexible Modeling of Survival Data with Covariates Subject to Detection Limits via Multiple Imputation.

    Science.gov (United States)

    Bernhardt, Paul W; Wang, Huixia Judy; Zhang, Daowen

    2014-01-01

    Models for survival data generally assume that covariates are fully observed. However, in medical studies it is not uncommon for biomarkers to be censored at known detection limits. A computationally-efficient multiple imputation procedure for modeling survival data with covariates subject to detection limits is proposed. This procedure is developed in the context of an accelerated failure time model with a flexible seminonparametric error distribution. The consistency and asymptotic normality of the multiple imputation estimator are established and a consistent variance estimator is provided. An iterative version of the proposed multiple imputation algorithm that approximates the EM algorithm for maximum likelihood is also suggested. Simulation studies demonstrate that the proposed multiple imputation methods work well while alternative methods lead to estimates that are either biased or more variable. The proposed methods are applied to analyze the dataset from a recently-conducted GenIMS study.

  14. Determining the effects of patient casemix on length of hospital stay: a proportional hazards frailty model approach.

    Science.gov (United States)

    Lee, A H; Yau, K K

    2001-01-01

    To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs). A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs. Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients. The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.

  15. Hospitality and Tourism Online Review Research: A Systematic Analysis and Heuristic-Systematic Model

    Directory of Open Access Journals (Sweden)

    Sunyoung Hlee

    2018-04-01

    Full Text Available With tremendous growth and potential of online consumer reviews, online reviews of hospitality and tourism are now playing a significant role in consumer attitude and buying behaviors. This study reviewed and analyzed hospitality and tourism related articles published in academic journals. The systematic approach was used to analyze 55 research articles between January 2008 and December 2017. This study presented a brief synthesis of research by investigating content-related characteristics of hospitality and tourism online reviews (HTORs in different market segments. Two research questions were addressed. Building upon our literature analysis, we used the heuristic-systematic model (HSM to summarize and classify the characteristics affecting consumer perception in previous HTOR studies. We believe that the framework helps researchers to identify the research topic in extended HTORs literature and to point out possible direction for future studies.

  16. A validation of ground ambulance pre-hospital times modeled using geographic information systems.

    Science.gov (United States)

    Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

    2012-10-03

    Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

  17. A cost-analysis model for anticoagulant treatment in the hospital setting.

    Science.gov (United States)

    Mody, Samir H; Huynh, Lynn; Zhuo, Daisy Y; Tran, Kevin N; Lefebvre, Patrick; Bookhart, Brahim

    2014-07-01

    Rivaroxaban is the first oral factor Xa inhibitor approved in the US to reduce the risk of stroke and blood clots among people with non-valvular atrial fibrillation, treat deep vein thrombosis (DVT), treat pulmonary embolism (PE), reduce the risk of recurrence of DVT and PE, and prevent DVT and PE after knee or hip replacement surgery. The objective of this study was to evaluate the costs from a hospital perspective of treating patients with rivaroxaban vs other anticoagulant agents across these five populations. An economic model was developed using treatment regimens from the ROCKET-AF, EINSTEIN-DVT and PE, and RECORD1-3 randomized clinical trials. The distribution of hospital admissions used in the model across the different populations was derived from the 2010 Healthcare Cost and Utilization Project database. The model compared total costs of anticoagulant treatment, monitoring, inpatient stay, and administration for patients receiving rivaroxaban vs other anticoagulant agents. The length of inpatient stay (LOS) was determined from the literature. Across all populations, rivaroxaban was associated with an overall mean cost savings of $1520 per patient. The largest cost savings associated with rivaroxaban was observed in patients with DVT or PE ($6205 and $2742 per patient, respectively). The main driver of the cost savings resulted from the reduction in LOS associated with rivaroxaban, contributing to ∼90% of the total savings. Furthermore, the overall mean anticoagulant treatment cost was lower for rivaroxaban vs the reference groups. The distribution of patients across indications used in the model may not be generalizable to all hospitals, where practice patterns may vary, and average LOS cost may not reflect the actual reimbursements that hospitals received. From a hospital perspective, the use of rivaroxaban may be associated with cost savings when compared to other anticoagulant treatments due to lower drug cost and shorter LOS associated with

  18. Effectiveness of screening hospital admissions to detect asymptomatic carriers of Clostridium difficile: a modeling evaluation.

    Science.gov (United States)

    Lanzas, Cristina; Dubberke, Erik R

    2014-08-01

    Both asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions. We developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission. In our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%-50% and 10%-25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy. Testing for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

  19. Fine particulate matter estimated by mathematical model and hospitalizations for pneumonia and asthma in children

    Directory of Open Access Journals (Sweden)

    Ana Cristina Gobbo César

    2016-03-01

    Full Text Available Abstract Objective: To estimate the association between exposure to fine particulate matter with an aerodynamic diameter <2.5 microns (PM2.5 and hospitalizations for pneumonia and asthma in children. Methods: An ecological study of time series was performed, with daily indicators of hospitalization for pneumonia and asthma in children up to 10 years of age, living in Taubaté (SP and estimated concentrations of PM2.5, between August 2011 and July 2012. A generalized additive model of Poisson regression was used to estimate the relative risk, with lag zero up to five days after exposure; the single pollutant model was adjusted by the apparent temperature, as defined from the temperature and relative air humidity, seasonality and weekday. Results: The values of the relative risks for hospitalization for pneumonia and asthma were significant for lag 0 (RR=1.051, 95%CI; 1.016 to 1.088; lag 2 (RR=1.066, 95%CI: 1.023 to 1.113; lag 3 (RR=1.053, 95%CI: 1.015 to 1.092; lag 4 (RR=1.043, 95%CI: 1.004 to 1.088 and lag 5 (RR=1.061, 95%CI: 1.018 to 1.106. The increase of 5mcg/m3 in PM2.5 contributes to increase the relative risk for hospitalization from 20.3 to 38.4 percentage points; however, the reduction of 5µg/m3 in PM2.5 concentration results in 38 fewer hospital admissions. Conclusions: Exposure to PM2.5 was associated with hospitalizations for pneumonia and asthma in children younger than 10 years of age, showing the role of fine particulate matter in child health and providing subsidies for the implementation of preventive measures to decrease these outcomes.

  20. Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

    Science.gov (United States)

    Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai

    2011-03-01

    Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one

  1. Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

    2013-04-01

    To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

  2. Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

    Science.gov (United States)

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  3. Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

    Science.gov (United States)

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-06-24

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

  4. Community-based management of multiple drug resistant tuberculosis in a tertiary hospital in Tanzania: a best practice implementation project.

    Science.gov (United States)

    Jelly, Isaya; Peters, Micah D J

    2017-12-01

    The World Health Organization (WHO) has prioritized collaboration with communities in its 2016 "End TB" implementation strategy. Acknowledging the difficulties that some communities face in gaining access to health facilities due to barriers such as stigma, discrimination, healthcare expenditure, transport and income loss, partnering with communities in the roll-out of community-based TB management activities is vital. The aim of this project was to make a contribution to promoting evidence-based practice with regards to the community-based management of multidrug-resistant tuberculosis (MDR-TB) at Kibong'oto National Infectious Disease Hospital, Tanzania, and thereby supporting improvements in patient outcomes and resource utilization. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) program to facilitate the collection of pre- and post-audit data. The Getting Research into Practice (GRiP) module was also used to analyze the potential barriers and for designing the final action plan. This project was conducted in three phases over a three-month period at the MDR-TB unit in a referral hospital in Northern Tanzania. The project showed that there were significant improvements in compliance rates in staff education and documentation of patients' suitability and preferences in receiving community-based care for MDR-TB. The compliance rate of criterion 2, which was already 100% at baseline, was slightly lower at follow-up. The project achieved significant improvements in the delivery of evidence-based practice with regards to community-based management of MDR-TB.

  5. Learned helplessness, discouraged workers, and multiple unemployment equilibria in a search model

    OpenAIRE

    Bjørnstad, Roger

    2001-01-01

    Abstract: Unemployment varies strongly between countries with comparable economic structure. Some economists have tried to explain these differences with institutional differences in the labour market. Instead, this paper focuses on a model with multiple equilibria so that the same socioeconomic structure can give rise to different levels of unemployment. Unemployed workers' search efficiency are modelled within an equilibrium search model and lay behind these results. In the model learned...

  6. Economic analysis of an epilepsy outreach model of care in a university hospital setting.

    Science.gov (United States)

    Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

    2017-07-01

    The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Optimization of the Darrieus wind turbines with double-multiple-streamtube model

    International Nuclear Information System (INIS)

    Paraschivoiu, I.

    1985-01-01

    This paper discusses a new improvement of the double-multiple-stream tube model by considering the stream tube expansion effects on the Darrieus wind turbine. These effects, allowing a more realistic modeling of the upwind/downwind flow field asymmetries inherent in the Darrieus rotor, were calculated by using CARDAAX computer code. When the dynamic stall is introduced in the double-multiple-stream tube model, the aerodynamic loads and performance show significant changes in the range of low tip-speed ratio

  8. A stochastic mathematical model to locate field hospitals under disruption uncertainty for large-scale disaster preparedness

    Directory of Open Access Journals (Sweden)

    Nezir Aydin

    2016-03-01

    Full Text Available In this study, we consider field hospital location decisions for emergency treatment points in response to large scale disasters. Specifically, we developed a two-stage stochastic model that determines the number and locations of field hospitals and the allocation of injured victims to these field hospitals. Our model considers the locations as well as the failings of the existing public hospitals while deciding on the location of field hospitals that are anticipated to be opened. The model that we developed is a variant of the P-median location model and it integrates capacity restrictions both on field hospitals that are planned to be opened and the disruptions that occur in existing public hospitals. We conducted experiments to demonstrate how the proposed model can be utilized in practice in a real life problem case scenario. Results show the effects of the failings of existing hospitals, the level of failure probability and the capacity of projected field hospitals to deal with the assessment of any given emergency treatment system’s performance. Crucially, it also specifically provides an assessment on the average distance within which a victim needs to be transferred in order to be treated properly and then from this assessment, the proportion of total satisfied demand is then calculated.

  9. Dependence of Xmax and multiplicity of electron and muon on different high energy interaction models

    Directory of Open Access Journals (Sweden)

    G Rastegarzadeh

    2010-06-01

    Full Text Available Different high energy interaction models are the applied in CORSIKA code to simulate Extensive Air Showers (EAS generated by Cosmic Rays (CR. In this work the effects of QGSJET01, QGSJETII, DPMJET, SIBYLL models on Xmax and multiplicity of secondary electrons and muons at observation level are studied.

  10. Modelling the Dynamics of Intracellular Processes as an Organisation of Multiple Agents

    NARCIS (Netherlands)

    Bosse, T.; Jonker, C.M.; Treur, J.; Armano, G.; Merelli, E.; Denzinger, J.; Martin, A.; Miles, S.; Tianfield, H.; Unland, R.

    2005-01-01

    This paper explores how the dynamics of complex biological processes can be modeled as an organisation of multiple agents. This modelling perspective identifies organisational structure occurring in complex decentralised processes and handles complexity of the analysis of the dynamics by structuring

  11. A Convex Variational Model for Restoring Blurred Images with Multiplicative Noise

    DEFF Research Database (Denmark)

    Dong, Yiqiu; Tieyong Zeng

    2013-01-01

    In this paper, a new variational model for restoring blurred images with multiplicative noise is proposed. Based on the statistical property of the noise, a quadratic penalty function technique is utilized in order to obtain a strictly convex model under a mild condition, which guarantees...

  12. Computational Tools for Probing Interactions in Multiple Linear Regression, Multilevel Modeling, and Latent Curve Analysis

    Science.gov (United States)

    Preacher, Kristopher J.; Curran, Patrick J.; Bauer, Daniel J.

    2006-01-01

    Simple slopes, regions of significance, and confidence bands are commonly used to evaluate interactions in multiple linear regression (MLR) models, and the use of these techniques has recently been extended to multilevel or hierarchical linear modeling (HLM) and latent curve analysis (LCA). However, conducting these tests and plotting the…

  13. INTRODUCTION TO A COMBINED MULTIPLE LINEAR REGRESSION AND ARMA MODELING APPROACH FOR BEACH BACTERIA PREDICTION

    Science.gov (United States)

    Due to the complexity of the processes contributing to beach bacteria concentrations, many researchers rely on statistical modeling, among which multiple linear regression (MLR) modeling is most widely used. Despite its ease of use and interpretation, there may be time dependence...

  14. Featuring Multiple Local Optima to Assist the User in the Interpretation of Induced Bayesian Network Models

    DEFF Research Database (Denmark)

    Dalgaard, Jens; Pena, Jose; Kocka, Tomas

    2004-01-01

    We propose a method to assist the user in the interpretation of the best Bayesian network model indu- ced from data. The method consists in extracting relevant features from the model (e.g. edges, directed paths and Markov blankets) and, then, assessing the con¯dence in them by studying multiple...

  15. Stepwise Analysis of Differential Item Functioning Based on Multiple-Group Partial Credit Model.

    Science.gov (United States)

    Muraki, Eiji

    1999-01-01

    Extended an Item Response Theory (IRT) method for detection of differential item functioning to the partial credit model and applied the method to simulated data using a stepwise procedure. Then applied the stepwise DIF analysis based on the multiple-group partial credit model to writing trend data from the National Assessment of Educational…

  16. Validation of a multiple compartment model for the transport of cesium through animals

    International Nuclear Information System (INIS)

    Assimakopoulos, P.A.; Ioannides, K.G.; Pakou, A.A.

    1991-01-01

    A general multiple compartment model, which describes the transport of trace elements through animals is presented. This model considers a system of K interconnected compartments of volume V i , i = 1,2,....,K, each containing, at a given time t, N i molecules of a trace substance. (5 figs.)

  17. Modelling and simulation of multiple single - phase induction motor in parallel connection

    Directory of Open Access Journals (Sweden)

    Sujitjorn, S.

    2006-11-01

    Full Text Available A mathematical model for parallel connected n-multiple single-phase induction motors in generalized state-space form is proposed in this paper. The motor group draws electric power from one inverter. The model is developed by the dq-frame theory and was tested against four loading scenarios in which satisfactory results were obtained.

  18. A basket two-part model to analyze medical expenditure on interdependent multiple sectors.

    Science.gov (United States)

    Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji

    2018-05-01

    This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.

  19. Alternative approaches to reliability modeling of a multiple engineered barrier system

    International Nuclear Information System (INIS)

    Ananda, M.M.A.; Singh, A.K.

    1994-01-01

    The lifetime of the engineered barrier system used for containment of high-level radioactive waste will significantly impact the total performance of a geological repository facility. Currently two types of designs are under consideration for an engineered barrier system, single engineered barrier system and multiple engineered barrier system. Multiple engineered barrier system consists of several metal barriers and the waste form (cladding). Some recent work show that a significant improvement of performance can be achieved by utilizing multiple engineered barrier systems. Considering sequential failures for each barrier, we model the reliability of the multiple engineered barrier system. Weibull and exponential lifetime distributions are used through out the analysis. Furthermore, the number of failed engineered barrier systems in a repository at a given time is modeled using a poisson approximation

  20. A prediction method based on wavelet transform and multiple models fusion for chaotic time series

    International Nuclear Information System (INIS)

    Zhongda, Tian; Shujiang, Li; Yanhong, Wang; Yi, Sha

    2017-01-01

    In order to improve the prediction accuracy of chaotic time series, a prediction method based on wavelet transform and multiple models fusion is proposed. The chaotic time series is decomposed and reconstructed by wavelet transform, and approximate components and detail components are obtained. According to different characteristics of each component, least squares support vector machine (LSSVM) is used as predictive model for approximation components. At the same time, an improved free search algorithm is utilized for predictive model parameters optimization. Auto regressive integrated moving average model (ARIMA) is used as predictive model for detail components. The multiple prediction model predictive values are fusion by Gauss–Markov algorithm, the error variance of predicted results after fusion is less than the single model, the prediction accuracy is improved. The simulation results are compared through two typical chaotic time series include Lorenz time series and Mackey–Glass time series. The simulation results show that the prediction method in this paper has a better prediction.

  1. The reverse effects of random perturbation on discrete systems for single and multiple population models

    International Nuclear Information System (INIS)

    Kang, Li; Tang, Sanyi

    2016-01-01

    Highlights: • The discrete single species and multiple species models with random perturbation are proposed. • The complex dynamics and interesting bifurcation behavior have been investigated. • The reverse effects of random perturbation on discrete systems have been discussed and revealed. • The main results can be applied for pest control and resources management. - Abstract: The natural species are likely to present several interesting and complex phenomena under random perturbations, which have been confirmed by simple mathematical models. The important questions are: how the random perturbations influence the dynamics of the discrete population models with multiple steady states or multiple species interactions? and is there any different effects for single species and multiple species models with random perturbation? To address those interesting questions, we have proposed the discrete single species model with two stable equilibria and the host-parasitoid model with Holling type functional response functions to address how the random perturbation affects the dynamics. The main results indicate that the random perturbation does not change the number of blurred orbits of the single species model with two stable steady states compared with results for the classical Ricker model with same random perturbation, but it can strength the stability. However, extensive numerical investigations depict that the random perturbation does not influence the complexities of the host-parasitoid models compared with the results for the models without perturbation, while it does increase the period of periodic orbits doubly. All those confirm that the random perturbation has a reverse effect on the dynamics of the discrete single and multiple population models, which could be applied in reality including pest control and resources management.

  2. Intriguing model significantly reduces boarding of psychiatric patients, need for inpatient hospitalization.

    Science.gov (United States)

    2015-01-01

    As new approaches to the care of psychiatric emergencies emerge, one solution is gaining particular traction. Under the Alameda model, which has been put into practice in Alameda County, CA, patients who are brought to regional EDs with emergency psychiatric issues are quickly transferred to a designated emergency psychiatric facility as soon as they are medically stabilized. This alleviates boarding problems in area EDs while also quickly connecting patients with specialized care. With data in hand on the model's effectiveness, developers believe the approach could alleviate boarding problems in other communities as well. The model is funded by through a billing code established by California's Medicaid program for crisis stabilization services. Currently, only 22% of the patients brought to the emergency psychiatric facility ultimately need to be hospitalized; the other 78% are able to go home or to an alternative situation. In a 30-day study of the model, involving five community hospitals in Alameda County, CA, researchers found that ED boarding times were as much as 80% lower than comparable ED averages, and that patients were stabilized at least 75% of the time, significantly reducing the need for inpatient hospitalization.

  3. A P-value model for theoretical power analysis and its applications in multiple testing procedures

    Directory of Open Access Journals (Sweden)

    Fengqing Zhang

    2016-10-01

    Full Text Available Abstract Background Power analysis is a critical aspect of the design of experiments to detect an effect of a given size. When multiple hypotheses are tested simultaneously, multiplicity adjustments to p-values should be taken into account in power analysis. There are a limited number of studies on power analysis in multiple testing procedures. For some methods, the theoretical analysis is difficult and extensive numerical simulations are often needed, while other methods oversimplify the information under the alternative hypothesis. To this end, this paper aims to develop a new statistical model for power analysis in multiple testing procedures. Methods We propose a step-function-based p-value model under the alternative hypothesis, which is simple enough to perform power analysis without simulations, but not too simple to lose the information from the alternative hypothesis. The first step is to transform distributions of different test statistics (e.g., t, chi-square or F to distributions of corresponding p-values. We then use a step function to approximate each of the p-value’s distributions by matching the mean and variance. Lastly, the step-function-based p-value model can be used for theoretical power analysis. Results The proposed model is applied to problems in multiple testing procedures. We first show how the most powerful critical constants can be chosen using the step-function-based p-value model. Our model is then applied to the field of multiple testing procedures to explain the assumption of monotonicity of the critical constants. Lastly, we apply our model to a behavioral weight loss and maintenance study to select the optimal critical constants. Conclusions The proposed model is easy to implement and preserves the information from the alternative hypothesis.

  4. A versatile method for confirmatory evaluation of the effects of a covariate in multiple models

    DEFF Research Database (Denmark)

    Pipper, Christian Bressen; Ritz, Christian; Bisgaard, Hans

    2012-01-01

    to provide a fine-tuned control of the overall type I error in a wide range of epidemiological experiments where in reality no other useful alternative exists. The methodology proposed is applied to a multiple-end-point study of the effect of neonatal bacterial colonization on development of childhood asthma.......Modern epidemiology often requires testing of the effect of a covariate on multiple end points from the same study. However, popular state of the art methods for multiple testing require the tests to be evaluated within the framework of a single model unifying all end points. This severely limits...

  5. Classification and regression tree (CART model to predict pulmonary tuberculosis in hospitalized patients

    Directory of Open Access Journals (Sweden)

    Aguiar Fabio S

    2012-08-01

    Full Text Available Abstract Background Tuberculosis (TB remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Methods Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART model was generated and validated. The area under the ROC curve (AUC, sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. Results We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. Conclusions The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with

  6. Model for nucleus-nucleus, hadron-nucleus and hadron-proton multiplicity distributions

    International Nuclear Information System (INIS)

    Singh, C.P.; Shyam, M.; Tuli, S.K.

    1986-07-01

    A model relating hadron-proton, hadron-nucleus and nucleus-nucleus multiplicity distributions is proposed and some interesting consequences are derived. The values of the parameters are the same for all the processes and are given by the QCD hypothesis of ''universal'' hadronic multiplicities which are found to be asymptotically independent of target and beam in hadronic and current induced reactions in particle physics. (author)

  7. Hair length, facial attractiveness, personality attribution: A multiple fitness model of hairdressing

    OpenAIRE

    Bereczkei, Tamas; Mesko, Norbert

    2007-01-01

    Multiple Fitness Model states that attractiveness varies across multiple dimensions, with each feature representing a different aspect of mate value. In the present study, male raters judged the attractiveness of young females with neotenous and mature facial features, with various hair lengths. Results revealed that the physical appearance of long-haired women was rated high, regardless of their facial attractiveness being valued high or low. Women rated as most attractive were those whose f...

  8. Validation of statistical models for estimating hospitalization associated with influenza and other respiratory viruses.

    Directory of Open Access Journals (Sweden)

    Lin Yang

    Full Text Available BACKGROUND: Reliable estimates of disease burden associated with respiratory viruses are keys to deployment of preventive strategies such as vaccination and resource allocation. Such estimates are particularly needed in tropical and subtropical regions where some methods commonly used in temperate regions are not applicable. While a number of alternative approaches to assess the influenza associated disease burden have been recently reported, none of these models have been validated with virologically confirmed data. Even fewer methods have been developed for other common respiratory viruses such as respiratory syncytial virus (RSV, parainfluenza and adenovirus. METHODS AND FINDINGS: We had recently conducted a prospective population-based study of virologically confirmed hospitalization for acute respiratory illnesses in persons <18 years residing in Hong Kong Island. Here we used this dataset to validate two commonly used models for estimation of influenza disease burden, namely the rate difference model and Poisson regression model, and also explored the applicability of these models to estimate the disease burden of other respiratory viruses. The Poisson regression models with different link functions all yielded estimates well correlated with the virologically confirmed influenza associated hospitalization, especially in children older than two years. The disease burden estimates for RSV, parainfluenza and adenovirus were less reliable with wide confidence intervals. The rate difference model was not applicable to RSV, parainfluenza and adenovirus and grossly underestimated the true burden of influenza associated hospitalization. CONCLUSION: The Poisson regression model generally produced satisfactory estimates in calculating the disease burden of respiratory viruses in a subtropical region such as Hong Kong.

  9. A modeling and numerical algorithm for thermoporomechanics in multiple porosity media for naturally fractured reservoirs

    Science.gov (United States)

    Kim, J.; Sonnenthal, E. L.; Rutqvist, J.

    2011-12-01

    Rigorous modeling of coupling between fluid, heat, and geomechanics (thermo-poro-mechanics), in fractured porous media is one of the important and difficult topics in geothermal reservoir simulation, because the physics are highly nonlinear and strongly coupled. Coupled fluid/heat flow and geomechanics are investigated using the multiple interacting continua (MINC) method as applied to naturally fractured media. In this study, we generalize constitutive relations for the isothermal elastic dual porosity model proposed by Berryman (2002) to those for the non-isothermal elastic/elastoplastic multiple porosity model, and derive the coupling coefficients of coupled fluid/heat flow and geomechanics and constraints of the coefficients. When the off-diagonal terms of the total compressibility matrix for the flow problem are zero, the upscaled drained bulk modulus for geomechanics becomes the harmonic average of drained bulk moduli of the multiple continua. In this case, the drained elastic/elastoplastic moduli for mechanics are determined by a combination of the drained moduli and volume fractions in multiple porosity materials. We also determine a relation between local strains of all multiple porosity materials in a gridblock and the global strain of the gridblock, from which we can track local and global elastic/plastic variables. For elastoplasticity, the return mapping is performed for all multiple porosity materials in the gridblock. For numerical implementation, we employ and extend the fixed-stress sequential method of the single porosity model to coupled fluid/heat flow and geomechanics in multiple porosity systems, because it provides numerical stability and high accuracy. This sequential scheme can be easily implemented by using a porosity function and its corresponding porosity correction, making use of the existing robust flow and geomechanics simulators. We implemented the proposed modeling and numerical algorithm to the reaction transport simulator

  10. Validation and calibration of structural models that combine information from multiple sources.

    Science.gov (United States)

    Dahabreh, Issa J; Wong, John B; Trikalinos, Thomas A

    2017-02-01

    Mathematical models that attempt to capture structural relationships between their components and combine information from multiple sources are increasingly used in medicine. Areas covered: We provide an overview of methods for model validation and calibration and survey studies comparing alternative approaches. Expert commentary: Model validation entails a confrontation of models with data, background knowledge, and other models, and can inform judgments about model credibility. Calibration involves selecting parameter values to improve the agreement of model outputs with data. When the goal of modeling is quantitative inference on the effects of interventions or forecasting, calibration can be viewed as estimation. This view clarifies issues related to parameter identifiability and facilitates formal model validation and the examination of consistency among different sources of information. In contrast, when the goal of modeling is the generation of qualitative insights about the modeled phenomenon, calibration is a rather informal process for selecting inputs that result in model behavior that roughly reproduces select aspects of the modeled phenomenon and cannot be equated to an estimation procedure. Current empirical research on validation and calibration methods consists primarily of methodological appraisals or case-studies of alternative techniques and cannot address the numerous complex and multifaceted methodological decisions that modelers must make. Further research is needed on different approaches for developing and validating complex models that combine evidence from multiple sources.

  11. A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.

    Science.gov (United States)

    Chong, Mei Sian; Empensando, Esmiller F; Ding, Yew Yoong; Tan, Thai Lian

    2012-08-01

    The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance. We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods. Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period. We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.

  12. Modelling multiple cycles of static and dynamic recrystallisation using a fully implicit isotropic material model based on dislocation density

    Science.gov (United States)

    Jansen van Rensburg, Gerhardus J.; Kok, Schalk; Wilke, Daniel N.

    2018-03-01

    This paper presents the development and numerical implementation of a state variable based thermomechanical material model, intended for use within a fully implicit finite element formulation. Plastic hardening, thermal recovery and multiple cycles of recrystallisation can be tracked for single peak as well as multiple peak recrystallisation response. The numerical implementation of the state variable model extends on a J2 isotropic hypo-elastoplastic modelling framework. The complete numerical implementation is presented as an Abaqus UMAT and linked subroutines. Implementation is discussed with detailed explanation of the derivation and use of various sensitivities, internal state variable management and multiple recrystallisation cycle contributions. A flow chart explaining the proposed numerical implementation is provided as well as verification on the convergence of the material subroutine. The material model is characterised using two high temperature data sets for cobalt and copper. The results of finite element analyses using the material parameter values characterised on the copper data set are also presented.

  13. The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system -a multiple case study.

    Science.gov (United States)

    Keugoung, Basile; Macq, Jean; Buve, Anne; Meli, Jean; Criel, Bart

    2013-03-22

    Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level. We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs. The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers. Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs

  14. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    Directory of Open Access Journals (Sweden)

    M Kit Delgado

    2013-09-01

    Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.

  15. COST VOLUME PROFIT MODEL, THE BREAK -EVEN POINT AND THE DECISION MAKING PROCESS IN THE HOSPITALITY INDUSTRY

    Directory of Open Access Journals (Sweden)

    Scorte Carmen

    2010-12-01

    Full Text Available Management accounting and cost calculation in the hospitality industry is a pathless land. The prezent article is a starting point of a long scientific approach on the domain of the hospitality industry and on the managerial accounting in this area. Our intention is to put the spot light back on the thorny problem of applying Financial Accounting and specifically its implementation in the hospitality industry. One aim of this article is to provide a picture of CVP analysis in decision making with customizing the hospitality industry. To cope with the crisis period, the competition and to achieve the expected profits of the hospitality industry ,managers have the possibility to apply CVP analysis, one of the most simple and useful analytical tools. This paper will address the basic version of the CVP model, exemplifying the main indicators of the particular model for the hospitality industry that can help guide decision-making.

  16. Improving the Pattern Reproducibility of Multiple-Point-Based Prior Models Using Frequency Matching

    DEFF Research Database (Denmark)

    Cordua, Knud Skou; Hansen, Thomas Mejer; Mosegaard, Klaus

    2014-01-01

    Some multiple-point-based sampling algorithms, such as the snesim algorithm, rely on sequential simulation. The conditional probability distributions that are used for the simulation are based on statistics of multiple-point data events obtained from a training image. During the simulation, data...... events with zero probability in the training image statistics may occur. This is handled by pruning the set of conditioning data until an event with non-zero probability is found. The resulting probability distribution sampled by such algorithms is a pruned mixture model. The pruning strategy leads...... to a probability distribution that lacks some of the information provided by the multiple-point statistics from the training image, which reduces the reproducibility of the training image patterns in the outcome realizations. When pruned mixture models are used as prior models for inverse problems, local re...

  17. Optimized production planning model for a multi-plant cultivation system under uncertainty

    Science.gov (United States)

    Ke, Shunkui; Guo, Doudou; Niu, Qingliang; Huang, Danfeng

    2015-02-01

    An inexact multi-constraint programming model under uncertainty was developed by incorporating a production plan algorithm into the crop production optimization framework under the multi-plant collaborative cultivation system. In the production plan, orders from the customers are assigned to a suitable plant under the constraints of plant capabilities and uncertainty parameters to maximize profit and achieve customer satisfaction. The developed model and solution method were applied to a case study of a multi-plant collaborative cultivation system to verify its applicability. As determined in the case analysis involving different orders from customers, the period of plant production planning and the interval between orders can significantly affect system benefits. Through the analysis of uncertain parameters, reliable and practical decisions can be generated using the suggested model of a multi-plant collaborative cultivation system.

  18. A multiplicative reinforcement learning model capturing learning dynamics and interindividual variability in mice

    OpenAIRE

    Bathellier, Brice; Tee, Sui Poh; Hrovat, Christina; Rumpel, Simon

    2013-01-01

    Learning speed can strongly differ across individuals. This is seen in humans and animals. Here, we measured learning speed in mice performing a discrimination task and developed a theoretical model based on the reinforcement learning framework to account for differences between individual mice. We found that, when using a multiplicative learning rule, the starting connectivity values of the model strongly determine the shape of learning curves. This is in contrast to current learning models ...

  19. Hospital-in-the-Home — essential to an integrated model of paediatric care

    LENUS (Irish Health Repository)

    Hensey, CC

    2017-01-01

    The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

  20. Analysis of the quality of hospital information systems in Isfahan teaching hospitals based on the DeLone and McLean model.

    Science.gov (United States)

    Saghaeiannejad-Isfahani, Sakineh; Saeedbakhsh, Saeed; Jahanbakhsh, Maryam; Habibi, Mahboobeh

    2015-01-01

    Quality is one of the most important criteria for the success of an information system, which refers to its desirable features of the processing system itself. The aim of this study was the analysis of system quality of hospital information systems (HIS) in teaching hospitals of Isfahan based on the DeLone and McLean model. This research was an applied and analytical-descriptive study. It was performed in teaching hospitals of Isfahan in 2010. The research population consisted of the HIS's users, system designers and hospital information technology (IT) authorities who were selected by random sampling method from users' group (n = 228), and system designers and IT authorities (n = 52) using census method. The data collection tool was two researcher-designed questionnaires. Questionnaires' reliability was estimated by using Cronbach's alpha was calculated. It was 97.1% for the system designers and IT authorities' questionnaire and 92.3% for system users' questionnaire. Findings showed that the mean of system quality score in a variety of HIS and among different hospitals was significantly different and not the same (P value ≥ 0.05). In general, Kosar (new version) system and Rahavard Rayaneh system have dedicated the highest and the lowest mean scores to themselves. The system quality criterion overall mean was 59.6% for different HIS and 57.5% among different hospitals respectively. According to the results of the research, it can be stated that based on the applied model, the investigated systems were relatively desirable in terms of quality. Thus, in order to achieve a good optimal condition, it is necessary to pay particular attention to the improving factors of system quality, type of activity, type of specialty and hospital ownership type.

  1. MODEL PENSKORAN PARTIAL CREDIT PADA BUTIR MULTIPLE TRUE-FALSE BIDANG FISIKA

    Directory of Open Access Journals (Sweden)

    Wasis Wasis

    2013-01-01

    Full Text Available Tujuan penelitian ini menghasilkan model penskoran politomus untuk respons butir multiple true-false, sehingga dapat mengestimasi secara lebih akurat kemampuan di bidang fisika. Pengembangan penskoran menggunakan Four-D model dan diuji akurasinya melalui penelitian empiris dan simulasi. Penelitian empiris menggunakan 15 butir multiple true-false yang diambil dari soal UMPTN tahun 1996-2006 dan dikenakan pada 410 mahasiswa baru FMIPA Universitas Negeri Surabaya angkatan tahun 2007. Respons peserta tes diskor dengan tiga model partial credit (PCM I; II; dan III dan secara dikotomus. Hasil penskoran dianalisis dengan program Quest untuk mendapat-kan estimasi tingkat kesukaran butir (δ dan estimasi ke-mampuan peserta (θ untuk menentukan nilai fungsi informasi tes dan kesalahan baku estimasi. Penelitian simulasi mengguna-kan data bangkitan berdasarkan parameter empiris (δ dan θ memakai program statistik SAS dan akurasi estimasinya di-analisis dengan metode root mean squared error (RMSE. Hasil penelitian ini menunjukkan: (i Penskoran PCM dengan pem-bobotan mampu mengestimasi kemampuan lebih akurat di-bandingkan tanpa pembobotan maupun secara dikotomus; (ii Semakin banyak jumlah kategori dalam penskoran partial credit, semakin akurat. Kata kunci: model penskoran partial credit, butir multiple true-false ____________________________________________________________ THE PARTIAL CREDIT SCORING MODEL FOR THE MULTIPLE TRUE-FALSE BUTIRS IN PHYSICS Abstract This study is an attempt to overcome the weaknesses. This study aims to produce a polytomous scoring model for responses to multiple true-false butirs in order to get a more accurate estimation of abilities in physics. It adopts the Four-D model and its accuracy is assessed through empirical and simulation studies. The empirical study employed 15 multiple true-false butirs taken from the New Students Entrance Test of State University the year of 1996–2006. It administered to 410 new students enrolled

  2. Control of hospital endemicity of multiple-drug-resistant Acinetobacter baumannii ST457 with directly observed hand hygiene.

    Science.gov (United States)

    Cheng, V C C; Chen, J H K; Poon, R W S; Lee, W M; So, S Y C; Wong, S C Y; Chau, P H; Yip, C C Y; Wong, S S Y; Chan, J F W; Hung, I F N; Ho, P L; Yuen, K Y

    2015-04-01

    An increasing endemicity of multiple-drug-resistant Acinetobacter baumannii (MRAB) ST457 was noted in Hong Kong. The epidemiology, risk factors, and infection control measures to prevent nosocomial transmission of this epidemic clone were analyzed. A total of 5,058 patients cultured positive with A. baumannii between 1 January 2004 and 30 June 2014 were included, of which 297 (5.9 %) had bacteremia. The first case of MRAB bacteremia emerged in 2009, with an incidence that increased from 0.27 (one case) in 2009 to 1.86 (14 cases) per 100,000 patient-days in 2013 (p hand hygiene in conscious patients immediately before receiving meals and medications in July 2013, the incidence of MRAB bacteremia reduced from its peak to 0.77 (one case) per 100,000 patient-days in the first 6 months of 2014 (p < 0.001). Patients from long-term care facilities for the elderly [odds ratio (OR) 18.6, confidence interval (CI) 2.1-162.4, p = 0.008] and history of carbapenem (OR 7.0, CI 1.7-28.0, p = 0.006) and beta-lactam/beta-lactamase use (OR 5.6, CI 1.1-28.7, p = 0.038) 90 days prior to admission were independent risk factors for MRAB bacteremia by logistic regression when compared with carbapenem-susceptible A. baumannii bacteremia.

  3. Sepsis Alert - a triage model that reduces time to antibiotics and length of hospital stay.

    Science.gov (United States)

    Rosenqvist, Mari; Fagerstrand, Emma; Lanbeck, Peter; Melander, Olle; Åkesson, Per

    2017-07-01

    To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection. A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist. Also, all ED staff participated in a designated sepsis education before Sepsis Alert was introduced. Medical records were evaluated for patients during a 3-month period after the triage system was started in 2012, and also during the corresponding months in 2010 and 2014. A total of 1837 patients presented with abnormal vital signs. Of these, 221 patients presented with fever and thus at risk of having severe sepsis. Among patients triaged according to the new model, median time to antibiotics was 58.5 at startup and 24.5 minutes at follow-up two years later. This was significantly less than for patients treated before the new model, 190 minutes. Also, median LOS was significantly decreased after introduction of the new triage model, from nine to seven days. A triage model at the ED with special attention to severe sepsis patients, led to sustained improvements of time to antibiotic treatment and LOS.

  4. Reduction of bias in neutron multiplicity assay using a weighted point model

    Energy Technology Data Exchange (ETDEWEB)

    Geist, W. H. (William H.); Krick, M. S. (Merlyn S.); Mayo, D. R. (Douglas R.)

    2004-01-01

    Accurate assay of most common plutonium samples was the development goal for the nondestructive assay technique of neutron multiplicity counting. Over the past 20 years the technique has been proven for relatively pure oxides and small metal items. Unfortunately, the technique results in large biases when assaying large metal items. Limiting assumptions, such as unifoh multiplication, in the point model used to derive the multiplicity equations causes these biases for large dense items. A weighted point model has been developed to overcome some of the limitations in the standard point model. Weighting factors are detemiined from Monte Carlo calculations using the MCNPX code. Monte Carlo calculations give the dependence of the weighting factors on sample mass and geometry, and simulated assays using Monte Carlo give the theoretical accuracy of the weighted-point-model assay. Measured multiplicity data evaluated with both the standard and weighted point models are compared to reference values to give the experimental accuracy of the assay. Initial results show significant promise for the weighted point model in reducing or eliminating biases in the neutron multiplicity assay of metal items. The negative biases observed in the assay of plutonium metal samples are caused by variations in the neutron multiplication for neutrons originating in various locations in the sample. The bias depends on the mass and shape of the sample and depends on the amount and energy distribution of the ({alpha},n) neutrons in the sample. When the standard point model is used, this variable-multiplication bias overestimates the multiplication and alpha values of the sample, and underestimates the plutonium mass. The weighted point model potentially can provide assay accuracy of {approx}2% (1 {sigma}) for cylindrical plutonium metal samples < 4 kg with {alpha} < 1 without knowing the exact shape of the samples, provided that the ({alpha},n) source is uniformly distributed throughout the

  5. Multiple attribute decision making model and application to food safety risk evaluation.

    Directory of Open Access Journals (Sweden)

    Lihua Ma

    Full Text Available Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

  6. Multiplicity distributions in a thermodynamical model of hadron production in e+e- collisions

    International Nuclear Information System (INIS)

    Becattini, F.; Giovannini, A.; Lupia, S.

    1996-01-01

    Predictions of a thermodynamical model of hadron production for multiplicity distributions in e + e - annihilations at LEP and PEP-PETRA centre of mass energies are shown. The production process is described as a two-step process in which primary hadrons emitted from the thermal source decay into final observable particles. The final charged track multiplicity distributions turn out to be of negative binomial type and are in quite good agreement with experimental observations. The average number of clans calculated from fitted negative binomial coincides with the average number of primary hadrons predicted by the thermodynamical model, suggesting that clans should be identified with primary hadrons. (orig.)

  7. A feedback control model for network flow with multiple pure time delays

    Science.gov (United States)

    Press, J.

    1972-01-01

    A control model describing a network flow hindered by multiple pure time (or transport) delays is formulated. Feedbacks connect each desired output with a single control sector situated at the origin. The dynamic formulation invokes the use of differential difference equations. This causes the characteristic equation of the model to consist of transcendental functions instead of a common algebraic polynomial. A general graphical criterion is developed to evaluate the stability of such a problem. A digital computer simulation confirms the validity of such criterion. An optimal decision making process with multiple delays is presented.

  8. Multiple Model Adaptive Attitude Control of LEO Satellite with Angular Velocity Constraints

    Science.gov (United States)

    Shahrooei, Abolfazl; Kazemi, Mohammad Hosein

    2018-04-01

    In this paper, the multiple model adaptive control is utilized to improve the transient response of attitude control system for a rigid spacecraft. An adaptive output feedback control law is proposed for attitude control under angular velocity constraints and its almost global asymptotic stability is proved. The multiple model adaptive control approach is employed to counteract large uncertainty in parameter space of the inertia matrix. The nonlinear dynamics of a low earth orbit satellite is simulated and the proposed control algorithm is implemented. The reported results show the effectiveness of the suggested scheme.

  9. Testing a multiple mediation model of Asian American college students' willingness to see a counselor.

    Science.gov (United States)

    Kim, Paul Youngbin; Park, Irene J K

    2009-07-01

    Adapting the theory of reasoned action, the present study examined help-seeking beliefs, attitudes, and intent among Asian American college students (N = 110). A multiple mediation model was tested to see if the relation between Asian values and willingness to see a counselor was mediated by attitudes toward seeking professional psychological help and subjective norm. A bootstrapping procedure was used to test the multiple mediation model. Results indicated that subjective norm was the sole significant mediator of the effect of Asian values on willingness to see a counselor. The findings highlight the importance of social influences on help-seeking intent among Asian American college students.

  10. A Point Kinetics Model for Estimating Neutron Multiplication of Bare Uranium Metal in Tagged Neutron Measurements

    International Nuclear Information System (INIS)

    Tweardy, Matthew C.; McConchie, Seth; Hayward, Jason P.

    2017-01-01

    An extension of the point kinetics model is developed in this paper to describe the neutron multiplicity response of a bare uranium object under interrogation by an associated particle imaging deuterium-tritium (D-T) measurement system. This extended model is used to estimate the total neutron multiplication of the uranium. Both MCNPX-PoliMi simulations and data from active interrogation measurements of highly enriched and depleted uranium geometries are used to evaluate the potential of this method and to identify the sources of systematic error. The detection efficiency correction for measured coincidence response is identified as a large source of systematic error. If the detection process is not considered, results suggest that the method can estimate total multiplication to within 13% of the simulated value. Values for multiplicity constants in the point kinetics equations are sensitive to enrichment due to (n, xn) interactions by D-T neutrons and can introduce another significant source of systematic bias. This can theoretically be corrected if isotopic composition is known a priori. Finally, the spatial dependence of multiplication is also suspected of introducing further systematic bias for high multiplication uranium objects.

  11. A Point Kinetics Model for Estimating Neutron Multiplication of Bare Uranium Metal in Tagged Neutron Measurements

    Science.gov (United States)

    Tweardy, Matthew C.; McConchie, Seth; Hayward, Jason P.

    2017-07-01

    An extension of the point kinetics model is developed to describe the neutron multiplicity response of a bare uranium object under interrogation by an associated particle imaging deuterium-tritium (D-T) measurement system. This extended model is used to estimate the total neutron multiplication of the uranium. Both MCNPX-PoliMi simulations and data from active interrogation measurements of highly enriched and depleted uranium geometries are used to evaluate the potential of this method and to identify the sources of systematic error. The detection efficiency correction for measured coincidence response is identified as a large source of systematic error. If the detection process is not considered, results suggest that the method can estimate total multiplication to within 13% of the simulated value. Values for multiplicity constants in the point kinetics equations are sensitive to enrichment due to (n, xn) interactions by D-T neutrons and can introduce another significant source of systematic bias. This can theoretically be corrected if isotopic composition is known a priori. The spatial dependence of multiplication is also suspected of introducing further systematic bias for high multiplication uranium objects.

  12. Improving service quality of hospital front office using an integrated Kano model and quality function deployment

    Directory of Open Access Journals (Sweden)

    Anjar Priyono

    2017-11-01

    Full Text Available Purpose: The aims of this study are twofold: first, it attempts to investigate service attributes in a hospital front office; and second, to identify strategies to improve those service attributes. Design/methodology/approach: This study used integration of Quality Function Deployment and Kano Model. The research instrument, which takes the SERVQUAL model as its starting point, was developed using a comprehensive set of techniques, including a literature review of relevant topics, interviews and focus group discussions. Using a sample of 140 customers of an international hospital situated in Yogyakarta, Indonesia, 14 service attributes required by customers were identified. The attributes, which were further categorised into 5 attractive, 4 one-dimensional and 5 ‘must-be’ attributes, were analysed using the Kano Model. Findings: Using the integrated QFD and Kano Model, the service attributes needed for improvement were identified. The results are different from those when the company used either SERVQUAL or QFD alone. This study also reveals that benchmarking with competitor might produce misleading results. The results are different when the analysis combined a comprehensive method of QFD and Kano Model. Practical implications: Service providers will benefit from the findings of this study, as both the service attributes and technical requirements that require improvement as a priority are identified. Originality/value: It is the first time that front office quality of hospital is examined using integrated method of SERVQUAL, QFD and Kano Model. The recommendations proposed from this comprehensive method offer novel solution that has never been found in existing study.

  13. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.

    2014-01-01

    Background: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care

  14. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Ubbink, Dirk T.; Huis In Het Veld, Judith G.; Bakker, Piet J.; Vermeulen, Hester

    2014-01-01

    Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and

  15. A minimal unified model of disease trajectories captures hallmarks of multiple sclerosis

    KAUST Repository

    Kannan, Venkateshan

    2017-03-29

    Multiple Sclerosis (MS) is an autoimmune disease targeting the central nervous system (CNS) causing demyelination and neurodegeneration leading to accumulation of neurological disability. Here we present a minimal, computational model involving the immune system and CNS that generates the principal subtypes of the disease observed in patients. The model captures several key features of MS, especially those that distinguish the chronic progressive phase from that of the relapse-remitting. In addition, a rare subtype of the disease, progressive relapsing MS naturally emerges from the model. The model posits the existence of two key thresholds, one in the immune system and the other in the CNS, that separate dynamically distinct behavior of the model. Exploring the two-dimensional space of these thresholds, we obtain multiple phases of disease evolution and these shows greater variation than the clinical classification of MS, thus capturing the heterogeneity that is manifested in patients.

  16. Enhancing CIDOC-CRM and compatible models with the concept of multiple interpretation

    Science.gov (United States)

    Van Ruymbeke, M.; Hallot, P.; Billen, R.

    2017-08-01

    Modelling cultural heritage and archaeological objects is used as much for management as for research purposes. To ensure the sustainable benefit of digital data, models benefit from taking the data specificities of historical and archaeological domains into account. Starting from a conceptual model tailored to storing these specificities, we present, in this paper, an extended mapping to CIDOC-CRM and its compatible models. Offering an ideal framework to structure and highlight the best modelling practices, these ontologies are essentially dedicated to storing semantic data which provides information about cultural heritage objects. Based on this standard, our proposal focuses on multiple interpretation and sequential reality.

  17. Service delivery innovation for hospital emergency management using rich organizational modelling.

    Science.gov (United States)

    Dhakal, Yogit; Bhuiyan, Moshiur; Prasad, Pwc; Krishna, Aneesh

    2018-04-01

    The purpose of this article is to identify and assess service delivery issues within a hospital emergency department and propose an improved model to address them. Possible solutions and options to these issues are explored to determine the one that best fits the context. In this article, we have analysed the emergency department's organizational models through i* strategic dependency and rational modelling technique before proposing updated models that could potentially drive business process efficiencies. The results produced by the models, framework and improved patient journey in the emergency department were evaluated against the statistical data revealed from a reputed government organization related to health, to ensure that the key elements of the issues such as wait time, stay time/throughput, workload and human resource are resolved. The result of the evaluation was taken as a basis to determine the success of the project. Based on these results, the article recommends implementing the concept on actual scenario, where a positive result is achievable.

  18. Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals.

    Science.gov (United States)

    Gilmartin, Heather M; Sousa, Karen H

    2016-01-01

    To test the Quality Health Outcomes Model to investigate the relationship between health care-associated infection (HAI) prevention interventions, organizational context, and HAI outcomes using structural equation modeling. Variables for adherence to the central line bundle, organizational context, and central line-associated bloodstream infections (CLABSIs) were selected for this secondary data analysis from 614 US hospitals that participated in the Prevention of Nosocomial Infection and Cost-effectiveness-Refined study. One half of the dataset was used for exploration of the concepts, the second half for confirmation of the measurement models and testing of the structural model. The final model resulted in a good fit to the data (χ (1215) = 1906.86, P preventing HAIs, ongoing research is needed to reveal the exact aspects of context that influence interventions and outcomes.

  19. A Multiple Items EPQ/EOQ Model for a Vendor and Multiple Buyers System with Considering Continuous and Discrete Demand Simultaneously

    Science.gov (United States)

    Jonrinaldi; Rahman, T.; Henmaidi; Wirdianto, E.; Zhang, D. Z.

    2018-03-01

    This paper proposed a mathematical model for multiple items Economic Production and Order Quantity (EPQ/EOQ) with considering continuous and discrete demand simultaneously in a system consisting of a vendor and multiple buyers. This model is used to investigate the optimal production lot size of the vendor and the number of shipments policy of orders to multiple buyers. The model considers the multiple buyers’ holding cost as well as transportation cost, which minimize the total production and inventory costs of the system. The continuous demand from any other customers can be fulfilled anytime by the vendor while the discrete demand from multiple buyers can be fulfilled by the vendor using the multiple delivery policy with a number of shipments of items in the production cycle time. A mathematical model is developed to illustrate the system based on EPQ and EOQ model. Solution procedures are proposed to solve the model using a Mixed Integer Non Linear Programming (MINLP) and algorithm methods. Then, the numerical example is provided to illustrate the system and results are discussed.

  20. Building interpretable predictive models for pediatric hospital readmission using Tree-Lasso logistic regression.

    Science.gov (United States)

    Jovanovic, Milos; Radovanovic, Sandro; Vukicevic, Milan; Van Poucke, Sven; Delibasic, Boris

    2016-09-01

    Quantification and early identification of unplanned readmission risk have the potential to improve the quality of care during hospitalization and after discharge. However, high dimensionality, sparsity, and class imbalance of electronic health data and the complexity of risk quantification, challenge the development of accurate predictive models. Predictive models require a certain level of interpretability in order to be applicable in real settings and create actionable insights. This paper aims to develop accurate and interpretable predictive models for readmission in a general pediatric patient population, by integrating a data-driven model (sparse logistic regression) and domain knowledge based on the international classification of diseases 9th-revision clinical modification (ICD-9-CM) hierarchy of diseases. Additionally, we propose a way to quantify the interpretability of a model and inspect the stability of alternative solutions. The analysis was conducted on >66,000 pediatric hospital discharge records from California, State Inpatient Databases, Healthcare Cost and Utilization Project between 2009 and 2011. We incorporated domain knowledge based on the ICD-9-CM hierarchy in a data driven, Tree-Lasso regularized logistic regression model, providing the framework for model interpretation. This approach was compared with traditional Lasso logistic regression resulting in models that are easier to interpret by fewer high-level diagnoses, with comparable prediction accuracy. The results revealed that the use of a Tree-Lasso model was as competitive in terms of accuracy (measured by area under the receiver operating characteristic curve-AUC) as the traditional Lasso logistic regression, but integration with the ICD-9-CM hierarchy of diseases provided more interpretable models in terms of high-level diagnoses. Additionally, interpretations of models are in accordance with existing medical understanding of pediatric readmission. Best performing models have

  1. Protein structure modeling for CASP10 by multiple layers of global optimization.

    Science.gov (United States)

    Joo, Keehyoung; Lee, Juyong; Sim, Sangjin; Lee, Sun Young; Lee, Kiho; Heo, Seungryong; Lee, In-Ho; Lee, Sung Jong; Lee, Jooyoung

    2014-02-01

    In the template-based modeling (TBM) category of CASP10 experiment, we introduced a new protocol called protein modeling system (PMS) to generate accurate protein structures in terms of side-chains as well as backbone trace. In the new protocol, a global optimization algorithm, called conformational space annealing (CSA), is applied to the three layers of TBM procedure: multiple sequence-structure alignment, 3D chain building, and side-chain re-modeling. For 3D chain building, we developed a new energy function which includes new distance restraint terms of Lorentzian type (derived from multiple templates), and new energy terms that combine (physical) energy terms such as dynamic fragment assembly (DFA) energy, DFIRE statistical potential energy, hydrogen bonding term, etc. These physical energy terms are expected to guide the structure modeling especially for loop regions where no template structures are available. In addition, we developed a new quality assessment method based on random forest machine learning algorithm to screen templates, multiple alignments, and final models. For TBM targets of CASP10, we find that, due to the combination of three stages of CSA global optimizations and quality assessment, the modeling accuracy of PMS improves at each additional stage of the protocol. It is especially noteworthy that the side-chains of the final PMS models are far more accurate than the models in the intermediate steps. Copyright © 2013 Wiley Periodicals, Inc.

  2. Identification of Multiple-Mode Linear Models Based on Particle Swarm Optimizer with Cyclic Network Mechanism

    Directory of Open Access Journals (Sweden)

    Tae-Hyoung Kim

    2017-01-01

    Full Text Available This paper studies the metaheuristic optimizer-based direct identification of a multiple-mode system consisting of a finite set of linear regression representations of subsystems. To this end, the concept of a multiple-mode linear regression model is first introduced, and its identification issues are established. A method for reducing the identification problem for multiple-mode models to an optimization problem is also described in detail. Then, to overcome the difficulties that arise because the formulated optimization problem is inherently ill-conditioned and nonconvex, the cyclic-network-topology-based constrained particle swarm optimizer (CNT-CPSO is introduced, and a concrete procedure for the CNT-CPSO-based identification methodology is developed. This scheme requires no prior knowledge of the mode transitions between subsystems and, unlike some conventional methods, can handle a large amount of data without difficulty during the identification process. This is one of the distinguishing features of the proposed method. The paper also considers an extension of the CNT-CPSO-based identification scheme that makes it possible to simultaneously obtain both the optimal parameters of the multiple submodels and a certain decision parameter involved in the mode transition criteria. Finally, an experimental setup using a DC motor system is established to demonstrate the practical usability of the proposed metaheuristic optimizer-based identification scheme for developing a multiple-mode linear regression model.

  3. An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Skovgaard Lasse

    2012-04-01

    Full Text Available Abstract Background The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. Discussion The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1 Working with an initial model 2 Unfolding the different treatment philosophies 3 Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme 4 Phrasing the common assumptions for an integrative MS program theory 5 Developing the integrative MS program theory 6 Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. Summary An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level.

  4. Developing a model for hospital inherent safety assessment: Conceptualization and validation.

    Science.gov (United States)

    Yari, Saeed; Akbari, Hesam; Gholami Fesharaki, Mohammad; Khosravizadeh, Omid; Ghasemi, Mohammad; Barsam, Yalda; Akbari, Hamed

    2018-01-01

    Paying attention to the safety of hospitals, as the most crucial institute for providing medical and health services wherein a bundle of facilities, equipment, and human resource exist, is of significant importance. The present research aims at developing a model for assessing hospitals' safety based on principles of inherent safety design. Face validity (30 experts), content validity (20 experts), construct validity (268 examples), convergent validity, and divergent validity have been employed to validate the prepared questionnaire; and the items analysis, the Cronbach's alpha test, ICC test (to measure reliability of the test), composite reliability coefficient have been used to measure primary reliability. The relationship between variables and factors has been confirmed at 0.05 significance level by conducting confirmatory factor analysis (CFA) and structural equations modeling (SEM) technique with the use of Smart-PLS. R-square and load factors values, which were higher than 0.67 and 0.300 respectively, indicated the strong fit. Moderation (0.970), simplification (0.959), substitution (0.943), and minimization (0.5008) have had the most weights in determining the inherent safety of hospital respectively. Moderation, simplification, and substitution, among the other dimensions, have more weight on the inherent safety, while minimization has the less weight, which could be due do its definition as to minimize the risk.

  5. Developing a model for the adequate description of electronic communication in hospitals.

    Science.gov (United States)

    Saboor, Samrend; Ammenwerth, Elske

    2011-01-01

    Adequate information and communication systems (ICT) can help to improve the communication in hospitals. Changes to the ICT-infrastructure of hospitals must be planed carefully. In order to support a comprehensive planning, we presented a classification of 81 common errors of the electronic communication on the MIE 2008 congress. Our objective now was to develop a data model that defines specific requirements for an adequate description of electronic communication processes We first applied the method of explicating qualitative content analysis on the error categorization in order to determine the essential process details. After this, we applied the method of subsuming qualitative content analysis on the results of the first step. A data model for the adequate description of electronic communication. This model comprises 61 entities and 91 relationships. The data model comprises and organizes all details that are necessary for the detection of the respective errors. It can be for either used to extend the capabilities of existing modeling methods or as a basis for the development of a new approach.

  6. Role of transformational leadership on employee productivity of teaching hospitals: using structural equation modeling.

    Science.gov (United States)

    Vatankhah, Soudabeh; Alirezaei, Samira; Khosravizadeh, Omid; Mirbahaeddin, Seyyed Elmira; Alikhani, Mahtab; Alipanah, Mobarakeh

    2017-08-01

    In today's transforming world, increased productivity and efficient use of existing facilities are practically beyond a choice and become a necessity. In this line, attention to change and transformation is one of the affecting factors on the growth of productivity in organizations, especially in hospitals. To examine the effect of transformational leadership on the productivity of employees in teaching hospitals affiliated to Iran University of Medical Sciences. This cross-sectional study was conducted on 254 participants from educational and medical centers affiliated to Iran University of Medical Sciences (Tehran, Iran) in 2016. The standard questionnaires of Bass & Avolio and of Hersi & Goldsmith were used to respectively assess transformational leadership and level of productivity. The research assumptions were tested in a significance level of 0.05 by applying descriptive statistics and structural equations modeling (SEM) using SPSS 19 and Amos 24. Results of the fitting indicators of the assessing model after amending includes Chi-square two to degrees of freedom of 2.756, CFI indicator 0.95, IFI indicator 0.92, Root mean square error of approximation (RMSEA) indicator 0.10. These results indicate that the assessing model is well fitting after the amendment. Also, analysis of the model's assumptions and the final model of the research reveals the effect of transformational leadership on employees' productivity with a significance level of 0.83 (p=0.001). This research indicates that the more the leadership and decision-making style in hospitals lean towards transformational mode, the more positive outcomes it brings among employees and the organization due to increased productivity. Therefore, it is essential to pay focused attention to training/educational programs in organizations to create and encourage transformational leadership behaviors which hopefully lead to more productive employees.

  7. Trauma na infância e adolescência: epidemiologia, tratamento e aspectos econômicos em um hospital público Epidemiology, treatment and economical aspects of multiple trauma in children and adolescents in a public hospital

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo da Silveira Franciozi

    2008-01-01

    Full Text Available INTRODUÇÃO: A realização deste trabalho foi motivada pela escassez de artigos encontrados na literatura que estudam o politrauma na infância e na adolescência.. O objetivo é descrever o perfil epidemiológico das lesões traumáticas na infância tratadas num centro de trauma, avaliar os aspectos econômicos relacionados com o gasto hospitalar e o tempo de internação de acordo com o tratamento realizado. MATERIAIS E MÉTODOS: analisamos todos os prontuários do hospital Geral de Pirajussara no período de dezembro de 2005 a dezembro de 2006. Obtivemos 182 pacientes, sendo 71% do sexo masculino e 29% do feminino; 48% brancos e 52% não brancos. RESULTADOS: houve predominância dos indivíduos do sexo masculino com 71% dos pacientes. O mecanismo de trauma mais freqüente foi a queda (36%. A média de dias de internação foi 4,1 dias, com gasto estimado de R$ 649,50 para cada paciente. A taxa de mortalidade foi de 2,74%, sendo o traumatismo crânio-encefálico responsável por 80% da mortalidade e os maus tratos presentes em 40% dos óbitos. CONCLUSÃO: a população pediátrica tem particularidades que a tornam distinta da população adulta em relação à epidemiologia e manejo das lesões.INTRODUCTION: the motivation to conduct this study was the reduced number of articles in literature correlating multiple trauma in childhood and infancy. The objective here was to describe the epidemiological profile of traumatic injuries treated in a trauma center, evaluating the economic aspects associated with hospitalized patients' costs and the period of hospital stay according to the treatment provided. MATERIAL AND METHODS: we assessed all Pirajussara Hospital patients' files in the period of December of 2005 to December 2006. We selected 182 patients, 129 (71% males and 53 (29% females; 88 (48% Caucasian and 94 (52% non-Caucasian children. RESULTS: male patients were prevalent, with 129 (71% cases. The most frequent trauma mechanism was fall

  8. Benthic macroinvertebrates and multiple stressors : quantification of the effects of multiple stressors in field, laboratory and model settings

    NARCIS (Netherlands)

    Peeters, E.T.H.M.

    2001-01-01

    Organisms are always exposed to several simultaneously operating stressors in nature. It appears that the combined effects of multiple stressors cannot be understood as a simple product of their individual effects. To understand how multiple stressors affect the composition and functioning

  9. Using Simulation to Model Improvements in Pediatric Bed Placement in an Acute Care Hospital.

    Science.gov (United States)

    Lambton, Judith; Roeder, Theresa; Saltzman, Robert; Param, Lila; Fernandes, Roxanne

    2017-02-01

    The objective of this project was to use an interdisciplinary approach to analyze strategies through simulation technology for improving patient flow in a pediatric hospital. Various statistics have been offered on the number of children admitted annually to hospitals. For administrators, particularly in smaller systems, the financial burden of equipping and staffing pediatric units often outweighs the moral desire to maintain a pediatric unit as a viable option for patients and pediatricians. Discrete event simulation was used to model current operations of a pediatric unit. Cost analysis was conducted using simulation reflecting various percentages of patients being referred to a discharge holding area (DHA) upon discharge and of the use of all private rooms. Both DHA and private rooms resulted in increased patient volumes. Administrators should consider the use of a DHA and/or private rooms to ease the census strains of pediatric units and the resultant revenue of this service.

  10. Managerial performance and cost efficiency of Japanese local public hospitals: a latent class stochastic frontier model.

    Science.gov (United States)

    Besstremyannaya, Galina

    2011-09-01

    The paper explores the link between managerial performance and cost efficiency of 617 Japanese general local public hospitals in 1999-2007. Treating managerial performance as unobservable heterogeneity, the paper employs a panel data stochastic cost frontier model with latent classes. Financial parameters associated with better managerial performance are found to be positively significant in explaining the probability of belonging to the more efficient latent class. The analysis of latent class membership was consistent with the conjecture that unobservable technological heterogeneity reflected in the existence of the latent classes is related to managerial performance. The findings may support the cause for raising efficiency of Japanese local public hospitals by enhancing the quality of management. Copyright © 2011 John Wiley & Sons, Ltd.

  11. Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

    Science.gov (United States)

    Toole, Cheryl A; DeGrazia, Michele; Connor, Jean Anne; Gauvreau, Kimberlee; Kuzdeba, Hillary Bishop; Hickey, Patricia A

    Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.

  12. A hospital-level cost-effectiveness analysis model for toxigenic Clostridium difficile detection algorithms.

    Science.gov (United States)

    Verhoye, E; Vandecandelaere, P; De Beenhouwer, H; Coppens, G; Cartuyvels, R; Van den Abeele, A; Frans, J; Laffut, W

    2015-10-01

    Despite thorough analyses of the analytical performance of Clostridium difficile tests and test algorithms, the financial impact at hospital level has not been well described. Such a model should take institution-specific variables into account, such as incidence, request behaviour and infection control policies. To calculate the total hospital costs of different test algorithms, accounting for days on which infected patients with toxigenic strains were not isolated and therefore posed an infectious risk for new/secondary nosocomial infections. A mathematical algorithm was developed to gather the above parameters using data from seven Flemish hospital laboratories (Bilulu Microbiology Study Group) (number of tests, local prevalence and hospital hygiene measures). Measures of sensitivity and specificity for the evaluated tests were taken from the literature. List prices and costs of assays were provided by the manufacturer or the institutions. The calculated cost included reagent costs, personnel costs and the financial burden following due and undue isolations and antibiotic therapies. Five different test algorithms were compared. A dynamic calculation model was constructed to evaluate the cost:benefit ratio of each algorithm for a set of institution- and time-dependent inputted variables (prevalence, cost fluctuations and test performances), making it possible to choose the most advantageous algorithm for its setting. A two-step test algorithm with concomitant glutamate dehydrogenase and toxin testing, followed by a rapid molecular assay was found to be the most cost-effective algorithm. This enabled resolution of almost all cases on the day of arrival, minimizing the number of unnecessary or missing isolations. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  13. Predicting 30-day Hospital Readmission with Publicly Available Administrative Database. A Conditional Logistic Regression Modeling Approach.

    Science.gov (United States)

    Zhu, K; Lou, Z; Zhou, J; Ballester, N; Kong, N; Parikh, P

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". Hospital readmissions raise healthcare costs and cause significant distress to providers and patients. It is, therefore, of great interest to healthcare organizations to predict what patients are at risk to be readmitted to their hospitals. However, current logistic regression based risk prediction models have limited prediction power when applied to hospital administrative data. Meanwhile, although decision trees and random forests have been applied, they tend to be too complex to understand among the hospital practitioners. Explore the use of conditional logistic regression to increase the prediction accuracy. We analyzed an HCUP statewide inpatient discharge record dataset, which includes patient demographics, clinical and care utilization data from California. We extracted records of heart failure Medicare beneficiaries who had inpatient experience during an 11-month period. We corrected the data imbalance issue with under-sampling. In our study, we first applied standard logistic regression and decision tree to obtain influential variables and derive practically meaning decision rules. We then stratified the original data set accordingly and applied logistic regression on each data stratum. We further explored the effect of interacting variables in the logistic regression modeling. We conducted cross validation to assess the overall prediction performance of conditional logistic regression (CLR) and compared it with standard classification models. The developed CLR models outperformed several standard classification models (e.g., straightforward logistic regression, stepwise logistic regression, random forest, support vector machine). For example, the best CLR model improved the classification accuracy by nearly 20% over the straightforward logistic regression model. Furthermore, the developed CLR models tend to achieve better sensitivity of

  14. Prevention of hospital-onset Clostridium difficile infection in the New York metropolitan region using a collaborative intervention model.

    Science.gov (United States)

    Koll, Brian S; Ruiz, Rafael E; Calfee, David P; Jalon, Hillary S; Stricof, Rachel L; Adams, Audrey; Smith, Barbara A; Shin, Gina; Gase, Kathleen; Woods, Maria K; Sirtalan, Ismail

    2014-01-01

    The incidence, severity, and associated costs of Clostridium difficile (C. difficile) infection (CDI) have dramatically increased in hospitals over the past decade, indicating an urgent need for strategies to prevent transmission of C. difficile. This article describes a multifaceted collaborative approach to reduce hospital-onset CDI rates in 35 acute care hospitals in the New York metropolitan region. Hospitals participated in a comprehensive CDI reduction intervention and formed interdisciplinary teams to coordinate their efforts. Standardized clinical infection prevention and environmental cleaning protocols were implemented and monitored using checklists. Monthly data reports were provided to hospitals for facility-specific performance evaluation and comparison to aggregate data from all participants. Hospitals also participated in monthly teleconferences to review data and highlight successes, challenges, and strategies to reduce CDI. Incidence of hospital-onset CDI per 10,000 patient days was the primary outcome measure. Additionally, the incidence of nonhospital-associated, community-onset, hospital-associated, and recurrent CDIs were measured. The use of a collaborative model to implement a multifaceted infection prevention strategy was temporally associated with a significant reduction in hospital-onset CDI rates in participating New York metropolitan regional hospitals. © 2013 National Association for Healthcare Quality.

  15. Comparing Multiple-Group Multinomial Log-Linear Models for Multidimensional Skill Distributions in the General Diagnostic Model. Research Report. ETS RR-08-35

    Science.gov (United States)

    Xu, Xueli; von Davier, Matthias

    2008-01-01

    The general diagnostic model (GDM) utilizes located latent classes for modeling a multidimensional proficiency variable. In this paper, the GDM is extended by employing a log-linear model for multiple populations that assumes constraints on parameters across multiple groups. This constrained model is compared to log-linear models that assume…

  16. A toy MCT model for multiple glass transitions: Double swallow tail singularity

    Energy Technology Data Exchange (ETDEWEB)

    Ryzhov, V.N. [Institute for High Pressure Physics, Russian Academy of Sciences, Troitsk 142190, Moscow region (Russian Federation); Moscow Institute of Physics and Technology, 141700 Moscow (Russian Federation); Tareyeva, E.E. [Institute for High Pressure Physics, Russian Academy of Sciences, Troitsk 142190, Moscow region (Russian Federation)

    2014-11-07

    We propose a toy model to describe in the frame of Mode Coupling Theory multiple glass transitions. The model is based on the postulated simple form for static structure factor as a sum of two delta-functions. This form makes it possible to solve the MCT equations in almost analytical way. The phase diagram is governed by two swallow tails resulting from two A{sub 4} singularities and includes liquid–glass transition and multiple glasses. The diagram has much in common with those of binary and quasibinary systems. - Highlights: • A simple toy model is proposed for description of glass–glass transitions. • The static structure factor of the model has the form of a sum of delta-functions. • The phase diagram contains A{sub 4} bifurcation singularities and A{sub 3} end points. • The results can be applied for the qualitative description of quasibinary systems.

  17. Hybrid models for the simulation of microstructural evolution influenced by coupled, multiple physical processes

    Energy Technology Data Exchange (ETDEWEB)

    Tikare, Veena [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hernandez-Rivera, Efrain [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Madison, Jonathan D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Holm, Elizabeth Ann [Carnegie Mellon Univ., Pittsburgh, PA (United States); Patterson, Burton R. [Univ. of Florida, Gainesville, FL (United States). Dept. of Materials Science and Engineering; Homer, Eric R. [Brigham Young Univ., Provo, UT (United States). Dept. of Mechanical Engineering

    2013-09-01

    Most materials microstructural evolution processes progress with multiple processes occurring simultaneously. In this work, we have concentrated on the processes that are active in nuclear materials, in particular, nuclear fuels. These processes are coarsening, nucleation, differential diffusion, phase transformation, radiation-induced defect formation and swelling, often with temperature gradients present. All these couple and contribute to evolution that is unique to nuclear fuels and materials. Hybrid model that combines elements from the Potts Monte Carlo, phase-field models and others have been developed to address these multiple physical processes. These models are described and applied to several processes in this report. An important feature of the models developed are that they are coded as applications within SPPARKS, a Sandiadeveloped framework for simulation at the mesoscale of microstructural evolution processes by kinetic Monte Carlo methods. This makes these codes readily accessible and adaptable for future applications.

  18. Slow walking model for children with multiple disabilities via an application of humanoid robot

    Science.gov (United States)

    Wang, ZeFeng; Peyrodie, Laurent; Cao, Hua; Agnani, Olivier; Watelain, Eric; Wang, HaoPing

    2016-02-01

    Walk training research with children having multiple disabilities is presented. Orthosis aid in walking for children with multiple disabilities such as Cerebral Palsy continues to be a clinical and technological challenge. In order to reduce pain and improve treatment strategies, an intermediate structure - humanoid robot NAO - is proposed as an assay platform to study walking training models, to be transferred to future special exoskeletons for children. A suitable and stable walking model is proposed for walk training. It would be simulated and tested on NAO. This comparative study of zero moment point (ZMP) supports polygons and energy consumption validates the model as more stable than the conventional NAO. Accordingly direction variation of the center of mass and the slopes of linear regression knee/ankle angles, the Slow Walk model faithfully emulates the gait pattern of children.

  19. Simultaneous small-sample comparisons in longitudinal or multi-endpoint trials using multiple marginal models

    DEFF Research Database (Denmark)

    Pallmann, Philip; Ritz, Christian; Hothorn, Ludwig A

    2018-01-01

    , however only asymptotically. In this paper, we show how to make the approach also applicable to small-sample data problems. Specifically, we discuss the computation of adjusted P values and simultaneous confidence bounds for comparisons of randomised treatment groups as well as for levels......Simultaneous inference in longitudinal, repeated-measures, and multi-endpoint designs can be onerous, especially when trying to find a reasonable joint model from which the interesting effects and covariances are estimated. A novel statistical approach known as multiple marginal models greatly...... simplifies the modelling process: the core idea is to "marginalise" the problem and fit multiple small models to different portions of the data, and then estimate the overall covariance matrix in a subsequent, separate step. Using these estimates guarantees strong control of the family-wise error rate...

  20. Micro-macro multilevel latent class models with multiple discrete individual-level variables

    NARCIS (Netherlands)

    Bennink, M.; Croon, M.A.; Kroon, B.; Vermunt, J.K.

    2016-01-01

    An existing micro-macro method for a single individual-level variable is extended to the multivariate situation by presenting two multilevel latent class models in which multiple discrete individual-level variables are used to explain a group-level outcome. As in the univariate case, the

  1. Comprehension of Multiple Documents with Conflicting Information: A Two-Step Model of Validation

    Science.gov (United States)

    Richter, Tobias; Maier, Johanna

    2017-01-01

    In this article, we examine the cognitive processes that are involved when readers comprehend conflicting information in multiple texts. Starting from the notion of routine validation during comprehension, we argue that readers' prior beliefs may lead to a biased processing of conflicting information and a one-sided mental model of controversial…

  2. Compacton solutions and multiple compacton solutions for a continuum Toda lattice model

    International Nuclear Information System (INIS)

    Fan Xinghua; Tian Lixin

    2006-01-01

    Some special solutions of the Toda lattice model with a transversal degree of freedom are obtained. With the aid of Mathematica and Wu elimination method, more explicit solitary wave solutions, including compacton solutions, multiple compacton solutions, peakon solutions, as well as periodic solutions are found in this paper

  3. Sensitivity Analysis of Multiple Informant Models When Data Are Not Missing at Random

    Science.gov (United States)

    Blozis, Shelley A.; Ge, Xiaojia; Xu, Shu; Natsuaki, Misaki N.; Shaw, Daniel S.; Neiderhiser, Jenae M.; Scaramella, Laura V.; Leve, Leslie D.; Reiss, David

    2013-01-01

    Missing data are common in studies that rely on multiple informant data to evaluate relationships among variables for distinguishable individuals clustered within groups. Estimation of structural equation models using raw data allows for incomplete data, and so all groups can be retained for analysis even if only 1 member of a group contributes…

  4. ANALYSIS OF THE FINANCIAL PERFORMANCES OF THE FIRM, BY USING THE MULTIPLE REGRESSION MODEL

    Directory of Open Access Journals (Sweden)

    Constantin Anghelache

    2011-11-01

    Full Text Available The information achieved through the use of simple linear regression are not always enough to characterize the evolution of an economic phenomenon and, furthermore, to identify its possible future evolution. To remedy these drawbacks, the special literature includes multiple regression models, in which the evolution of the dependant variable is defined depending on two or more factorial variables.

  5. Global and 3D Spatial Assessment of Neuroinflammation in Rodent Models of Multiple Sclerosis

    DEFF Research Database (Denmark)

    Gupta, Shashank; Utoft, Regine Egeholm; Hasseldam, Henrik

    2013-01-01

    Multiple Sclerosis (MS) is a progressive autoimmune inflammatory and demyelinating disease of the central nervous system (CNS). T cells play a key role in the progression of neuroinflammation in MS and also in the experimental autoimmune encephalomyelitis (EAE) animal models for the disease. A te...

  6. A general framework for the evaluation of genetic association studies using multiple marginal models

    DEFF Research Database (Denmark)

    Kitsche, Andreas; Ritz, Christian; Hothorn, Ludwig A.

    2016-01-01

    OBJECTIVE: In this study, we present a simultaneous inference procedure as a unified analysis framework for genetic association studies. METHODS: The method is based on the formulation of multiple marginal models that reflect different modes of inheritance. The basic advantage of this methodology...

  7. Estimating Ambiguity Preferences and Perceptions in Multiple Prior Models: Evidence from the Field

    NARCIS (Netherlands)

    S.G. Dimmock (Stephen); R.R.P. Kouwenberg (Roy); O.S. Mitchell (Olivia); K. Peijnenburg (Kim)

    2015-01-01

    markdownabstractWe develop a tractable method to estimate multiple prior models of decision-making under ambiguity. In a representative sample of the U.S. population, we measure ambiguity attitudes in the gain and loss domains. We find that ambiguity aversion is common for uncertain events of

  8. Inference regarding multiple structural changes in linear models with endogenous regressors

    NARCIS (Netherlands)

    Boldea, O.; Hall, A.R.; Han, S.

    2012-01-01

    This paper considers the linear model with endogenous regressors and multiple changes in the parameters at unknown times. It is shown that minimization of a Generalized Method of Moments criterion yields inconsistent estimators of the break fractions, but minimization of the Two Stage Least Squares

  9. On an efficient multiple time step Monte Carlo simulation of the SABR model

    NARCIS (Netherlands)

    Leitao Rodriguez, A.; Grzelak, L.A.; Oosterlee, C.W.

    2017-01-01

    In this paper, we will present a multiple time step Monte Carlo simulation technique for pricing options under the Stochastic Alpha Beta Rho model. The proposed method is an extension of the one time step Monte Carlo method that we proposed in an accompanying paper Leitao et al. [Appl. Math.

  10. Clinical trials: odds ratios and multiple regression models--why and how to assess them

    NARCIS (Netherlands)

    Sobh, Mohamad; Cleophas, Ton J.; Hadj-Chaib, Amel; Zwinderman, Aeilko H.

    2008-01-01

    Odds ratios (ORs), unlike chi2 tests, provide direct insight into the strength of the relationship between treatment modalities and treatment effects. Multiple regression models can reduce the data spread due to certain patient characteristics and thus improve the precision of the treatment

  11. Eikonal multiple scattering model within the framework of Feynman's positron theory

    International Nuclear Information System (INIS)

    Tekou, A.

    1986-07-01

    The Bethe Salpeter equation for nucleon-nucleon, nucleon-nucleus and nucleus-nucleus scattering is eikonalized. Multiple scattering series is obtained. Contributions of three body interations are included. The model presented below may be used to investigate atomic collisions. (author)

  12. Performance modeling and optimization of sparse matrix-vector multiplication on NVIDIA CUDA platform

    NARCIS (Netherlands)

    Xu, S.; Xue, W.; Lin, H.X.

    2011-01-01

    In this article, we discuss the performance modeling and optimization of Sparse Matrix-Vector Multiplication (SpMV) on NVIDIA GPUs using CUDA. SpMV has a very low computation-data ratio and its performance is mainly bound by the memory bandwidth. We propose optimization of SpMV based on ELLPACK from

  13. Testing Mediation Using Multiple Regression and Structural Equation Modeling Analyses in Secondary Data

    Science.gov (United States)

    Li, Spencer D.

    2011-01-01

    Mediation analysis in child and adolescent development research is possible using large secondary data sets. This article provides an overview of two statistical methods commonly used to test mediated effects in secondary analysis: multiple regression and structural equation modeling (SEM). Two empirical studies are presented to illustrate the…

  14. An explicit statistical model of learning lexical segmentation using multiple cues

    NARCIS (Netherlands)

    Çöltekin, Ça ̆grı; Nerbonne, John; Lenci, Alessandro; Padró, Muntsa; Poibeau, Thierry; Villavicencio, Aline

    2014-01-01

    This paper presents an unsupervised and incremental model of learning segmentation that combines multiple cues whose use by children and adults were attested by experimental studies. The cues we exploit in this study are predictability statistics, phonotactics, lexical stress and partial lexical

  15. Modeling transport pricing with multiple stakeholders. Working paper : Methodology and a case study

    NARCIS (Netherlands)

    Smits, E.

    2012-01-01

    Pricing measures (e.g., a kilometre charge or cordon toll) are used to improve the external effects of transportation (e.g., congestion or emissions). This working paper presents a planning model for pricing while taking the preferences and interactions of multiple stakeholders (e.g., governments or

  16. Statistical models for quantifying diagnostic accuracy with multiple lesions per patient

    NARCIS (Netherlands)

    Zwinderman, Aeilko H.; Glas, Afina S.; Bossuyt, Patrick M.; Florie, Jasper; Bipat, Shandra; Stoker, Jaap

    2008-01-01

    We propose random-effects models to summarize and quantify the accuracy of the diagnosis of multiple lesions on a single image without assuming independence between lesions. The number of false-positive lesions was assumed to be distributed as a Poisson mixture, and the proportion of true-positive

  17. Application of Item Response Theory to Modeling of Expanded Disability Status Scale in Multiple Sclerosis.

    NARCIS (Netherlands)

    Novakovic, A.M.; Krekels, E.H.; Munafo, A.; Ueckert, S.; Karlsson, M.O.

    2016-01-01

    In this study, we report the development of the first item response theory (IRT) model within a pharmacometrics framework to characterize the disease progression in multiple sclerosis (MS), as measured by Expanded Disability Status Score (EDSS). Data were collected quarterly from a 96-week phase III

  18. Probing for the Multiplicative Term in Modern Expectancy-Value Theory: A Latent Interaction Modeling Study

    Science.gov (United States)

    Trautwein, Ulrich; Marsh, Herbert W.; Nagengast, Benjamin; Ludtke, Oliver; Nagy, Gabriel; Jonkmann, Kathrin

    2012-01-01

    In modern expectancy-value theory (EVT) in educational psychology, expectancy and value beliefs additively predict performance, persistence, and task choice. In contrast to earlier formulations of EVT, the multiplicative term Expectancy x Value in regression-type models typically plays no major role in educational psychology. The present study…

  19. Cost optimization in the (S-1,S) lost sales inventory model with multiple demand classes

    NARCIS (Netherlands)

    Kranenburg, A.A.; Houtum, van G.J.J.A.N.

    2007-01-01

    For the (S-1,S) lost sales inventory model with multiple demand classes that have different lost sales penalty cost parameters, three accurate and efficient heuristic algorithms are presented that, at a given base stock level, aim to find optimal values for the critical levels, i.e., values that

  20. Modeling complex effects of multiple environmental stresses on carbon dynamics of Mid-Atlantic temperate forests

    Science.gov (United States)

    Yude Pan; Richard Birdsey; John Hom; Kevin McCullough

    2007-01-01

    We used our GIS variant of the PnET-CN model to investigate changes of forest carbon stocks and fluxes in Mid-Atlantic temperate forests over the last century (1900-2000). Forests in this region are affected by multiple environmental changes including climate, atmospheric CO2 concentration, N deposition and tropospheric ozone, and extensive land disturbances. Our...