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  1. Diagnosis-Related Groups (DRG and Hospital Business Performance Management

    Directory of Open Access Journals (Sweden)

    Szynkiewicz Piotr

    2014-12-01

    Full Text Available The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.

  2. Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis-related groups (DRG).

    Science.gov (United States)

    Syrjälä, M T; Kytöniemi, I; Mikkolainen, K; Ranimo, J; Lauharanta, J

    2001-12-01

    Transfusion data combined with data automatically recorded in hospital databases provides an outstanding tool for blood utilization reporting. When the reporting is performed with an online analytical processing (OLAP) tool, real time reporting can be provided to blood subscribers. When this data is combined with a common patient classification system, Diagnosis-Related Groups (DRG), it is possible to produce statistical results, that are similar in different institutions and may provide a means for international transfusion bench-marking and cost comparison. We use a DRG classification to describe the transfusion practice in Helsinki University Central Hospital. The key indicators include the percentage of transfused patients, the number of transfused units and costs in different DRG groups, as well as transfusion rates per DRG weighted treatment episodes. Ninety-three per cent of all transfusions could be classified into different DRGs. The largest blood-using DRG group was acute adult leukaemia (DRG 473), which accounted for 10.4% of all transfusion costs. The 13 largest blood consuming DRGs accounted for half the total costs in 1998. Currently, there is a lack of an internationally accepted standardized way to report institutional or national transfusion practices. DRG-based transfusion reporting might serve as a means for transfusion benchmarking and thus aid studies of variations in transfusion practice.

  3. [Cardiovascular medicine in the German diagnosis-related group--(G-DRG) system 2005].

    Science.gov (United States)

    Fürstenberg, T; Bunzemeier, H; Roeder, N; Reinecke, H

    2005-05-01

    The German diagnosis-related Group (G-DRG) System has recently been published in its third version. From 2005 on, this system will be the definite measure for the budgets of nearly all german hospitals. The preliminary phase with no budget reduction or redistribution being made and in which an inappropriate classification system had no negative impact on reimbursement has, thus, come to an end. At present, many hospitals are struggling in an economic competition about the independence or maintenance of the hospital or several sub-departments. The changes in the classification system with regard to a marked increase in the number of G DRGs, a modified grouping-logic, more properly determined reductions and extra charges for low and high outlier as well as the introduction of further additional charges contribute thereby to a better covering of services and treatments of cardiovascular patients. However, while many of the known problems have been eliminated, there are still weaknesses in the G-DRG System even concerning cardiovascular medicine. The G-DRG System has to be adapted continuously with consultation of the clinical expertise of the respective medical societies. The most important new aspects and changes in the G-DRG System 2005 and the accompanied execution regulations are explained with special view on cardiology.

  4. [Changes to diagnosis-related groups in urology in 2007. Urology in the G-DRG-System 2007].

    Science.gov (United States)

    Wenke, A; Franz, D; Pühse, G; Hertle, L; Roeder, N

    2008-02-01

    The German DRG (dose-related groups) system is updated each year by the institution dealing with the remuneration in hospitals (InEK). Once again, the German Spcoety for Urology has supported the adjustment process in a constructive manner. Analysis of the changes and their implications is highly significant for urology. This article describes and discusses the main changes in the system for the specialty of urology insofar as they concern the structure of the DRG system and the catalogues of diagnoses (ICD) and of procedures (OPS). The 2007 edition of the DRG system leads to numerous changes for urology. There are new OPS codes for partial resection of the kidney, treatment of urinary incontinence and radical resection in the pelvis minor. Additional payment for implantation of a prosthetic penis is divided with reference to the type of prosthesis. At DRG level, new DRG splits are found depending on the PCCL and patient age. Combination operations on the bladder and bowel and on the male genitalia are assigned to newly established DRGs. The changes described enhance the professional accuracy of the representations of urological care provision. New strategies designed to solve problems in representation have been established (e.g. multi-step interventions). Various problems persist, e.g. those of operations on the penis (DRG M03Z) and the need for more finely defined representation of laser treatment in urology. In the short term practicable solutions to the problem of improving the quality of representation are needed.

  5. Heterogeneity of European DRG systems and potentials for a common EuroDRG system Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries".

    Science.gov (United States)

    Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

    2015-03-05

    Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals), a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium. © 2015 by Kerman University of Medical Sciences.

  6. Heterogeneity of European DRG systems and potentials for a common EuroDRG system: Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries"

    OpenAIRE

    Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

    2015-01-01

    Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring...

  7. Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG)

    Data.gov (United States)

    U.S. Department of Health & Human Services — A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related...

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

    Science.gov (United States)

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

    2018-05-13

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

  9. Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries.

    Science.gov (United States)

    Geissler, Alexander; Scheller-Kreinsen, David; Quentin, Wilm

    2012-08-01

    This paper assesses the variations in costs and length of stay for hip replacement cases in Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden and examines the ability of national diagnosis-related group (DRG) systems to explain the variation in resource use against a set of patient characteristic and treatment specific variables. In total, 195,810 cases clustered in 712 hospitals were analyzed using OLS fixed effects models for cost data (n=125,698) and negative binominal models for length-of-stay data (n=70,112). The number of DRGs differs widely across the 10 European countries (range: 2-14). Underlying this wide range is a different use of classification variables, especially secondary diagnoses and treatment options are considered to a different extent. In six countries, a standard set of patient characteristics and treatment variables explain the variation in costs or length of stay better than the DRG variables. This raises questions about the adequacy of the countries' DRG system or the lack of specific criteria, which could be used as classification variables. Copyright © 2012 John Wiley & Sons, Ltd.

  10. Lifting the weight of a diagnosis-related groups family change: a comparison between refined and non-refined DRG systems for top-down cost accounting and efficiency indicators.

    Science.gov (United States)

    Zlotnik, Alexander; Cuchi, Miguel Alfaro; Pérez Pérez, Maria Carmen

    Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account.

  11. Heterogeneity of European DRG Systems and Potentials for a Common Eurodrg System; Comment on “Cholecystectomy and Diagnosis-Related Groups (DRGs: Patient Classification and Hospital Reimbursement in 11 European Countries”

    Directory of Open Access Journals (Sweden)

    Alexander Geissler

    2015-05-01

    Full Text Available Diagnosis-Related Group (DRG systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals, a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium.

  12. Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk.

    Science.gov (United States)

    McCormick, Patrick J; Lin, Hung-Mo; Deiner, Stacie G; Levin, Matthew A

    2018-03-22

    The All Patient Refined Diagnosis Related Group (APR-DRG) is an inpatient visit classification system that assigns a diagnostic related group, a Risk of Mortality (ROM) subclass and a Severity of Illness (SOI) subclass. While extensively used for cost adjustment, no study has compared the APR-DRG subclass modifiers to the popular Charlson Comorbidity Index as a measure of comorbidity severity in models for perioperative in-hospital mortality. In this study we attempt to validate the use of these subclasses to predict mortality in a cohort of surgical patients. We analyzed all adult (age over 18 years) inpatient non-cardiac surgery at our institution between December 2005 and July 2013. After exclusions, we split the cohort into training and validation sets. We created prediction models of inpatient mortality using the Charlson Comorbidity Index, ROM only, SOI only, and ROM with SOI. Models were compared by receiver-operator characteristic (ROC) curve, area under the ROC curve (AUC), and Brier score. After exclusions, we analyzed 63,681 patient-visits. Overall in-hospital mortality was 1.3%. The median number of ICD-9-CM diagnosis codes was 6 (Q1-Q3 4-10). The median Charlson Comorbidity Index was 0 (Q1-Q3 0-2). When the model was applied to the validation set, the c-statistic for Charlson was 0.865, c-statistic for ROM was 0.975, and for ROM and SOI combined the c-statistic was 0.977. The scaled Brier score for Charlson was 0.044, Brier for ROM only was 0.230, and Brier for ROM and SOI was 0.257. The APR-DRG ROM or SOI subclasses are better predictors than the Charlson Comorbidity Index of in-hospital mortality among surgical patients.

  13. Experts' perspectives on SwissDRG: Second class care for vulnerable patient groups?

    Science.gov (United States)

    Leu, A; Wepf, H; Elger, B; Wangmo, T

    2018-03-14

    On the 1st of January 2012, Switzerland introduced the diagnosis-related group hospital tariff structure (SwissDRG). It was recognised that healthcare provided to the most vulnerable patient groups would be a challenge for the new SwissDRG. Coincident with the implementation of SwissDRG, we explored hospital experts' perceptions of which patient groups are vulnerable under the SwissDRG system, what has changed for this group, as well as solutions to ensure adequate access to health care for them. We interviewed 43 experts from 40 Swiss hospitals. Participating experts named several vulnerable patient groups who share some common characteristics. These hospital experts were concerned about the patient groups that are not financially profitable and questioned the practicability of the current regulation. At the same time, they highlighted the complexity associated with caring for this group under the new SwissDRG and reported measures at the macro, meso, and micro levels to protect vulnerable patient groups from negative effects. To curb negative outcomes for vulnerable patient groups after the introduction of the SwissDRG, the Swiss legislation has introduced various instruments including the acute and transitional care (ATC) measures. We conclude that ATC measures do not produce the expected effect the legislators had hoped for. More health data is needed to identify situations where vulnerable patient groups are more susceptible to inadequate health care access in Switzerland. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. 42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Revision of LTC-DRG group classifications and... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.517 Revision of LTC-DRG group...

  15. [Cost assessment for endoscopic procedures in the German diagnosis-related-group (DRG) system - 5 year cost data analysis of the German Society of Gastroenterology project].

    Science.gov (United States)

    Rathmayer, Markus; Heinlein, Wolfgang; Reiß, Claudia; Albert, Jörg G; Akoglu, Bora; Braun, Martin; Brechmann, Thorsten; Gölder, Stefan K; Lankisch, Tim; Messmann, Helmut; Schneider, Arne; Wagner, Martin; Dollhopf, Markus; Gundling, Felix; Röhling, Michael; Haag, Cornelie; Dohle, Ines; Werner, Sven; Lammert, Frank; Fleßa, Steffen; Wilke, Michael H; Schepp, Wolfgang; Lerch, Markus M

    2017-10-01

    Background  In the German hospital reimbursement system (G-DRG) endoscopic procedures are listed in cost center 8. For reimbursement between hospital departments and external providers outdated or incomplete catalogues (e. g. DKG-NT, GOÄ) have remained in use. We have assessed the cost for endoscopic procedures in the G-DRG-system. Methods  To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK) made their data (2011 - 2015; § 21 KHEntgG) available to the German-Society-of-Gastroenterology (DGVS) in anonymized form (4873 809 case-data-sets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. Results  Robust mean endoscopy costs ranged from 230.56 € for gastroscopy (144 666 cases), 276.23 € (n = 32 294) for a simple colonoscopy, to 844.07 € (n = 10 150) for ERCP with papillotomy and plastic stent insertion and 1602.37 € (n = 967) for ERCP with a self-expanding metal stent. Higher costs, specifically for complex procedures, were identified for University Hospitals. Discussion  For the first time this catalogue for endoscopic procedure-tiers, based on § 21 KHEntgG data-sets from 74 InEK-calculating hospitals, permits a realistic assessment of endoscopy costs in German hospitals. The higher costs in university hospitals are likely due to referral bias for complex cases and emergency interventions. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible. By international comparison the costs of endoscopic procedures in Germany are low, due to either greater efficiency, lower personnel allocation or incomplete documentation of the real expenses. © Georg Thieme Verlag KG Stuttgart · New York.

  16. The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG).

    Science.gov (United States)

    Hackworth, Jodi; Askegard-Giesmann, Johanna; Rouse, Thomas; Benneyworth, Brian

    2017-05-01

    Literature has shown there are significant differences between administrative databases and clinical registry data. Our objective was to compare the identification of trauma patients using All Patient Refined Diagnosis Related Groups (APR-DRG) as compared to the Trauma Registry and estimate the effects of those discrepancies on utilization. Admitted pediatric patients from 1/2012-12/2013 were abstracted from the trauma registry. The patients were linked to corresponding administrative data using the Pediatric Health Information System database at a single children's hospital. APR-DRGs referencing trauma were used to identify trauma patients. We compared variables related to utilization and diagnosis to determine the level of agreement between the two datasets. There were 1942 trauma registry patients and 980 administrative records identified with trauma-specific APR-DRG during the study period. Forty-two percent (816/1942) of registry records had an associated trauma-specific APR-DRG; 69% of registry patients requiring ICU care had trauma APR-DRGs; 73% of registry patients with head injuries had trauma APR-DRGs. Only 21% of registry patients requiring surgical management had associated trauma APR-DRGs, and 12.5% of simple fractures had associated trauma APR-DRGs. APR-DRGs appeared to only capture a fraction of the entire trauma population and it tends to be the more severely ill patients. As a result, the administrative data was not able to accurately answer hospital or operating room utilization as well as specific information on diagnosis categories regarding trauma patients. APR-DRG administrative data should not be used as the only data source for evaluating the needs of a trauma program. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The Expenditures for Academic Inpatient Care of Inflammatory Bowel Disease Patients Are Almost Double Compared with Average Academic Gastroenterology and Hepatology Cases and Not Fully Recovered by Diagnosis-Related Group (DRG) Proceeds.

    Science.gov (United States)

    Baumgart, Daniel C; le Claire, Marie

    2016-01-01

    Crohn's disease (CD) and ulcerative colitis (UC) challenge economies worldwide. Detailed health economic data of DRG based academic inpatient care for inflammatory bowel disease (IBD) patients in Europe is unavailable. IBD was identified through ICD-10 K50 and K51 code groups. We took an actual costing approach, compared expenditures to G-DRG and non-DRG proceeds and performed detailed cost center and type accounting to identify coverage determinants. Of all 3093 hospitalized cases at our department, 164 were CD and 157 UC inpatients in 2012. On average, they were 44.1 (CD 44.9 UC 43.3 all 58) years old, stayed 10.1 (CD 11.8 UC 8.4 vs. all 8) days, carried 5.8 (CD 6.4 UC 5.2 vs. all 6.8) secondary diagnoses, received 7.4 (CD 7.7 UC 7 vs. all 6.2) procedures, had a higher cost weight (CD 2.8 UC 2.4 vs. all 1.6) and required more intense nursing. Their care was more costly (means: total cost IBD 8477€ CD 9051€ UC 7903€ vs. all 5078€). However, expenditures were not fully recovered by DRG proceeds (means: IBD 7413€, CD 8441€, UC 6384€ vs all 4758€). We discovered substantial disease specific mismatches in cost centers and types and identified the medical ward personnel and materials budgets to be most imbalanced. Non-DRG proceeds were almost double (IBD 16.1% vs. all 8.2%), but did not balance deficits at total coverage analysis, that found medications (antimicrobials, biologics and blood products), medical materials (mostly endoscopy items) to contribute most to the deficit. DRGs challenge sophisticated IBD care.

  18. Association of Differentiation-Related Gene-1 (DRG1) with Breast Cancer Survival and in Vitro Impact of DRG1 Suppression

    International Nuclear Information System (INIS)

    Baig, Ruqia Mehmood; Sanders, Andrew J.; Kayani, Mahmood Akhtar; Jiang, Wen G.

    2012-01-01

    Differentiation-related gene-1, DRG1, is a metastasis suppressor gene whose expression has been shown to be dysregulated in a number of malignancies. The current study examines the expression of DRG1 in a clinical breast cohort and its association with a number of clinical pathological factors using quantitative polymerase chain reaction. Additionally, DRG1 expression is targeted in vitro using ribozyme transgene technology to explore the function of DRG1 in two human breast cancer cell lines. Low levels of DRG1 were found in patients who developed metastasis (p = 0.036) and who died of breast cancer (p = 0.0048) compared to disease free patients. Knockdown of DRG1 also resulted in significantly increased invasion and motility, but decreased matrix-adhesion in MCF7 cells. Knockdown of DRG1 seemed to have minimal impact on the cellular functions of the MDA-MB-231 breast cancer cell line causing no significant differences in cell growth, invasion, motility or matrix-adhesion. Thus, DRG1 appears to be linked to development of metastasis and death in patients who died as a result of breast cancer and may be useful as a prognostic factor as its knockdown appears to be linked with increased invasion and motility and decreased adhesion in MCF7 breast cancer cells

  19. Systém DRG

    OpenAIRE

    Vraná, Lenka

    2011-01-01

    This thesis is focused on description of the DRG (Diagnosis Related Groups) classification system and its application as the inpatient care financing tool. The objectives of this thesis are to sum up the possible applications of DRG system, to describe the calculation of indicators needed for health care payment in 2012 and to suggest some improvements to the algorithm to enhance the quality of data processing in the years ahead. The first part of this thesis is theoretical and it includes es...

  20. The Dictyostelium Bcr/Abr-related protein DRG regulates both Rac- and Rab-dependent pathways

    OpenAIRE

    Knetsch, Menno L.W.; Schäfers, Nicole; Horstmann, Heinz; Manstein, Dietmar J.

    2001-01-01

    Dictyostelium discoideum DdRacGap1 (DRG) contains both Rho-GEF and Rho-GAP domains, a feature it shares with mammalian Bcr and Abr. To elucidate the physiological role of this multifunctional protein, we characterized the enzymatic activity of recombinant DRG fragments in vitro, created DRG-null cells, and studied the function of the protein in vivo by analysing the phenotypic changes displayed by DRG-depleted cells and DRG-null cells complemented with DRG or DRG fragments. Our results show t...

  1. Common DRG System - the Future of Europe? A Response to Recent Commentary

    Directory of Open Access Journals (Sweden)

    Gerli Paat-Ahi

    2015-07-01

    Full Text Available This is a short piece in response to the “Heterogeneity of European DRG systems and potentials for a common EuroDRG system”1 by Alexander Geissler, Wilm Quentin and Reinhard Busse from the EuroDRG team. We would like to thank them for taking the time to read our article and offer excellent suggestions to the diagnosis-related group (DRG systems for further development.

  2. Nursing dependency, diagnosis-related groups, and length of hospital stay

    OpenAIRE

    Halloran, Edward J.; Kiley, Marylou

    1987-01-01

    Most efforts to modify the diagnosis-related group (DRG) case classification system focus on variables related to medical management. In this study, we investigated the separate but related natures of medicine and nursing by examining 1,288 adult medical and surgical patients in an urban teaching hospital. The complexity of medical treatment was measured by use of the DRG relative cost weight. The nursing indicator was derived from a set of nursing diagnoses. We found that the DRG cost weight...

  3. [The possible drawbacks of applying the DRG classification].

    Science.gov (United States)

    Huber, Zofia Swinarski

    2006-09-06

    The objective of this article is to present the difficulties linked to the measure and use of the Diagnosis Related Group (DRG) as part of a hospital's production and management accounting evaluation system. We will present here all the criticisms brought forth in management literature against DRG classifications. The article isn't intended to argue against and to push people to reconsider the tool but rather to attract the attention of politicians and hospital managers to all the possible difficulties and outcomes that could be generated by the DRG, this in terms of either the AP-DRG or the German-DRG, the latter being the classification that has been adopted in Switzerland as the basis for the construction of the future Swiss-DRG.

  4. [Orthopedic and trauma surgery in the German DRG system 2008].

    Science.gov (United States)

    Franz, D; Kaufmann, M; Siebert, C H; Windolf, J; Roeder, N

    2008-04-01

    The German DRG (diagnosis-related groups) system has been modified and updated into version 2008. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and the DRG structure were made. The modified version has been analyzed in order to ascertain whether the DRG system is suitably qualified to fulfill the demands of the reimbursement system or whether further improvements are necessary. Analysis of the severity of relevant side-effect diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 was carried out based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2008 focused on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. G-DRG system has become even more complex and the new regulations have also resulted in new problems associated with complications.. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case allocation within the G-DRG system has been improved. Nevertheless, further improvements of the G-DRG system are necessary, especially for cases with severe injuries.

  5. Cholecystectomy and Diagnosis-Related Groups (DRGs): Patient Classification and Hospital Reimbursement in 11 European Countries

    OpenAIRE

    Gerli Paat-Ahi; Ain Aaviksoo; Maria Świderek

    2014-01-01

    Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectom...

  6. Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries

    OpenAIRE

    Quentin, Wilm; Scheller-Kreinsen, David; Geissler, Alexander; Busse, Reinhard

    2012-01-01

    Background As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a diagnosis of appendicitis treated with a procedure ...

  7. Radioiodine therapy within the German DRG-system 2005; Die Radioiodtherapie im DRG-System 2005

    Energy Technology Data Exchange (ETDEWEB)

    Lorenz, R. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Wuerzburg (Germany); Dressler, J. [Nuklearmedizinische Klinik Henriettenstiftung, Hannover (Germany)

    2005-06-01

    With introduction of a diagnosis-related groups system (DRG-system) in Germany the previous duration of stay based refunding is also replaced for the radioiodine therapies by a performance oriented reimbursement system. Since the at first optional start of the DRG-system in 2003 the adaptations which take place every year should lead, up to the planned end of the convergence phase in 2009, to a transparent, fair and economical financing system of the stationary hospital service. The physician is responsible for the right and complete coding of the diagnoses and procedures, which serve as essential parameters for the determination of the diagnosis related group (DRG) of a hospital case. In the actual version of the year 2005 the DRG-system still supplies for radioiodine therapy of thyroid carcinoma some unclarity in the coding of the diagnosis, as well as clear inadequacy with the fair mapping of the therapy costs. (orig.)

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

    Science.gov (United States)

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

    2005-09-01

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

  9. Cholecystectomy and Diagnosis-Related Groups (DRGs: Patient Classification and Hospital Reimbursement in 11 European Countries

    Directory of Open Access Journals (Sweden)

    Gerli Paat-Ahi

    2014-12-01

    Full Text Available Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain compared how their Diagnosis-Related Groups (DRG systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England. The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.

  10. Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Paat-Ahi, Gerli; Aaviksoo, Ain; Swiderek, Maria

    2014-12-01

    As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries' DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.

  11. [Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

    Science.gov (United States)

    Schütz, U; Reichel, H; Dreinhöfer, K

    2007-01-01

    We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

  12. DIAGNOSTIC-RELATED GROUPS IN PEDIATRICS AND NEONATOLOGY: PERSPECTIVES

    Directory of Open Access Journals (Sweden)

    M. V. Avksent'eva

    2014-01-01

    Full Text Available Diagnostic-related groups (DRG are being implemented in Russian Federation since 2012 for hospital and day hospital payment. Unification of provider-payment methods and increase of health care efficiency are considered as the main goal of DRG. Presently the 2d version of Russian DRG model is approved by the Federal Fund of mandatory medical insurance, order from 14.11.2013 № 229. Treatment of children is mostly paid for by the same rules as adults’ treatment just now. There are several separate neonatal groups, as well as separate groups for diabetes and acute leukemia in children. The federal DRG model should be used in all regions of Russia, still it’s not final now and has to be improved. For example, number of pediatric groups will be increased. Each DRG has its own weight coefficient for calculating the tariff. The regions in RF can use correction coefficients to adjust the model. Besides regions can extract subgroups from basic DRG on the basis of standard methodology.

  13. [G-DRG system 2009: relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Liedtke-Dyong, A; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Bessler, F; Roeder, N

    2009-08-01

    The following article presents the main general and specific changes in the G-DRG (German diagnosis-related groups) system in terms of the classification systems for diagnoses and procedures as well as the billing process for 2009. Of fundamental relevance is the national weighting of the G-DRG I97Z (complex rheumatologic treatment), which up to now had to be negotiated individually by each hospital. Emphasis is also put on case auditing by the health insurers. Being primarily a tool for redistribution of resources, every hospital has to analyze the economic effects of the 2009 G-DRG system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus rheumatological departments may experience positive or negative consequences from the development. The strain imposed on hospitals by inadequate refunding of rising costs has to be assessed separately from the effects of redistribution by the G-DRG system.

  14. Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan.

    Science.gov (United States)

    Hamada, Hironori; Sekimoto, Miho; Imanaka, Yuichi

    2012-10-01

    In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality. Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service. DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82). This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. [Development of the 2014 G-DRG system. Departure from coding of secondary diagnoses?].

    Science.gov (United States)

    Volkmer, B G; Kahlmeyer, A; Petervari, M; Pechoel, M

    2014-01-01

    The objective of the German DRG (diagnosis-related groups) system is to adequately reimburse hospital costs using flat rate payments. The goal is to thereby achieve the most adequate representation of hospital costs in flat rate payments. The DRG for 2014 is based on the actual number of cases treated and the costs determined from 2012. For 2014, the current changes of the DRG system for the specialty urology concerning the coding and recording of secondary diagnoses are presented and discussed.

  16. Bayesian logistic regression approaches to predict incorrect DRG assignment.

    Science.gov (United States)

    Suleiman, Mani; Demirhan, Haydar; Boyd, Leanne; Girosi, Federico; Aksakalli, Vural

    2018-05-07

    Episodes of care involving similar diagnoses and treatments and requiring similar levels of resource utilisation are grouped to the same Diagnosis-Related Group (DRG). In jurisdictions which implement DRG based payment systems, DRGs are a major determinant of funding for inpatient care. Hence, service providers often dedicate auditing staff to the task of checking that episodes have been coded to the correct DRG. The use of statistical models to estimate an episode's probability of DRG error can significantly improve the efficiency of clinical coding audits. This study implements Bayesian logistic regression models with weakly informative prior distributions to estimate the likelihood that episodes require a DRG revision, comparing these models with each other and to classical maximum likelihood estimates. All Bayesian approaches had more stable model parameters than maximum likelihood. The best performing Bayesian model improved overall classification per- formance by 6% compared to maximum likelihood, with a 34% gain compared to random classification, respectively. We found that the original DRG, coder and the day of coding all have a significant effect on the likelihood of DRG error. Use of Bayesian approaches has improved model parameter stability and classification accuracy. This method has already lead to improved audit efficiency in an operational capacity.

  17. Impact of the Korean Diagnosis-Related Groups payment system on the outcomes of adenotonsillectomy: A single center experience.

    Science.gov (United States)

    Kwak, Sang Hyun; Kim, Ji Hoon; Kim, Da Hee; Kim, Jung Min; Byeon, Hyung Kwon; Kim, Won Shik; Koh, Yoon Woo; Kim, Se-Heon; Choi, Eun Chang

    2018-06-01

    To report outcomes with regard to clinical aspects and medical costs of adenotonsillectomy and tonsillectomy at a single institution before and after implementation of the Diagnosis-Related Groups (DRG) payment system in Korea. We retrospectively reviewed the records of patients treated with adenotonsillectomy or tonsillectomy between July 2012 and June 2014. The Korean DRG payment system was applied to seven groups of specific diseases and surgeries including adenotonsillectomy and tonsillectomy from July 2013 at all hospitals in Korea. We divided patients into four groups according whether the fee-for-service (FFS) or DRG payment system was implemented and operation type (FFS-adenotonsillectomy (AT), DRG-AT, FFS-tonsillectomy (T), and DRG-T). A total of 1402 patients were included (485 FFS-AT, 490 DRG-AT, 203 FFS-T, and 223 DRG-T). The total medical cost of the DRG-AT group was significantly lower than that of the FFS-AT group (1191±404 vs. 1110±279 USD, PDRG system for adenotonsillectomy and tonsillectomy reduced medical costs and clinical outcomes were not significantly altered by the adoption of the DRG system. 4. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Introducing diagnosis-related groups: is the information system ready?

    Science.gov (United States)

    Jian, Weiyan; Lu, Ming; Han, Wei; Hu, Mu

    2016-01-01

    Diagnosis-related group (DRG) system is a classification system widely used in health managements, the foundation of which lies in the medical information system. A large effort had been made to improve the quality of discharge data before the introduction of DRGs in Beijing. We extract discharge data from 108 local hospitals spanning 4 years before and after standardization to evaluate the impact of standardization on DRG grouping performance. The data was grouped on an annual basis in accordance with Beijing's local DRG system. Proportion of ungrouped data, coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of the DRG system. Both the descriptive and regression analysis indicate a significant reduction in terms of ungrouped data and CV for expenditure, increase of RIV for expenditure and length of stay. However, when there was no intervention, that is, between 2005 and 2006 and between 2008 and 2009, changes in these indicators were all insignificant. Therefore, the standardization of discharge data did improve data quality and consequently enhanced the performance of DRGs. Developing countries with a relatively weak information infrastructure should strengthen their medical information system before the introduction of the DRG system. Copyright © 2014 John Wiley & Sons, Ltd.

  19. Radioiodine therapy within the German DRG-system 2005

    International Nuclear Information System (INIS)

    Lorenz, R.; Dressler, J.

    2005-01-01

    With introduction of a diagnosis-related groups system (DRG-system) in Germany the previous duration of stay based refunding is also replaced for the radioiodine therapies by a performance oriented reimbursement system. Since the at first optional start of the DRG-system in 2003 the adaptations which take place every year should lead, up to the planned end of the convergence phase in 2009, to a transparent, fair and economical financing system of the stationary hospital service. The physician is responsible for the right and complete coding of the diagnoses and procedures, which serve as essential parameters for the determination of the diagnosis related group (DRG) of a hospital case. In the actual version of the year 2005 the DRG-system still supplies for radioiodine therapy of thyroid carcinoma some unclarity in the coding of the diagnosis, as well as clear inadequacy with the fair mapping of the therapy costs. (orig.)

  20. Nav1.7-related small fiber neuropathy: impaired slow-inactivation and DRG neuron hyperexcitability.

    NARCIS (Netherlands)

    Han, C.; Hoeijmakers, J.G.; Ahn, H.S.; Zhao, P.; Shah, P.; Lauria, G.; Gerrits, M.M.; Morsche, R.H.M. te; Dib-Hajj, S.D.; Drenth, J.P.H.; Faber, C.G.; Merkies, I.S.; Waxman, S.G.

    2012-01-01

    OBJECTIVES: Although small fiber neuropathy (SFN) often occurs without apparent cause, the molecular etiology of idiopathic SFN (I-SFN) has remained enigmatic. Sodium channel Na(v)1.7 is preferentially expressed within dorsal root ganglion (DRG) and sympathetic ganglion neurons and their

  1. [Orthopedic and trauma surgery in the German DRG System 2007].

    Science.gov (United States)

    Franz, D; Kaufmann, M; Siebert, C H; Windolf, J; Roeder, N

    2007-03-01

    The German Diagnosis-Related Groups (DRG) System was further developed into its 2007 version. For orthopedic and trauma surgery, significant changes were made in terms of the coding of diagnoses and medical procedures, as well as in the DRG structure itself. The German Societies for Trauma Surgery and for Orthopedics and Orthopedic Surgery (Deutsch Gesellschaft für Unfallchirurgie, DGU; and Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie, DGOOC) once again cooperated constructively with the German DRG Institute InEK. Among other innovations, new International Classification of Diseases (ICD) codes for second-degree burns were implemented. Procedure codes for joint operations, endoprosthetic-surgery and spine surgery were restructured. Furthermore, a specific code for septic surgery was introduced in 2007. In addition, the DRG structure was improved. Case allocation of patients with more than one significant operation was established. Further DRG subdivisions were established according to the patients age and the Patient Clinical Complexity Level (PCCL). DRG developments for 2007 have improved appropriate case allocation, but once again increased the system's complexity. Clinicians need an ever growing amount of specific coding know-how. Still, further adjustments to the German DRG system are required to allow for a correct allocation of cases and funds.

  2. Evaluating the efficacy of the current diagnosis-related group reimbursement system for laparoscopic appendectomy at a single institute in Korea

    OpenAIRE

    Yoo, Ri Na; Chung, Chul-Woon; Kim, Jong-Woo

    2014-01-01

    Purpose The diagnosis-related group (DRG) system has been adapted to reduce overall medical costs by grouping and classifying relatively homogenous patients based on similar resource consumption patterns in the treatment. However, despite its wide range of disease manifestation from early inflammation to severe peritonitis, acute appendicitis is included in the DRG system. Responding to a need to assess the DRG system for patients diagnosed with appendicitis, this study evaluates the efficacy...

  3. 42 CFR 412.60 - DRG classification and weighting factors.

    Science.gov (United States)

    2010-10-01

    ... DRG classification system provides a DRG, and an appropriate weighting factor, for the group of cases... 42 Public Health 2 2010-10-01 2010-10-01 false DRG classification and weighting factors. 412.60... Determining Prospective Payment Federal Rates for Inpatient Operating Costs § 412.60 DRG classification and...

  4. Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme

    Science.gov (United States)

    Pongpirul, Krit

    2011-01-01

    In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

  5. Participation determinants in the DRG payment system of obstetrics and gynecology clinics in South Korea.

    Science.gov (United States)

    Song, Jung-Kook; Kim, Chang-yup

    2010-03-01

    The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (psystem are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

  6. Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries.

    Science.gov (United States)

    Peltola, Mikko; Quentin, Wilm

    2013-01-01

    Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and

  7. The debate over diagnosis related groups.

    Science.gov (United States)

    Spiegel, A D; Kavaler, F

    1985-01-01

    With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogeneity, severity of illness, length of stay, technology limitations and the erosion of standards.

  8. [DRG systems in Europe. Incentives, purposes and differences in 12 countries].

    Science.gov (United States)

    Geissler, A; Scheller-Kreinsen, D; Quentin, W; Busse, R

    2012-05-01

    DRG systems were introduced across Europe based on expected transparency and efficiency gains. However, European DRG systems have not been systematically analysed so far. As a consequence little is known about the relative strengths and weaknesses of different DRG systems. The EuroDRG project closed this research and knowledge gap by systematically analysing and comparing the DRG systems of 12 countries with different health systems (Austria, the UK, Estonia, Finland, France, Germany, Ireland, The Netherlands, Poland, Portugal, Spain and Sweden).This article summarizes the results of this analysis illustrating how DRG systems across Europe differ with regard to policy goals, patient classification, data collection, price setting and actual reimbursement. Moreover, it outlines which main challenges arise within and across the different types of DRG systems. The results show that the European DRG systems are very heterogeneous. Even if the basic DRG approach of grouping similar patients remains the same across countries, the design of the main building blocks differs to a great extent.

  9. Adopting Thai Diagnosis Related Group for Vietnam Universal Health Coverage: A Case of Ba Vi District Hospital

    Directory of Open Access Journals (Sweden)

    Pham Le Tuan, M.D., Ph.D.

    2015-09-01

    Full Text Available Objective: This studyaimedtoclassifyallhospitaldischargescoveredbyhealthinsurancesystem intodiagnosis relatedgroup (DRG to guideproviderpayment reforms of universalhealth coverage roadmap in Vietnam. Methods: Data from Ba Vi hospital from January to December 2012 were grouped into DRGs by Viet-DRG grouperversion1.0developedbasedon Thai-DRG version5methodologies. ThePearsoncorrelation(r wasused to assess the performance of Viet-DRG grouper as against Thai-DRG grouper. A 5-step trimming of individual inpatientdata to achieve thehighest correlations was performed. Results: Dataof12,220inpatientcases wereanalyzedbybothgroupers,84.4% of totalcases wereclassifiedinto 89 DRGs. Thefive mostcommon DRGs werevaginaldelivery withoutcomplicatingdiagnosis (14500; Respira- tory infection/inflammation, no complication and comorbidity (04520; Otitis media and URI, no complication andcomorbidity(03530; Viral illnessexceptdengue,child,nocomplicationandcomorbidity(18610; Bronchitis and asthma, no complication and comorbidity (04590. The performance of Viet-DRG grouper v1.0 compared with Thai-DRG grouper v5.0for 89 DRGs intermsof relative weights as of 0.4 andlength of stay as of 0.5. Conclusion: Validity of thefirst Viet-DRG was at moderate level compared to Thai-DRG due to the limitation ofdata availability andqualityat thehospital.

  10. Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Quentin, Wilm; Scheller-Kreinsen, David; Geissler, Alexander; Busse, Reinhard

    2012-02-01

    As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of appendicitis treated with a procedure of appendectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify appendectomy patients according to different sets of variables (between two and six classification variables) into diverging numbers of DRGs (between two and 11 DRGs). The most complex DRG is valued 5.1 times more resource intensive than an index case in France but only 1.1 times more resource intensive than an index case in Finland. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the most complex case vignette amount to only 1,005 in Poland but to 12,304 in France. Large variations in the classification of appendectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons and national DRG authorities should consider how other countries' DRG systems classify appendectomy patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement.

  11. [Heterogeneity of costs and performance for penetrating eye injuries and suturing amniotic membranes under DRG conditions : Analysis of case constellations of the G-DRG C01B of the Regensburg University eye clinic].

    Science.gov (United States)

    Franz, D; Mrosek, M; Mrosek, S; Helbig, H; Framme, C

    2012-01-01

    Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions. A retrospective analysis was conducted from the standardized G-DRG data of 277 patients with open eye injuries and AMT between 2007 and 2008, grouped under the 2008 G-DRG system version to the G-DRG C01Z category. This data was provided by the Department of Ophthalmology at the University Hospital Regensburg. Additionally case-based data of the following were supplemented: length of surgery, time of anesthesia and intensity of patient care. Fixed and variable costs were determined for surgery and other inpatient treatment. Finally, an analysis of the heterogeneity of costs within the G-DRG C01B of the G-DRG system 2009 was implemented. Inhomogeneity was evident within the G-DRG C01B of the G-DRG system 2009 for the two groups suture of open eye injuries and AMT concerning the parameters length of stay, proportion of high outliers and cost per case. Multiple surgeries during an inpatient stay lead to an extended length of stay and increasing costs, especially within the AMT group. Intensity of patient care and the consideration of patient comorbidity did not yield relevant differences. The quality of the G-DRG system is measured by its ability to obtain adequate funding for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation for patients with open eye injuries within the G-DRG C01B of the German DRG system 2009. As a result of the present study, cases

  12. Australian diagnosis related groups: Drivers of complexity adjustment.

    Science.gov (United States)

    Jackson, Terri; Dimitropoulos, Vera; Madden, Richard; Gillett, Steve

    2015-11-01

    In undertaking a major revision to the Australian Refined Diagnosis Related Group (ARDRG) classification, we set out to contrast Australia's approach to using data on additional (not principal) diagnoses with major international approaches in splitting base or Adjacent Diagnosis Related Groups (ADRGs). Comparative policy analysis/narrative review of peer-reviewed and grey literature on international approaches to use of additional (secondary) diagnoses in the development of Australian and international DRG systems. European and US approaches to characterise complexity of inpatient care are well-documented, providing useful points of comparison with Australia's. Australia, with good data sources, has continued to refine its national DRG classification using increasingly sophisticated approaches. Hospital funders in Australia and in other systems are often under pressure from provider groups to expand classifications to reflect clinical complexity. DRG development in most healthcare systems reviewed here reflects four critical factors: these socio-political factors, the quality and depth of the coded data available to characterise the mix of cases in a healthcare system, the size of the underlying population, and the intended scope and use of the classification. Australia's relatively small national population has constrained the size of its DRG classifications, and development has been concentrated on inpatient care in public hospitals. Development of casemix classifications in health care is driven by both technical and socio-political factors. Use of additional diagnoses to adjust for patient complexity and cost needs to respond to these in each casemix application. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. [Financing of inpatient orthopedics and trauma surgery in the G-DRG system 2010].

    Science.gov (United States)

    Franz, D; Schemmann, F; Roeder, N; Mahlke, L

    2010-08-01

    The German DRG (diagnosis-related groups) system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also additional and innovation payments. This paper analyzes and evaluates the relevant developments of the G-DRG System 2010 for orthopedics and traumatology from the medical and classification perspectives. Analyses of relevant diagnoses, medical procedures and G-DRGs in the versions 2009 and 2010 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI) were carried out. The DRG catalog is has grown from 8 to 1,200 G-DRGs. A number of codes for surgical measures have been newly established or modified. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopedics and traumatology has been changed, especially in the areas of spinal surgery and surgery of the upper and lower extremities. The actual impact of the changes may vary depending on the individual hospital services. For the first time since the introduction of the G-DRG system, the pure numerical changes at the level of DRGs themselves are so marginal that only part of the DRG users in the hospitals will register them. The changes implemented not only a high selectivity between complex and less complex scenarios, but partly also unintended and unjustified revaluation of less complex measures. The G-DRG system has gained complexity again. Especially the G-DRG allocation of spinal surgery and multiple surgical interventions of the upper and/or lower extremities have reached such a complexity that only a few DRG users can follow them.

  14. Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

    2013-07-01

    As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.

  15. Early results of pediatric appendicitis after adoption of diagnosis-related group-based payment system in South Korea

    Directory of Open Access Journals (Sweden)

    Moon SB

    2015-11-01

    Full Text Available Suk-Bae MoonDepartment of Surgery, Kangwon National University Hospital, Kangwon National School of Medicine, Kangwon National University, Chuncheon, South KoreaPurpose: As an alternative to the existing fee-for-service (FFS system, a diagnosis-related group (DRG-based payment system has been suggested. The aim of this study was to investigate the early results of pediatric appendicitis treatment under the DRG system, focusing on health care expenditure and quality of health care services.Patients and methods: The medical records of 60 patients, 30 patients before (FFS group, and 30 patients after adoption of the DRG system (DRG, were reviewed retrospectively.Results: Mean hospital stay was shortened, but the complication and readmission rates did not worsen in the DRG. Overall health care expenditure and self-payment decreased from Korean Won (KRW 2,499,935 and KRW 985,540, respectively, in the FFS group to KRW 2,386,552 and KRW 492,920, respectively, in the DRG. The insurer’s payment increased from KRW 1,514,395 in the FFS group to KRW 1,893,632 in the DRG. For patients in the DRG, calculation by the DRG system yielded greater overall expenditure (KRW 2,020,209 vs KRW 2,386,552 but lower self-payment (KRW 577,803 vs KRW 492,920 than calculation by the FFS system.Conclusion: The DRG system worked well in pediatric patients with acute appendicitis in terms of cost-effectiveness over the short term. The gradual burden on the national health insurance fund should be taken into consideration.Keywords: appendicitis, child, fee-for-service plans, diagnosis-related groups, quality of health care, health care expenditures

  16. [Costs of appendicitis treatment by diagnosis-related groups in a third-level pediatric hospital].

    Science.gov (United States)

    Tlacuilo-Parra, Alberto; Hernández-Hernández, Araceli; Venegas-Dávalos, Martha; Gutiérrez-Hermosillo, Violeta; Guevara-Gutiérrez, Elizabeth; Ambriz-González, Gabriela

    2014-01-01

    Diagnosis-related groups (DRGs) are widely used in Europe. They allow performing comparisons in hospitals and incurrent hospital payment systems, defining the payment categories. We undertook this study to classify children who underwent appendectomy according to DRGs. Cross-sectional study. Comorbidities, length of hospitalization, histopathologic classification, and DRG classifications were analyzed. We included 313 patients, 62% males, with an average age of 8 ± 3 years; 91% were referred by another hospital and 67% were treated at night. Average length of hospitalization was 4 ± 3 days. There were comorbidities in 8% and surgical complications in 11%. According to histopathology, appendicitis was edematous (11%), suppurative (36%), gangrenous (22%), perforated (29%), and abscessed (2%). At discharge, 97% of the patients were healthy. Total cost for DRG 343 was $10,470,173.00 (Mexican pesos), DRG 342 was $1,227,592.00 and DRG 340 was $511,521.00. The global amount was $12,209,286.00 (Mexican pesos). The unitary cost for treatment of appendectomy for DRG 343 was $37,935.00, for DRG 342 was $49,103.00 and for DRG 340 was $42,626.00 (Mexican pesos). Because 88% of the cases of appendicitis were uncomplicated, this amount of money could be spent to treat these patients in a second-level hospital, using reimbursement 343 without generating additional expenses.

  17. [What is the value of pain therapy in the German refined diagnosis-related-groups system?].

    Science.gov (United States)

    Meissner, W; Thoma, R; Bauer, M

    2006-03-01

    The German refined diagnosis-related-groups (G-DRG) system was introduced on 1st January 2003, initially on a voluntary basis and on 1st January 2004 the use of a G-DRG costing for stationary hospital treatment became obligatory. The possibility of a description of acute and chronic pain therapy in the G-DRG system was initially rudimentary and not logically planned and also a fair allotment of proceeds according to resources was not possible. By further development of the G-DRG system, pain therapeutic treatment could be improved in some areas, but in others it still remains unsatisfactory. This article offers a summary of the underlying systematics of the G-DRG system and consideration of chronic and current pain therapy in the G-DRG system 2006. In addition to information on currently available possibilities of a pain therapeutical coding in conformation with the G-DRG system, the tasks which are still outstanding will be outlined.

  18. [Description of the severely injured in the DRG system: is treatment of the severely injured still affordable?].

    Science.gov (United States)

    Mahlke, L; Lefering, R; Siebert, H; Windolf, J; Roeder, N; Franz, D

    2013-11-01

    Due to the heterogeneity of severely injured patients (multiple trauma) it is difficult to assign them to homogeneic diagnosis-related groups (DRG). In recent years this has led to a systematic underfunding in the German reimbursement system (G-DRG) for cases of multiply injured patients. This project aimed to improve the reimbursement by modifying the case allocation algorithms of multiply injured patients within the G-DRG system. A retrospective analysis of standardized G-DRG data according to §21 of the Hospital Reimbursement Act (§ 21 KHEntgG) including case-related cost data from 3,362 critically injured patients from 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals was carried out. For 1,241 cases complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of multiply injured patients within the G-DRG system. Analysis of coding and grouping, performance of case allocation and the homogeneity of costs in the G-DRG versions 2008-2012 was carried out. The results showed systematic underfunding of trauma patients in the G-DRG version 2008 but adequate cost covering in the majority of cases with the G-DRG versions 2011 and 2012. Cost coverage was foundfor multiply injured patients from the clinical viewpoint who were identified as multiple trauma by the G-DRG system. Some of the overfunded trauma patients had high intensive care costs. Also there was underfunding for multiple injured patients not identified as such in the G-DRG system. Specific modifications of the G-DRG allocation structures could increase the appropriateness of reimbursement of multiply injured patients. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical specialist societies.

  19. Digital Raster Graphics (DRG) 24k Polygons, US EPA Region 9, 2006, USGS

    Data.gov (United States)

    U.S. Environmental Protection Agency — This document describes the contents of the file 'drg.list'. The drg.list contains metadata information relative to the DRG data set held at the USGS EROS Data...

  20. [Definition of polytrauma in the German DRG system 2006. Up to 30% "incorrect classifications"].

    Science.gov (United States)

    Flohé, S; Buschmann, C; Nabring, J; Merguet, P; Luetkes, P; Lefering, R; Nast-Kolb, D; Ruchholtz, S

    2007-07-01

    Severely injured patients represent a relevant financial cost factor in the health system especially for high level trauma centres. The introduction of a"diagnosis-related group" (DRG) system in Germany further revealed the potential negative economic impact of severely injured patients for trauma centres. In recent years several changes of the specific DRG for severely injured patients occurred with the aim of a convenient reimbursement for the trauma patient. The present study analysed 38 multiply injured patients admitted in the first half of the year 2004. These patients were analysed in terms of the respective DRG that was attributed to the patient on the basis of the definition criteria for 2004 and 2005. In addition for the same patient group the total inpatient treatment costs were calculated according to the algorithm developed by the Working Group on Polytrauma of the German Trauma Society. The analysis revealed three major problems in the reimbursement for severely injured patients according to the German DRG system: (1) In spite of the additional payment for blood compounds on top of the DRG reimbursement in 2005 a mean economic deficit of more than 4000 euro remains for each severely injured patient. (2) In 30% of the analysed trauma patients the combination of the diagnosis and operations did not lead to a specific polytrauma DRG or to an intensive care medicine DRG. (3) In the patients that could not be attributed to a polytrauma DRG, the economic deficit was with an average of more than 9000 euro even higher. This attribution aspect is also currently relevant, since the definition criteria for a polytrauma DRG were not changed in 2006 or 2007. We conclude that besides the recent changes in the reimbursement for polytrauma DRGs, which have been at least partly adapted to the real financial burden of these patients, the definition of a severely injured patient in the German DRG system may also need to be revised.

  1. [The challenge of adequate reimbursement for the seriously injured patient in the German DRG system].

    Science.gov (United States)

    Franz, D; Lefering, R; Siebert, H; Windolf, J; Roeder, N; Mahlke, L

    2013-02-01

    Critically injured patients are a very heterogeneous group, medically and economically. Their treatment is a major challenge for both the medical care and the appropriate financial reimbursement. Systematic underfunding can have a significant impact on the quality of patient care. In 2009 the German Trauma Society and the DRG-Research Group of the University Hospital Muenster initialised a DRG evaluation project to analyse the validity of case allocation of critically injured patients within the German DRG system versions 2008 and 2011 with additional consideration of clinical data from the trauma registry of the German Trauma Society. Severe deficits within the G-DRG structure were identified and specific solutions were designed and realised. A retrospective analysis was undertaken of standardised G-DRG data (§ 21 KHEntgG) including case-related cost data from 3 362 critically injured patients in the periods 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals. For 1 241 cases of the sample, complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of critically injured patients within the G-DRG system. Analyses of coding and grouping, performance of case allocation, and the homogeneity of costs in the G-DRG versions 2008 and 2011 were done. The following situations were found: (i) systematic underfunding of trauma patients in the G-DRG-Version 2008, especially trauma patients with acute paraplegia; (ii) participation in the official G-DRG development for 2011 with 13 proposals which were largely realised; (ii) the majority of cases with cost-covering in the G-DRG version 2011; (iv) significant improvements in the quality of statistical criteria; (v) overfunded trauma patients with high intensive care costs; (vi) underfunding for clinically relevant critically injured patients not identified in the G-DRG system. The quality of the G-DRG system is measured by the

  2. [Treatment aspects of unstable angina. Costs and payments for DRG].

    Science.gov (United States)

    Brunelli, C; Spallarossa, P; Pasdera, A; Bezante, G P; Zorzet, F; Rossettin, P

    1998-01-01

    Patients with unstable angina fall into a wide prognostic and therapeutic spectrum but, in general, have great access to specialty care and invasive procedures. In the modern era, in which admissions for unstable angina outnumber those for myocardial infarction, and growing economic pressures are placed on health care systems, cardiologists must re-examine clinical strategies for treating unstable angina in the light of health-cost accounting. The aims of the present study were to examine the current management of patients admitted to our cardiology department and to calculate the medical costs. A patient schedule was drawn up to prospectively register the number and type of cardiac processes carried out during hospitalization for all unstable angina patients in the period between March 1st and May 30th, 1995. Time (minutes) actually spent by both physicians and nurses for each cardiac process were carefully recorded in order to calculate the activity budget. The effective economic budget was built for each cardiac process taking into account salaries, consumable supplies, equipment service contracts, depreciation and indirect medical and non medical costs for CCU and ward. Based to the Diagnosis Related Groups (DRG) system, 53 out of 318 patients (16%) were admitted with documented or suspected unstable angina and allocated to discharge into four DRGs: DRG 140-medically treated unstable angina: 18 patients; DRG 124-unstable angina with angiography: 16 patients; DRG 122-unstable angina evolving in myocardial infarction: 6 patients; DRG 112-unstable angina with angioplasty: 13 patients. The mean cost for hospitalized patient with unstable angina was 5,574,958 Italian Liras (DRG 140 = 2,687,719; DRG 124 = 2,800,347; DRG 122 = 6,086,563; DRG 112 = 12,751,454). The difference in costs was essentially related to the procedures involved in medical care, DRGs with expensive cardiac processes having higher costs. Furthermore, these data show a deep discrepancy between

  3. Reimbursement of care for severe trauma under SwissDRG.

    Science.gov (United States)

    Moos, Rudolf M; Sprengel, Kai; Jensen, Kai Oliver; Jentzsch, Thorsten; Simmen, Hans-Peter; Seifert, Burkhardt; Ciritsis, Bernhard; Neuhaus, Valentin; Volbracht, Jörk; Mehra, Tarun

    2016-01-01

    Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.

  4. Investigating DRG cost weights for hospitals in middle income countries.

    Science.gov (United States)

    Ghaffari, Shahram; Doran, Christopher; Wilson, Andrew; Aisbett, Chris; Jackson, Terri

    2009-01-01

    Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.

  5. Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Bellanger, Martine M; Quentin, Wilm; Tan, Siok Swan

    2013-05-01

    The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only € 479 in Poland but to € 5532 in Ireland. Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Review of Diagnosis-Related Group-Based Financing of Hospital Care

    Directory of Open Access Journals (Sweden)

    Natasa Mihailovic

    2016-05-01

    Full Text Available Since the 1990s, diagnosis-related group (DRG-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.

  7. Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

    Science.gov (United States)

    Liang, Li-Lin

    2015-04-01

    This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

  8. Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

    Science.gov (United States)

    Parnell, Aimee S; Shults, Justine; Gaynor, J William; Leonard, Mary B; Dai, Dingwei; Feudtner, Chris

    2014-02-01

    Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (pDRG (pDRG experienced a significantly increased mortality (pDRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic-related groups and Weighted Inlier Equivalent Separation.

    Science.gov (United States)

    Chin, N; Perera, P; Roberts, A; Nagappan, R

    2013-07-01

    Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  10. Physicians' Patient Load per DRG, the Consumption of Hospital Resources, and the Incentives of the DRG Prospective Payment System.

    Science.gov (United States)

    Munoz, Eric; And Others

    1990-01-01

    The relationship between numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and hospital resource consumption of the patients at a large academic medical center was studied for the period 1985-87. The findings, although a result of many varied factors, suggest a relationship between the two…

  11. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany

    Science.gov (United States)

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the “one hospital” approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the “one hospital” model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital’s cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level. PMID:22935314

  12. DRG migration: A novel measure of inefficient surgical care in a value-based world.

    Science.gov (United States)

    Hughes, Byron D; Mehta, Hemalkumar B; Sieloff, Eric; Shan, Yong; Senagore, Anthony J

    2018-03-01

    Diagnosis-Related Group (DRG) migration, DRG 331 to 330, is defined by the assignment to a higher cost DRG due only to post admission comorbidity or complications (CC). We assessed the 5% national Medicare data set (2011-2014) for colectomy (DRG's 331/330), excluding present on admission CC's and selecting patients with one or more CC's post-admission to define the impact on payments, cost, and length of stay (LOS). The incidence of DRG migration was 14.2%. This was associated with statistically significant increases in payments, hospital cost, and LOS compared to DRG 331 patients. When DRG migration rate was extrapolated to the entire at risk population, the results were an increase of Centers for Medicare and Medicaid Services (CMS) cost by $98 million, hospital cost by $418 million, and excess hospital days equaling 68,669 days. These negative outcomes represent potentially unnecessary variations in the processes of care, and therefore a unique economic concept defining inefficient surgical care. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. [Orthopedic and trauma surgery in the German DRG system. Recent developments].

    Science.gov (United States)

    Franz, D; Schemmann, F; Selter, D D; Wirtz, D C; Roeder, N; Siebert, H; Mahlke, L

    2012-07-01

    Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.

  14. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany.

    Science.gov (United States)

    Vogl, Matthias

    2012-08-30

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level.

  15. Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm

    Science.gov (United States)

    Luo, Ai-Jing; Chang, Wei-Fu; Xin, Zi-Rui; Ling, Hao; Li, Jun-Jie; Dai, Ping-Ping; Deng, Xuan-Tong; Zhang, Lei; Li, Shao-Gang

    2018-01-01

    AIM To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. METHODS The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. RESULTS The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. CONCLUSION The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund. PMID:29487824

  16. Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm.

    Science.gov (United States)

    Luo, Ai-Jing; Chang, Wei-Fu; Xin, Zi-Rui; Ling, Hao; Li, Jun-Jie; Dai, Ping-Ping; Deng, Xuan-Tong; Zhang, Lei; Li, Shao-Gang

    2018-01-01

    To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

  17. Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm

    Directory of Open Access Journals (Sweden)

    Ai-Jing Luo

    2018-02-01

    Full Text Available AIM: To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP and build up an area-specified senile cataract diagnosis related group (DRG of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. METHODS: The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. RESULTS: The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. CONCLUSION: The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

  18. [Impact of DRG payment on the length of stay and the number of outpatient visits after discharge for caesarean section during 2004-2007].

    Science.gov (United States)

    Shon, Changwoo; Chung, Seolhee; Yi, Seonju; Kwon, Soonman

    2011-01-01

    The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the difference-in-differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

  19. Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries

    Science.gov (United States)

    Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

    2013-01-01

    Aims As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. Methods and results National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Conclusions Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. PMID:23364755

  20. Testing a diagnosis-related group index for skilled nursing facilities

    Science.gov (United States)

    Cotterill, Philip G.

    1986-01-01

    Interest in case-mix measures for use in nursing home payment systems has been stimulated by the Medicare prospective payment system (PPS) for short-term acute-care hospitals. Appropriately matching payment with care needs is important to equitably compensate providers and to encourage them to admit patients who are most in need of nursing home care. The skilled nursing facility (SNF) Medicare benefit covers skilled convalescent or rehabilitative care following a hospital stay. Therefore, it might appear that diagnosis-related groups (DRG's), the basis for patient classification in PPS, could also be used for the Medicare SNF program. In this study, a DRG-based case-mix index (CMI) was developed and tested to determine how well it explains cost differences among SNF's. The results suggest that a DRG-based SNF payment system would be highly problematic. Incentives of this system would appear to discourage placement of patients who require relatively expensive care. PMID:10311674

  1. Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia.

    Science.gov (United States)

    Ali Jadoo, Saad Ahmed; Aljunid, Syed Mohamed; Nur, Amrizal Muhammad; Ahmed, Zafar; Van Dort, Dexter

    2015-02-10

    The service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital. All patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components' cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs). Drugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83. A mixed

  2. The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective.

    Science.gov (United States)

    Busato, André; von Below, Georg

    2010-10-16

    Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

  3. Development of lengths of stay and DRG cost weights in dermatology from 2003 to 2006.

    Science.gov (United States)

    Wenke, Andreas; Müller, Marcel L; Babapirali, Judith; Rompel, Rainer; Hensen, Peter

    2009-08-01

    The G-DRG per case payments are calculated annually on the basis of present output and cost data provided from German hospitals. The economic valuation of dermatology-related DRGs depends largely on inpatients' length of stay. At present, longitudinal analyses of dermatologic hospital data considering the development of length of stay under DRG conditions are not available. A multicenter, longitudinal study of clinical data from hospitals with different care levels was performed (n = 23). Frequent and relevant dermatologic diagnoses were grouped and analyzed over a time period of four years (2003-2006). The development of lengths of stay and of G-DRG cost weights were studied in detail. Descriptive statistical methods were applied. After introduction of DRG, the data reveal a) reduction of length of stay in inpatient dermatology and b) after an initial abrupt rise, DRG valuation of dermatologic groups moderately decreased over time. Both trends changed most rapidly in the early years but reached a stable niveau in 2006. The study furthermore points out that not only length of stay, but also other type of costs influence DRG calculations. German dermatology reflects the international trend showing reductions of length of stay after introduction of a DRG-based hospital funding system. The DRG calculation and valuation of inpatient services depend on the duration of hospital stay. However, increasing per diem costs resulting from higher performances of every inpatient bed day are also taken into account. Further reduction of length of stay must not threaten the quality of inpatient care in dermatology.

  4. [Differential features of DRG 541 readmitting patients].

    Science.gov (United States)

    López Pérez, J; López Álvarez, J; Montero Ruiz, E

    2015-01-01

    Hospital readmission is considered an adverse outcome, and the hospital readmission ratio is an indicator of health care quality. Published studies show a wide variability and heterogeneity, with large groups of patients with different diagnoses and prognoses. The aim of the study was to analyse the differences between patients readmitted and those who were not, in patients grouped into the diagnosis related group (DRG) 541. A retrospective observational study was conducted on DRG 541 patients discharged in 2010. Readmission is defined as any admission into any hospital department, and for any reason at ≤30 days from discharge. An analysis was performed that included age, sex, day of discharge, month of discharge, number of diagnoses and drugs at discharge, respiratory depressant drugs, length of stay, requests for consultations/referrals, Charlson comorbidity index, feeding method, hospitalisations in the previous 6 months, albumin and haemoglobin levels and medical examinations within 30 days after discharge. Of the 985 patients included in the study, 189 were readmitted. On multivariate analysis, significant variables were: Haemoglobin -0.6g/dl (95% confidence interval [95%CI] -0.9 to -0.3), gastrostomy feeding odds ratio (OR) 5.6 (95%CI: 1.5 to 21.6), hospitalisations in previous 6 months OR 1.9 (95%CI: 1.3 to 2.8), visits to emergency department OR 17.4 (95%CI: 11.3 to 26.8), medical checks after discharge OR 0.4 (95%CI: 0.2 to 0.8). DRG 541 readmitting patients have some distinctive features that could allow early detection and prevent hospital readmission. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  5. [Complex surgical procedures in orthopedics and trauma surgery. A contribution to the proposal procedure for the DRG system in 2009].

    Science.gov (United States)

    Flohé, S; Nabring, J; Luetkes, P; Nast-Kolb, D; Windolf, J

    2008-10-01

    Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.

  6. Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Tan, Siok Swan; Chiarello, Pietro; Quentin, Wilm

    2013-11-01

    Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems. National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained. Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between euro 4,920 in Estonia and euro 14,081 in Spain. Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries' DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.

  7. [Neonatal septicemia in the G-DRG system].

    Science.gov (United States)

    Mohrmann, M; Hentschel, R; Böhler, T; Dirschedl, P

    2006-12-01

    The introduction of Diagnosis Related Groups in Germany (G-DRG) has brought forward the obligation for physicians to take into account an intricate system of medical, economical and legal implementations. Mistakes in the process of encoding the principal diagnosis or procedures may have financial consequences. Problems to determine the correct ICD-code will be most prominent for diseases with poorly defined or even inconsistent diagnostic criteria as is the case for neonatal septicemia. We decided to evaluate whether the introduction of G-DRG resulted in a change of frequency of the diagnosis "neonatal septicemia". We analysed data derived from the quality assurance program "Neonatalerhebung" in the state of Baden-Württemberg during the years of 2001 through 2004, i. e., 2 years before and 2 years during the introduction of G-DRG. During this period an annual number of 12,316 up to 13,172 newborns were admitted to the participating hospitals. The mean number of diagnoses per patient increased from 2.2 to 3.8. The frequency of the diagnosis of septicemia remained constant. The percentage of newborns receiving antibiotic therapy did not change. The ratio of cases with "septicemia yes" over "antibiotics yes" did not change. Although it is difficult to determine the diagnosis of neonatal septicemia and in spite of the economic implications of this diagnosis, no change in the frequency of this diagnosis occurred during the introduction of DRG. Assuming that the participating hospitals used an identical database for the quality assurance program "Neonatalerhebung" and for accounting, we conclude that the DRG system is stable with respect to neonatal septicemia.

  8. [Is polytrauma affordable these days? G-DRG system vs per diem charge based on 1,030 patients with multiple injuries].

    Science.gov (United States)

    Qvick, B; Buehren, V; Woltmann, A

    2012-10-01

    The introduction of diagnosis-related groups (DRG) in Germany comprises the risk of a non-cost-effective reimbursement in complex medical treatments. The aim of this study was to compare the reimbursement between the DRG system and the system of hospital per diem charge in effect until now. The G-DRG (Version 2004) reimbursement was calculated for 1,030 polytrauma patients (average ISS 26.4) treated at the BGU Murnau from 2000 to 2004, using a base value of 2900 euros, and compared to the reimbursement of hospital per diem charge. Just half of all polytrauma patients are classified as a polytrauma according to the DRG (18.7%) or as requiring artificial respiration based on the DRG (29.1%). The average G-DRG reimbursement was 27,157 euros vs 36,387 euros (74.6%). Patients with minor trauma, increasing age, high GCS, ICU stay without artificial respiration, trauma of the upper extremity and patients who survived show the greatest discrepancy. A revision of the G-DRG definition of polytrauma is necessary to ensure adequate reimbursement for management of patients with multiple injuries. The severity of a trauma has to be considered in the DRG system.

  9. Effects of diagnosis-related group payment system on appendectomy outcomes.

    Science.gov (United States)

    Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

    2016-12-01

    The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. All patient refined-diagnostic related group and case mix index in acute care palliative medicine.

    Science.gov (United States)

    Lagman, Ruth L; Walsh, Declan; Davis, Mellar P; Young, Brett

    2007-03-01

    The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P DRG classifications captured a higher severity of illness and may better reflect resource utilization.

  11. [Quality assessment of dermatology in the G-DRG system 2004].

    Science.gov (United States)

    Fürstenberg, T; Hensen, P; Rompel, R; Roeder, N

    2004-11-01

    Since January 2004, all German hospitals have been obliged to operate with a new hospital funding system based on DRGs. For the DRG system to serve as a fair basis for reimbursement requires that the dermatologic services be adequately covered in the classification system. The German Dermatologic Society (DDG) in cooperation with the DRG-Research Group of the University Hospital Muenster carried out a DRG evaluation study. Based on these results, suggestions for the adjustment of the G-DRG system were proposed by the DDG in the G-DRG adaptation round for 2004. Based on data of the DRG evaluation project (14,555 dermatological cases from 19 hospitals) the homogeneity in the G-DRG system 2004 was examined and compared with the quality of depiction in the G-DRG version 1.0. The correlation between expenditure and case mix index in the hospitals improved in the G-DRG system 2004. Most proposals submitted by the German Dermatologic Society for the adaptation into the G-DRG system 2004 were accepted. Some fundamental problems such as reimbursement of high cost drugs and special services, as well as the reimbursement of high and low outliers, were only marginally addressed. The G-DRG system 2004 will need to be continuously adapted in the field of dermatology. Based on this work, the German Dermatologic Society has made suggestions to be adapted in the G-DRG system 2005 and submitted them to the German DRG Institute.

  12. Distribution des durées de séjour par Diagnosis Related Group

    OpenAIRE

    Eggli, Yves; Koehn, Véronique; Paccaud, Fred; Moyard M. (Collab.),

    1988-01-01

    Ce cahier fournit les principales informations concernant les durées de séjour et le nombre de sorties observées dans 33 hôpitaux suisses pour l'années 1984. La description des clientèles hospitalières est fondée sur les "Diagnosis Related Groups" (DRG), qui forment une classification de 472 groupes de patients hospitalisés. [Auteurs, p. 1

  13. Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea.

    Science.gov (United States)

    Lee, Kwangsoo; Lee, Sangil

    2007-05-01

    This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating health care organizations had similar CS rates despite the varied participation periods. The study sample included delivery claims data from the Korean national health insurance program for the year 2003. Risk factors were identified and used in the adjustment model to distinguish the main reason for CS. Their risk-adjusted CS rates were compared by the reimbursement methods, and the organizations' internal and external environments were controlled. The final risk-adjustment model for the CS rates meets the criteria for an effective model. There were no significant differences of CS rates between providers in the DRG and fee-for-service system after controlling for organizational variables. The CS rates did not vary significantly depending on the providers' DRG participation periods. The results provide evidence that the DRG payment system operated by volunteering health care organizations had no impact on the CS rates, which can lower the quality of care. Although the providers joined the DRG system in different years, there were no differences in the CS rates among the DRG providers. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

  14. Association of the position of a hospital-acquired condition diagnosis code with changes in medicare severity diagnosis-related group assignment.

    Science.gov (United States)

    Johnson, Tricia; Kane, Jason M; Odwazny, Richard; McNutt, Robert

    2014-11-01

    Incentives to improve quality include paying less for adverse events, including the Centers for Medicare and Medicaid Services' policy to not pay additionally for events classified as hospital-acquired conditions (HACs). This policy is controversial, as variable coding practices at hospitals may lead to differences in the inclusion and position of HACs in the list of codes used for Medicare Severity Diagnosis-Related Group (MS-DRG) assignment. Evaluate changes in MS-DRG assignment for patients with an HAC and test the association of the position of an HAC in the list of International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes with change in MS-DRG assignment. Retrospective analysis of patients discharged from hospital members of the University HealthSystem Consortium's Clinical Data Base between October 2007 and April 2008. Comparisons were made between the MS-DRG assigned when the HAC was not included in the list of ICD-9 diagnosis codes and the MS-DRG that would have been assigned had the HAC code been included in the assignment. Of the 7027 patients with an HAC, 13.8% changed MS-DRG assignment when the HAC was removed. An HAC in the second position versus third position or lower was associated with a 40-fold increase in the likelihood of MS-DRG change. The position of an HAC in the list of diagnosis codes, rather than the presence of an HAC, is associated with a change in MS-DRG assignment. HACs have little effect on reimbursement unless the HAC is in the second position and patients have minor severity of illness. © 2014 Society of Hospital Medicine.

  15. Charting a path forward: policy analysis of China's evolved DRG-based hospital payment system.

    Science.gov (United States)

    Liu, Rui; Shi, Jianwei; Yang, Beilei; Jin, Chunlin; Sun, Pengfei; Wu, Lingfang; Yu, Dehua; Xiong, Linping; Wang, Zhaoxin

    2017-09-01

    At present, the diagnosis-related groups-based prospective payment system (DRG-PPS) that has been implemented in China is merely a prototype called the simplified DRG-PPS, which is known as the 'ceiling price for a single disease'. Given that studies on the effects of a simplified DRG-PPS in China have usually been controversial, we aim to synthesize evidence examining whether DRGs can reduce medical costs and length of stay (LOS) in China. Data were searched from both Chinese [Wan Fang and China National Knowledge Infrastructure Database (CNKI)] and international databases (Web of Science and PubMed), as well as the official websites of Chinese health departments in the 2004-2016 period. Only studies with a design that included both experimental (with DRG-PPS implementation) and control groups (without DRG-PPS implementation) were included in the review. The studies were based on inpatient samples from public hospitals distributed in 12 provinces of mainland China. Among them, 80.95% (17/21) revealed that hospitalization costs could be reduced significantly, and 50.00% (8/16) indicated that length of stay could be decreased significantly. In addition, the government reports showed the enormous differences in pricing standards and LOS in various provinces, even for the same disease. We conclude that the simplified DRGs are useful in controlling hospitalization costs, but they fail to reduce LOS. Much work remains to be done in China to improve the simplified DRG-PPS. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  16. [Classification of severely injured patients in the G-DRG System 2008].

    Science.gov (United States)

    Juhra, C; Franz, D; Roeder, N; Vordemvenne, T; Raschke, M J

    2009-05-01

    Since the introduction of a per-case reimbursement system in Germany (German Diagnosis-Related Groups, G-DRG), the correct reimbursement for the treatment of severely injured patients has been much debated. While the classification of a patient in a polytrauma DRG follows different rules than the usual clinical definition, leading to a high number of patients not grouped as severely injured by the system, the system was also criticized in 2005 for its shortcomings in financing the treatment of severely injured patients. The development of financial reimbursement will be discussed in this paper. 167 patients treated in 2006 and 2007 due to a severe injury at the University-Hospital Münster and grouped into a polytrauma-DRG were included in this study. For each patient, cost-equivalents were estimated. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK cost-calculation method. The reimbursement was calculated using the G-DRG-Systems of 2007, 2008 and 2009. Cost-equivalents/costs and clinical parameters were correlated. A total of 167 patients treated in 2006 and 2007 for a severe injury at the Münster University Hospital and grouped into a polytrauma DRG were included in this study. Cost equivalents were estimated for each patient. For those patients treated in 2007 (n=110), exact costs were calculated following the InEK (Institute for the Hospital Remuneration System) cost calculation method. Reimbursement was calculated using the G-DRG systems of 2007, 2008 and 2009. Cost equivalents/costs and clinical parameters were correlated. With the ongoing development of the G-DRG system, reimbursement for the treatment of severely injured patient has improved, but the amount of underfinancing remains substantial. As treatment of severely injured patients must be reimbursed using the G-DRG system, this system must be further adapted to better meet the needs of severely injured patients. Parameters such as total surgery time, injury

  17. Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

    OpenAIRE

    Peltola, Mikko; Quentin, Wilm

    2013-01-01

    Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich. This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. Background: Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems...

  18. Dokumentation, Kalkulation und Prozessanalyse im DRG-Zeitalter

    OpenAIRE

    Ingenerf, J; Gerdsen, F; Seik, B; Pöppl, SJ; Schreiber, R; Heinemeier, AK; Köppe, K; Bruch, HP

    2005-01-01

    The introduction of the G-DRGs (German Diagnosis Related Groups) in the year 2002 and the gradual use as a reimbursement system beginning from 2005 forces hospitals to meet enormous challenges with respect to organizational and IT-issues. The quality of the basic data set in terms of case and data completeness, accuracy and timeliness has to be ensured because with that the DRG case group and hence, the associated revenue is determined. From the economic point of view the costs of providing t...

  19. [Consistency and Reliability of MDK Expertise Examining the Encoding in the German DRG System].

    Science.gov (United States)

    Gaertner, T; Lehr, F; Blum, B; van Essen, J

    2015-09-01

    Hospital inpatient stays are reimbursed on the basis of German diagnosis-related groups (G-DRG). The G-DRG classification system is based on complex coding guidelines. The Medical Review Board of the Statutory Health Insurance Funds (MDK) examines the encoding by hospitals and delivers individual expertises on behalf of the German statutory health insurance companies in cases in which irregularities are suspected. A study was conducted on the inter-rater reliability of the MDK expertises regarding the scope of the assessment. A representative sample of 212 MDK expertises was taken from a selected pool of 1 392 MDK expertises in May 2013. This representative sample underwent a double-examination by 2 independent MDK experts using a special software based on the 3MTM G-DRG Grouper 2013 of 3M Medica, Germany. The following items encoded by the hospitals were examined: DRG, principal diagnosis, secondary diagnoses, procedures and additional payments. It was analysed whether the results of MDK expertises were consistent, reliable and correct. 202 expertises were eligible for evaluation, containing a total of 254 questions regarding one or more of the 5 items encoded by hospitals. The double-examination by 2 independent MDK experts showed matching results in 187 questions (73.6%) meaning they had been examined consistently and correctly. 59 questions (23.2%) did not show matching results, nevertheless they had been examined correctly regarding the scope of the assessment. None of the principal diagnoses was significantly affected by inconsistent or wrong judgment. A representative sample of MDK expertises examining the DRG encoding by hospitals showed a very high percentage of correct examination by the MDK experts. Identical MDK expertises cannot be achieved in all cases due to the scope of the assessment. Further improvement and simplification of codes and coding guidelines are required to reduce the scope of assessment with regard to correct DRG encoding and its

  20. Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

    Science.gov (United States)

    Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

    2015-03-01

    Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p payment system (β = 0.843, p payment system (β = 0.737, p payment method and the pro- jected DRG payment methods (β = 0.501, p Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

  1. Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

    Science.gov (United States)

    2014-01-01

    Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past

  2. [Gastroenterology in the G-DRG-System 2004].

    Science.gov (United States)

    Bunzemeier, H; Frühmorgen, P; Caspary, W F; Roeder, N

    2003-11-01

    After a year of preliminary voluntarily introduction of casemix funding in hospitals in 2003 nearly every German hospital will be confronted with lump sump payments on the basis of the G-DRG system for their inpatient care starting from January 2004. To analyse weaknesses referring to gastroenterology services within the G-DRG version 1.0 the German Association for Disorders of the Digestive System and Metabolism (DGVS) and the DRG-Research-Group from the University of Muenster conducted a DRG evaluation project. In the analysis patient data from 16 hospitals were included. As a result of the project recommendations for G-DRG adjustments were generated. Those recommendations were implemented in the advancement to G-DRG version 2004. Also the International Classification of Diseases (ICD-10) was modified to ICD-10 German Modification. The classification of procedures OPS-301 was revised. The main adjustments to the G-DRG system and both classifications will be presented in this paper.

  3. [Changes for rheumatology in the G-DRG system 2005].

    Science.gov (United States)

    Fiori, W; Roeder, N; Lakomek, H-J; Liman, W; Köneke, N; Hülsemann, J L; Lehmann, H; Wenke, A

    2005-02-01

    The German prospective payment system G-DRG has been recently adapted and recalculated. Apart from the adjustments of the G-DRG classification system itself changes in the legal framework like the extension of the "convergence period" or the limitation of budget loss due to DRG introduction have to be considered. Especially the introduction of new procedure codes (OPS) describing the specialized and complex rheumatologic treatment of inpatients might be of significant importance. Even though these procedures will not yet develop influence on the grouping process in 2005, it will enable a more accurate description of the efforts of acute-rheumatologic treatment which can be used for further adaptations of the DRG algorithm. Numerous newly introduced additive payment components (ZE) result in a more adequate description of the "DRG-products". Although not increasing the individual hospital budget, these additive payments contribute to more transparency of high cost services and can be addressed separately from the DRG-budget. Furthermore a lot of other relevant changes to the G-DRG catalogue, the classification systems ICD-10-GM and OPS-301 and the German Coding Standards (DKR) are presented.

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

    Science.gov (United States)

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

    2003-06-01

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

  5. Functional, electrophysiological recoveries of rats with sciatic nerve lesions following transplantation of elongated DRG cells.

    Science.gov (United States)

    Dayawansa, Samantha; Zhang, Jun; Shih, Chung-Hsuan; Tharakan, Binu; Huang, Jason H

    2016-04-01

    Functional data are essential when confirming the efficacy of elongated dorsal root ganglia (DRG) cells as a substitute for autografting. We present the quantitative functional motor, electrophysiological findings of engineered DRG recipients for the first time. Elongated DRG neurons and autografts were transplanted to bridge 1-cm sciatic nerve lesions of Sprague Dawley (SD) rats. Motor recoveries of elongated DRG recipients (n=9), autograft recipients (n=9), unrepaired rats (n=9) and intact rats (n=6) were investigated using the angle board challenge test following 16 weeks of recovery. Electrophysiology studies were conducted to assess the functional recovery at 16 weeks. In addition, elongated DRGs were subjected to histology assessments. At threshold levels (35° angle) of the angle board challenge test, the autograft recipients', DRG recipients' and unrepaired group's performances were equal to each other and were less than the intact group (pDRG recipients' performance was similar to both the intact group and the autograft nerve recipients, and was better (pDRG constructs had intact signal transmission when recorded over the lesion, while the unrepaired rats did not. It was observed that elongated DRG neurons closely resembled an autograft during histological assessments. Performances of autograft and elongated DRG construct recipients were similar. Elongated DRG neurons should be further investigated as a substitute for autografting.

  6. [OR minute myth : Guidelines for calculation of DRG revenues per OR minute].

    Science.gov (United States)

    Waeschle, R M; Hinz, J; Bleeker, F; Sliwa, B; Popov, A; Schmidt, C E; Bauer, M

    2016-02-01

    The economic situation in German Hospitals is tense and needs the implementation of differentiated controlling instruments. Accordingly, parameters of revenue development of different organizational units within a hospital are needed. This is particularly necessary in the revenue and cost-intensive operating theater field. So far there are only barely established productivity data for the control of operating room (OR) revenues during the year available. This article describes a valid method for the calculation of case-related revenues per OR minute conform to the diagnosis-related groups (DRG).For this purpose the relevant datasets from the OR information system and the § 21 productivity report (DRG grouping) of the University Medical Center Göttingen were combined. The revenues defined in the DRG browser of the Institute for Hospital Reimbursement (InEK) were assigned to the corresponding process times--incision-suture time (SNZ), operative preparation time and anesthesiology time--according to the InEK system. All full time stationary DRG cases treated within the OR were included and differentiated according to the surgical department responsible. The cost centers "OR section" and "anesthesia" were isolated to calculate the revenues of the operating theater. SNZ clusters and cost type groups were formed to demonstrate their impact on the revenues per OR minute. A surgical personal simultaneity factor (GZF) was calculated by division of the revenues for surgeons and anesthesiologists. This factor resembles the maximum DRG financed personnel deployment for surgeons in German hospitals.The revenue per OR minute including all cost types and DRG was 16.63 €/min. The revenues ranged from 10.45 to 24.34 €/min depending on the surgical field. The revenues were stable when SNZ clusters were analyzed. The differentiation of cost type groups revealed a revenue reduction especially after exclusion of revenues for implants and infrastructure. The calculated GZF over

  7. Towards An Improvement of Hospital Services and Streamlining of Health Care Costs: The DRG Analysis in Italy.

    Science.gov (United States)

    Bellavia, M; Tomasello, G; Damiani, P; Damiani, F; Geraci, A; Accardo, Fm; Gioviale, Mc; Lo Monte, Ai

    2012-01-01

    The term Diagnosis-related Group (DRG) refers to a classification system used to assess hospital services with the aim of a better management of health care costs and improving performance. The DRG system focuses on the utilization of resources, and is not concerned with the specific type of care provided to the patient. This system highlights any diseconomies and eventual critical aspects of the hospital system. This article, starting from the history of heath care financing in Italy and pointing out the difficulty to define the "quality" of health care services, describes the variables used to evaluate correctly hospital performance based on the DRG system. These include Average Length of Stay, Average Daily Patient Load, Comparative Performance Index, and Case Mix Index.

  8. Digital Raster Graphics (DRG) Lambert

    Data.gov (United States)

    Kansas Data Access and Support Center — The Digital Raster Graphic-Lambert (DRG-Lam) is a raster image of a scanned USGS topographic map with the collar information clipped out, georeferenced to the...

  9. Comparison of alternative weight recalibration methods for diagnosis-related groups

    Science.gov (United States)

    Rogowski, Jeannette Roskamp; Byrne, Daniel J.

    1990-01-01

    In this article, alternative methodologies for recalibration of the diagnosis-related group (DRG) weights are examined. Based on 1984 data, cost and charge-based weights are less congruent than those calculated with 1981 data. Previous studies using 1981 data demonstrated that cost- and charge-based weights were not very different. Charge weights result in higher payments to surgical DRGs and lower payments to medical DRGs, relative to cost weights. At the provider level, charge weights result in higher payments to large urban hospitals and teaching hospitals, relative to cost weights. PMID:10113568

  10. Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

    Science.gov (United States)

    Wittenbecher, Friedrich

    2013-01-01

    Abstract Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. PMID:24115798

  11. Variability of nursing care by APR-DRG and by severity of illness in a sample of nine Belgian hospitals.

    Science.gov (United States)

    Pirson, Magali; Delo, Caroline; Di Pierdomenico, Lionel; Laport, Nancy; Biloque, Veronique; Leclercq, Pol

    2013-10-10

    As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI. Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile -1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay). The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers' rate: 5.19%, low outliers' rate: 0.14%). The outlier's rate varies according to the studied variable. The high outliers' rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care). It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is

  12. Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure.

    Science.gov (United States)

    Palmieri, Vittorio; Baldi, Cesare; Di Blasi, Paola E; Citro, Rodolfo; Di Lorenzo, Emilio; Bellino, Elisabetta; Preziuso, Feliciano; Ranaudo, Carlo; Sauro, Rosario; Rosato, Giuseppe

    2015-02-01

    Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact. This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs. Over 5535 discharges between 2012-2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of €24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was ∼ €16,300. Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.

  13. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    Directory of Open Access Journals (Sweden)

    Emil OLTEANU

    2014-11-01

    Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.

  14. [Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital].

    Science.gov (United States)

    Christaras, A; Schaper, J; Strelow, H; Laws, H-J; Göbel, U

    2006-01-01

    Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. An unchanged population of 349 patients associated with 1,731 inpatient stays of a Clinic of Pediatric Oncology, Hematology, and Immunology in 2004 was analyzed by methods and means of G-DRG systems 2004, 2005, and 2006. DRGs and additional payments for drugs and procedures eligible for all and/or individual hospitals were calculated. G-DRG system 2005 resulted in overall reimbursement loss of 3.77 % compared to G-DRG 2004. G-DRG 2006 leads to slightly improved overall reimbursements compared to G-DRG 2005 by increasing DRG-based revenues. G-DRG 2006 effects 2.40 % reduction in overall reimbursement compared to G-DRG 2004. This loss includes ameliorating effects of additional payments for drugs and blood products already. Despite introduction of additional payments especially designed for children and teenagers in 2006, additional payment volume is decreased by 21.71 % from 2005 to 2006. G-DRG 2006 yields over-all reimbursement losses of 1.45 % in comparison to G-DRG 2004. Overall reimbursements include introduced additional payments for drugs and blood products. (Reimbursements resulting out of DRG payment alone drop by 14.73 % from 2004 to 2005, and increase by 3.26 % from 2005 to 2006 (2004 vs. 2006 11.95 %). Introduction of additional payments for drugs and blood products on a Germany-wide basis introduced in 2005 dampens DRG-based reimbursement losses. Despite introduction of dosage

  15. Comparative analysis of current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology

    Directory of Open Access Journals (Sweden)

    Babić Uroš

    2015-01-01

    Full Text Available Background/Aim. Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. Methods. The data were obtained from the information system used in the Clinical Hospital Center “Dr. Dragiša Mišović” - Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Results. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0,001 respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively. Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001 as well as under the projected DRG payment system (β = 0.737, p < 0.001. The same predictor was crucial for the difference in the current payment method and the projected DRG payment methods (β = 0.501, p <0.001. Conclusion. Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs per DRG. Given that aggregate costs of treatment under two hospital payment methods compared

  16. Reimbursement of radiologically guided vascular interventions within the DRG-System: What wil change?; Verguetung radiologischer Gefaessinterventionen im DRG-System: Was wird sich aendern?

    Energy Technology Data Exchange (ETDEWEB)

    Strotzer, M. [Krankenhaus Hohe Warte, Bayreuth (Germany). Abt. fuer Radiologie; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Diagnostische Radiologie; Voelk, M. [Bundeswehrkrankenhaus Ulm (Germany). Abt. Radiologie

    2004-09-01

    Purpose: To evaluate reimbursement within the DRG-system ('diagnosis-related groups') compared with traditional reimbursement for interventional therapy of hospitalized patients. Materials and Methods: Reimbursement calculation was prospectively analyzed in two respects for 30 consecutive patients who underwent percutaneous transluminal angioplasty (PTA) of the lower extremity arteries: (1) based on the DRG-system; (2) based on the traditional system. Additional evaluation was performed for five further, typical vascular procedures on the basis of real documentation and calculation data (stenting of the carotid artery, fibrinolytic therapy of basilar artery occlusion, stenting of renal artery stenosis, angioplasty of hemodialysis-shunt stenosis and aspiration thrombectomy of an infrapopliteal arterial occlusion). Results: In our hospital, the introduction of the DRG system would reduce reimbursement by approximately 1100 Euro per PTA patient. However, the other vascular radiological procedures can be expected to increase the payments by up to 4500 Euro. Conclusion: To minimize imminent reduction of reimbursement for patients with peripheral PTA, complete documentation and economical patient management is mandatory. Payment may increase significantly for patients with the other reported vascular interventional procedures. (orig.)

  17. [Inpatient therapy of urinary stones in Germany: development of the G-DRG system].

    Science.gov (United States)

    Bauer, J; Kahlmeyer, A; Stredele, R; Volkmer, B G

    2014-12-01

    The therapy of urinary stones in Germany is mostly a domain of hospitals even now. With the introduction of the German diagnosis-related groups (G-DRG) system in the years 2003/2004 an attempt was made to realize an ever-increasing fair representation and remuneration of treatment costs. Simultaneously, a declared target was to transfer all forms of treatment which did not necessitate hospital admission to the outpatient department. Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12% with a parallel increase in the volume of revenues of around 37%. A special feature was a reduction in the proportion of extracorporeal shockwave therapy (ESWL) as inpatient treatment with a parallel increase in the proportion of ureteroscopic and percutaneous interventions.

  18. The variance of length of stay and the optimal DRG outlier payments.

    Science.gov (United States)

    Felder, Stefan

    2009-09-01

    Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining the profit risk of the hospitals. In most DRG systems, this threshold increases with the standard deviation of the LOS distribution. The present paper addresses the adequacy of this DRG outlier threshold rule for risk-averse hospitals with preferences depending on the expected value and the variance of profits. It first shows that the optimal threshold solves the hospital's tradeoff between higher profit risk and lower premium loading payments. It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation.

  19. [Changing the internal cost allocation (ICA) on DRG shares : Example of computed tomography in a university radiology setting].

    Science.gov (United States)

    Wirth, K; Zielinski, P; Trinter, T; Stahl, R; Mück, F; Reiser, M; Wirth, S

    2016-08-01

    In hospitals, the radiological services provided to non-privately insured in-house patients are mostly distributed to requesting disciplines through internal cost allocation (ICA). In many institutions, computed tomography (CT) is the modality with the largest amount of allocation credits. The aim of this work is to compare the ICA to respective DRG (Diagnosis Related Groups) shares for diagnostic CT services in a university hospital setting. The data from four CT scanners in a large university hospital were processed for the 2012 fiscal year. For each of the 50 DRG groups with the most case-mix points, all diagnostic CT services were documented including their respective amount of GOÄ allocation credits and invoiced ICA value. As the German Institute for Reimbursement of Hospitals (InEK) database groups the radiation disciplines (radiology, nuclear medicine and radiation therapy) together and also lacks any modality differentiation, the determination of the diagnostic CT component was based on the existing institutional distribution of ICA allocations. Within the included 24,854 cases, 63,062,060 GOÄ-based performance credits were counted. The ICA relieved these diagnostic CT services by € 819,029 (single credit value of 1.30 Eurocent), whereas accounting by using DRG shares would have resulted in € 1,127,591 (single credit value of 1.79 Eurocent). The GOÄ single credit value is 5.62 Eurocent. The diagnostic CT service was basically rendered as relatively inexpensive. In addition to a better financial result, changing the current ICA to DRG shares might also mean a chance for real revenues. However, the attractiveness considerably depends on how the DRG shares are distributed to the different radiation disciplines of one institution.

  20. Nf2-Yap signaling controls the expansion of DRG progenitors and glia during DRG development.

    Science.gov (United States)

    Serinagaoglu, Yelda; Paré, Joshua; Giovannini, Marco; Cao, Xinwei

    2015-02-01

    Molecular mechanisms governing the maintenance and proliferation of dorsal root ganglia (DRG) progenitors are largely unknown. Here we reveal that the Hippo pathway regulates the expansion of DRG progenitors and glia during mammalian DRG development. The key effectors of this pathway, transcriptional coactivators Yap and Taz, are expressed in DRG progenitors and glia during DRG development but are at least partially inhibited from activating transcription. Aberrant YAP activation leads to overexpansion of DRG progenitor and glial populations. We further show that the Neurofibromatosis 2 (Nf2) tumor suppressor inhibits Yap during DRG development. Loss of Nf2 leads to similar phenotypes as does YAP hyperactivation, and deleting Yap suppresses these phenotypes. Our study demonstrates that Nf2-Yap signaling plays important roles in controlling the expansion of DRG progenitors and glia during DRG development. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. [Cases and duration of mechanical ventilation in German hospitals : An analysis of DRG incentives and developments in respiratory medicine].

    Science.gov (United States)

    Biermann, A; Geissler, A

    2016-09-01

    Diagnosis-related groups (DRGs) have been used to reimburse hospitals services in Germany since 2003/04. Like any other reimbursement system, DRGs offer specific incentives for hospitals that may lead to unintended consequences for patients. In the German context, specific procedures and their documentation are suspected to be primarily performed to increase hospital revenues. Mechanical ventilation of patients and particularly the duration of ventilation, which is an important variable for the DRG-classification, are often discussed to be among these procedures. The aim of this study was to examine incentives created by the German DRG-based payment system with regard to mechanical ventilation and to identify factors that explain the considerable increase of mechanically ventilated patients in recent years. Moreover, the assumption that hospitals perform mechanical ventilation in order to gain economic benefits was examined. In order to gain insights on the development of the number of mechanically ventilated patients, patient-level data provided by the German Federal Statistical Office and the German Institute for the Hospital Remuneration System were analyzed. The type of performed ventilation, the total number of ventilation hours, the age distribution, mortality and the DRG distribution for mechanical ventilation were calculated, using methods of descriptive and inferential statistics. Furthermore, changes in DRG-definitions and changes in respiratory medicine were compared for the years 2005-2012. Since the introduction of the DRG-based payment system in Germany, the hours of ventilation and the number of mechanically ventilated patients have substantially increased, while mortality has decreased. During the same period there has been a switch to less invasive ventilation methods. The age distribution has shifted to higher age-groups. A ventilation duration determined by DRG definitions could not be found. Due to advances in respiratory medicine, new

  2. Examination of changes in pathology tests ordered by Diagnosis-Related Group (DRGs) following CPOE introduction.

    Science.gov (United States)

    Vecellio, Elia; Georgiou, Andrew; Toouli, George; Eigenstetter, Alex; Li, Ling; Wilson, Roger; Westbrook, Johanna I

    2013-01-01

    Electronic test ordering, via the Electronic Medical Record (EMR), which incorporates computerised provider order entry (CPOE), is widely considered as a useful tool to support appropriate pathology test ordering. Diagnosis-related groups (DRGs) are clinically meaningful categories that allow comparisons in pathology utilisation by patient groups by controlling for many potentially confounding variables. This study used DRG data linked to pathology test data to examine changes in rates of test ordering across four years coinciding with the introduction of an EMR in six hospitals in New South Wales, Australia. This method generated a list of high pathology utilisation DRGs. We investigated patients with a Chest pain DRG to examine whether tests rates changed for specific test groups by hospital emergency department (ED) pre- and post-EMR. There was little change in testing rates between EDs or between time periods pre- and post-EMR. This is a valuable method for monitoring the impact of EMR and clinical decision support on test order rates.

  3. Implications of DRG Classification in a Bundled Payment Initiative for COPD.

    Science.gov (United States)

    Parekh, Trisha M; Bhatt, Surya P; Westfall, Andrew O; Wells, James M; Kirkpatrick, Denay; Iyer, Anand S; Mugavero, Michael; Willig, James H; Dransfield, Mark T

    2017-12-01

    Institutions participating in the Medicare Bundled Payments for Care Improvement (BPCI) initiative invest significantly in efforts to reduce readmissions and costs for patients who are included in the program. Eligibility for the BPCI initiative is determined by diagnosis-related group (DRG) classification. The implications of this methodology for chronic diseases are not known. We hypothesized that patients included in a BPCI initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. Retrospective observational study. We sought to determine the clinical characteristics and outcomes of Medicare patients admitted to the University of Alabama at Birmingham Hospital with acute exacerbations of COPD between 2012 and 2014 who were included and excluded in a BPCI initiative. Patients were included in the analysis if they were discharged with a COPD DRG or with a non-COPD DRG but with an International Classification of Diseases, Ninth Revision code for COPD exacerbation. Six hundred and ninety-eight unique patients were discharged for an acute exacerbation of COPD; 239 (34.2%) were not classified into a COPD DRG and thus were excluded from the BPCI initiative. These patients were more likely to have intensive care unit (ICU) admissions (63.2% vs 4.4%, respectively; P initiative. They also had a longer ICU length of stay (5.2 vs 1.8 days; P = .011), longer hospital length of stay (10.3 days vs 3.9 days; P initiative led to the exclusion of more than one-third of patients with acute exacerbations who had more severe illness and worse outcomes and who may benefit most from the additional interventions provided by the initiative.

  4. [Diagnosis-related groups as an instrument to develop suitable case-based lump sums in hematology and oncology].

    Science.gov (United States)

    Thalheimer, Markus

    2011-01-01

    In 2003 a new reimbursement system was established for German hospitals. The approximately 17 million inpatient cases per year are now reimbursed based on a per-case payment regarding diagnoses and procedures, which was developed from an internationally approved system. The aim was a better conformity of costs and efforts in in-patient cases. In the first 2 years after implementation, the German diagnosis-related group (DRG) system was not able to adequately represent the complex structures of treatment in hematological and oncological in-patients. By creating new diagnoses and procedures (International Classification of Diseases 10 (ICD-10) and Surgical Operations and Procedures Classification System (OPS) catalogues), generating new DRGs and better splitting of existing ones, the hematology and oncology field could be much better described in the following years. The implementation of about 70 'co-payment structures' for new and expensive drugs and procedures in oncology was also crucial. To reimburse innovations, an additional system of co-payments for innovations was established to bridge the time until innovations are represented within the DRG system itself. In summary, hematological and oncological in-patients, including cases with extraordinary costs, are meanwhile well mapped in the German reimbursement system. Any tendencies to rationing could thereby be avoided, as most of the established procedures and costly drugs are adequately represented in the DRG system. Copyright © 2011 S. Karger AG, Basel.

  5. [Comparison of hand surgery in the German and Italian DRG systems].

    Science.gov (United States)

    Lotter, O; Dolderer, J; Stahl, S; Atzei, A; Haerle, M; Schaller, H E

    2011-12-01

    Diagnosis-related groups (DRGs) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis we compared the Italian and the German DRG systems regarding hand surgery with an emphasis on reimbursement of clinical cases. The 15 most common hand surgical diagnoses and their corresponding operative treatment in our clinic in 2009 were processed using a DRG grouper. The underlying data were transferred to the Italian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The latter was adjusted and corrected by the purchasing power of each country. The mean of the upper threshold of length of stay was 10 days in the German as well as the Italian system whereas the median was 2 times higher in Italy (6 vs. 12 days). Fifteen out of 19 cases showed higher reimbursement in Germany. The case mix index (CMI) of 0.917 in Germany represents a mean payment of 2,676 € per case. In Italy the hypothetical CMI of 0.635 resulted in a mean reimbursement of 1,853 € per case. The biggest difference in remuneration could be found for replantation of multiple fingers. For this service the German health-care system pays 12,320 € more than the Italian. Total proceeds of the top 15 diagnoses applying the number of cases treated in our clinic revealed 1.7 million € in the German and 1.2 million € in the Italian DRG system. Considering the purchasing power utilizing consumer prize parities, the difference of reimbursement between the countries decreased to 300,000 €. There is no mean length of stay per DRG in Italy, only the upper threshold of length of stay is determined. In most cases the latter is higher in Italy compared to Germany. The consumption of resources for finger replantation is not adequately represented in the Italian DRG system compared to finger amputation. Reimbursement of inpatient care is influenced by multiple factors not being subject

  6. Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?

    Science.gov (United States)

    McNutt, Robert; Johnson, Tricia J; Odwazny, Richard; Remmich, Zachary; Skarupski, Kimberly; Meurer, Steven; Hohmann, Samuel; Harting, Brian

    2010-01-01

    In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. The primary objectives were to estimate the proportion of cases that change MS-DRG assignment when HACs are removed from the calculation, the subsequent changes in reimbursement to hospitals, and the attenuation in changes in MS-DRG assignment after factoring in those that may be POA. Last, we explored the effect of the numbers of ICD-9-CM diagnosis codes on MS-DRG assignment. We obtained 2 years of discharge data from academic medical centers that were members of the University Health System Consortium and identified all cases with 1 of 7 HACs coded through ICD-9-CM diagnosis codes. We calculated the MS-DRG for each case with and without the HAC and, hence, the proportion where MS-DRG assignment changed. Next, we used a bootstrap method to calculate the range in the proportion of cases changing assignment to account for POA status. Changes in reimbursement were estimated by using the 2008 MS-DRG weights payment formula. Of 184,932 cases with at least 1 HAC, 27.6% (n = 52,272) would experience a change in MS-DRG assignment without the HAC factored into the assignment. After taking into account those conditions that were potentially POA, 7.5% (n = 14,176) of the original cases would change MS-DRG assignment, with an average loss in reimbursement per case ranging from $1548 with a catheter-associated urinary tract infection to $7310 for a surgical site infection. These reductions would translate into a total reimbursement loss of $50 261,692 (range: $38 330,747-$62 344,360) for the 86

  7. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

    Science.gov (United States)

    Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

    2012-10-01

    To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (pDRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. [Is surgical education associated with additional costs? A controlled economic study on the German DRG System for primary TKA].

    Science.gov (United States)

    Göbel, P; Piesche, K; Randau, T; Wimmer, M D; Wirtz, D C; Gravius, S

    2013-04-01

    Total knee arthroplasty (TKA) is one of the most common procedures in orthopaedic surgery, the cost of surgical training has as yet not been quantified. In a pilot study, we investigated the economic impact of surgical training under DRG system influences, analysing the cost-proceeds structure in surgical training for orthopaedic residents. Consecutive TKAs were performed by the most educated surgeon (Group A) having implanted ≥ 1000 TKAs, another attending (Group B) with ≥ 200 TKAs and a resident (Group C) having assisted in 25 TKAs (n = 30 patients per Group A-C). All patients were embedded in a standardised clinical pathway. By analysing the costs parameters such as numbers of blood transfusions, the operating time and the length of stay in the hospital we investigated the health care-related costs matched to the DRG-based financial refunding. Data were analysed after undergoing a analysis of variance followed by a post-hoc Scheffé procedure. On the one hand the resident generated additional costs of 1111,7 ± 97 € in comparison to the Group A surgeon and 1729,8 ± 152 € compared to the attending Group B (p > 0,05), these were generated by longer stay in hospital, longer operation time and higher need of resources. On the other hand there were significantly higher proceeds of the Group C in comparison to the attending Group B and also to Group A: 474,78 ± 82 € vs. A and 150,54 ± 52 € vs. Group B (p DRG. Overall the deficit per patient treated by the resident is 637 ± 77 € vs. Group A and 1579,3 ± 137 € vs. Group B (p > 0,05). The German DRG matrix results in higher profits accounted to the learning surgeon by increased PCCL relevant status and grouping the case to a more profitable DRG. Hereby, the additional costs are only partly redeemed. Surgical education of residents is associated with additional costs for the hospital. These costs have to be redeemed to allow good surgical training for hospitals having good teaching conditions. Georg

  9. [Cost-benefit analysis of cranial computed tomography in mild traumatic brain injury--appropriate depiction within the G-DRG system?].

    Science.gov (United States)

    Garving, C; Weber, C D; Poßelt, S; Pishnamaz, M; Pape, H C; Dienstknecht, T

    2014-06-01

    The treatment of patients with mild head injury is related to a continuous lack of finances. The current investigation summarises radiological costs of patients from a level I trauma centre and discusses the indication for CT scanning within the G-DRG system. The study includes all patients who underwent a CCT scan in 2011. Diagnosis, length of stay and cost data were recorded for every patient. Finally, frequent diagnosis groups were summarised to clusters (Basis-DRG/MDC 21A). A total of 380 patients was treated. Within the largest group (G-DRG B80Z) the costs for a CCT already took up one quarter of the total proceedings. In combination with the high cost for monitoring patients with mild head injuries this causes an ongoing lack of finances. In spite of the often necessary CCT investigation in mild head injuries, the earnings do not cover the costs of the patients. To improve the situation clear guidelines for CCT scanning should be provided and the reimbursement in particular in the diagnosis group of the G-DRG B80Z has to be improved. Georg Thieme Verlag KG Stuttgart · New York.

  10. Impact of the DRG System in Arizona. Hearing before the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session (September 14, 1985, Tucson, AZ).

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    Text of a Congressional hearing held in Tucson, Arizona, to examine health care and the diagnostic related group (DRG) system is presented in this document. Opening statements are delivered by Representatives Kolbe and McCain. Witnesses testifying include: (1) two older Arizona residents who had experienced problems related to diagnostic related…

  11. Why and how did Israel adopt activity-based hospital payment? The Procedure-Related Group incremental reform.

    Science.gov (United States)

    Brammli-Greenberg, Shuli; Waitzberg, Ruth; Perman, Vadim; Gamzu, Ronni

    2016-10-01

    Historically, Israel paid its non-profit hospitals on a perdiem (PD) basis. Recently, like other OECD countries, Israel has moved to activity-based payments. While most countries have adopted a diagnostic related group (DRG) payment system, Israel has chosen a Procedure-Related Group (PRG) system. This differs from the DRG system because it classifies patients by procedure rather than diagnosis. In Israel, the PRG system was found to be more feasible given the lack of data and information needed in the DRG classification system. The Ministry of Health (MoH) chose a payment scheme that depends only on inhouse creation of PRG codes and costing, thus avoiding dependence on hospital data. The PRG tariffs are priced by a joint Health and Finance Ministry commission and updated periodically. Moreover, PRGs are believed to achieve the same main efficiency objectives as DRGs: increasing the volume of activity, shortening unnecessary hospitalization days, and reducing the gaps between the costs and prices of activities. The PRG system is being adopted through an incremental reform that started in 2002 and was accelerated in 2010. The Israeli MoH involved the main players in the hospital market in the consolidation of this potentially controversial reform in order to avoid opposition. The reform was implemented incrementally in order to preserve the balance of resource allocation and overall expenditures of the system, thus becoming budget neutral. Yet, as long as gaps remain between marginal costs and prices of procedures, PRGs will not attain all their objectives. Moreover, it is still crucial to refine PRG rates to reflect the severity of cases, in order to tackle incentives for selection of patients within each procedure. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  12. ["Something humane has been lost". Re-evaluation of the attitudes of senior physicians towards the G-DRG System - a qualitative normative analysis].

    Science.gov (United States)

    Knoll, Marco; Otte, Ina; Salloch, Sabine; Ruiner, Caroline; Kruppa, Esta; Vollmann, Jochen

    2018-04-01

    Only a few years after the implementation of the G-DRG (German Diagnosis Related Group) system physicians already began to complain of its negative effects on the quality of inpatient healthcare. The present study examines the recent experiences senior physicians have made with regard to the impact of the G-DRG system on the quality of healthcare and medical professionalism. Nine qualitative guided expert interviews were conducted focusing on the experiences of physicians in leading positions dealing with the G-DRG system in their everyday work. The interviewees report an intensification of work attributable to an increasing number of inpatient cases, a more lenient definition of medical indications and a reduction in patient retention time. The physicians interviewed have felt increasingly constrained by economic conditions. Additionally, they stated that the G-DRG system's incentive structure encourages the discrimination of older, care-dependent and multimorbid patients. Possible countermeasures include a political revision of incentive regulation as well as a strengthening of up-to-date professional ethical education and teaching. Copyright © 2018. Published by Elsevier GmbH.

  13. [Comparison of pedicle and free tissue transfers in the German DRG system].

    Science.gov (United States)

    Lotter, O; Stahl, S; Hohenstein, C; Schaller, H-E; Jaminet, P

    2011-12-01

    Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. The mean value of the average length of stay was higher in free flaps as compared to pedicle flaps (15 vs. 9 days) and the mean reimbursement in free flaps was almost twice as high as in pedicle flaps (8 936 € vs. 4 582 €). Regarding the diagnosis, third-grade open fractures in pedicle flaps and full-thickness burns in free flaps are in the vanguard of reimbursement. Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Optimizing diagnostic workup in the DRG environment: Dynamic algorithms and minimizing radiologic costs may cost your hospital money

    International Nuclear Information System (INIS)

    Saint-Louis, L.A.; Henschke, C.I.; Balter, S.; Whalen, J.P.; Balter, P.

    1987-01-01

    In certain diagnosis-related group (DRG) categories, the availability of sufficient CT scanners or of new equipment, such as MR equipment, can expedite the definitive workup. This will reduce the average length of stay and hospital cost. We analyzed the total hospital and radiologic charges by DRG category for all patients admitted to our hospital in 1985 and 1986. Although the cost per procedure is relatively high, the radiologic component is a small percentage of total hospital costs (median, 3%; maximum, <10%). The authors developed alternative diagnostic algorithms for radiologic-intensive DRG categories. Different diagnostic algorithms proposed for the same clinical problems were compared analytically in terms of impact on the hospital (cost, equipment availability, and length of stay). An example is the workup for FUO. Traditional approach uses plain x-rays and gallium scans and only uses CT when localizing symptoms are present. An alternative approach is to perform CT only. Although more CT examinations would be required, there is considerable reduction in the length of hospital stay and in overall charges. Neurologic and thoracic workups will be given as examples of classes or problems that can be addressed analytically: sequencing of the workup; prevalence; patient population; resource of allocation; and introduction of new imaging modality

  15. [Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care].

    Science.gov (United States)

    Geuss, S; Jungmeister, A; Baumgart, A; Seelos, R; Ockert, S

    2018-02-01

    In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety. A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality. A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p  0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.

  16. [Comparison between the Austrian and German DRG systems in hand surgery].

    Science.gov (United States)

    Lotter, O; Jaminet, P; Schwarzach, S; Schaller, H E

    2013-02-01

    Diagnosis-Related Groups (DRG) are a patient classification system grouping related types of patients treated to the resources they consumed. In this analysis, we compared the Austrian and the German DRG systems. The 15 most common hand surgical diagnoses and their corresponding operative treatment were transferred into the Austrian system. Thus, the length of stay and the reimbursement of both countries could be obtained and compared. The mean values and the median values of the upper and lower thresholds of length of stay as well as the average length of stay were all lower in Austria compared to Germany. Reimbursement in Germany was higher in 13 of 19 cases. Total proceeds amounted to 1.67 million in the German and 1.70 million in the Austrian health care system. Considering the purchasing power applying consumer prize parities, the difference of reimbursement between the countries rose to 130,000 which equals a difference of almost 8%. Reimbursement of the top 15 diagnoses in hand surgery in Austria is 8% higher than in Germany. Except for one case, mean values as well as upper and lower thresholds of length of stay are considerably shorter in Austria. Comparison of international data to refine a national compensation system is advocated.

  17. [Financing of inpatient orthopaedics and trauma surgery in the 2011 G-DRG System].

    Science.gov (United States)

    Franz, D; Schemmann, F; Roeder, N; Siebert, H; Mahlke, L

    2011-09-01

    The German DRG system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also copayments. This paper analyses and evaluates the relevant developments of the 2011 G-DRG system for orthopaedics and traumatology from the medical and classificatory perspective. An analysis was performed of relevant diagnoses, medical procedures and G-DRGs in the 2010 and 2011 versions based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). A number of codes for surgical measures have been newly established or modified - above all in foot surgery, arthroscopic surgery and wound surgery. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopaedics and traumatology is changed, especially for polytraumata. The allocation of common cases with a standardized treatment pattern appears to be appropriate and the reimbursement adequate. For the less common and more complex cases the 2011 G-DRG system still shows need for further modification (e.g. polytraumata, joint replacement, spine surgery). The proper integration of the modified OPS classification for foot surgery to the appropriate G-DRGs will be essential to maintain the high quality of the reimbursement structure for the future.

  18. Group & Intergroup Relations in Living Human Systems.

    Science.gov (United States)

    1980-06-01

    organizational diagnosis , the group is itself a living human system. A group may be underbounded, overbounded, or optimally bounded. The state of group...very im- portant to understand and to use in order to conduct organizational diagnosis " using group methods. 2 -43 (Alderfer, 1977b). The group...Boundary Relations and Organizational Diagnosis . In H. Meltzer and F.W. Wickert (eds.) Humanizing Organizational Behavior. Springfield, Illinois: Thomas

  19. How recalibration method, pricing, and coding affect DRG weights

    Science.gov (United States)

    Carter, Grace M.; Rogowski, Jeannette A.

    1992-01-01

    We compared diagnosis-related group (DRG) weights calculated using the hospital-specific relative-value (HSR V) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross-subsidization. HSR V weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSR V weights is counterbalanced by the fact that more high-weight cases qualify as outliers. PMID:10127456

  20. Hysterectomy in Germany: a DRG-based nationwide analysis, 2005-2006.

    Science.gov (United States)

    Stang, Andreas; Merrill, Ray M; Kuss, Oliver

    2011-07-01

    Hysterectomy is among the more common surgical procedures in gynecology. The aim of this study was to calculate population-wide rates of hysterectomy across Germany and to obtain information on the different modalities of hysterectomy currently performed in German hospitals. This was done on the basis of nationwide DRG statistics (DRG = diagnosis-related groups) covering the years 2005-2006. We analyzed the nationwide DRG statistics for 2005 and 2006, in which we found 305 015 hysterectomies. Based on these data we calculated hysterectomy rates for the female population. We determined the indications for each hysterectomy with an algorithm based on the ICD-10 codes, and we categorized the operations on the basis of their OPS codes (OPS = Operationen- und Prozedurenschlüssel [Classification of Operations and Procedures]). The overall rate of hysterectomy in Germany was 362 per 100 000 person-years. 55% of hysterectomies for benign diseases of the female genital tract were performed transvaginally. Bilateral ovariectomy was performed concomitantly in 23% of all hysterectomies, while 4% of all hysterectomies were subtotal. Hysterectomy rates varied considerably across federal states: the rate for benign disease was lowest in Hamburg (213.8 per 100 000 women per year) and highest in Mecklenburg-West Pomerania (361.9 per 100 000 women per year). Hysterectomy rates vary markedly from one region to another. Moreover, even though recent studies have shown that bilateral ovariectomy is harmful to women under 50 who undergo hysterectomy for benign disease, it is still performed in 4% of all hysterectomies for benign indications in Germany.

  1. [Quality of case allocation of orthopedics and trauma surgery in the 2004 and 2014 versions of the German DRG system. An interim assessment of the development process].

    Science.gov (United States)

    Franz, D; Schemmann, F; Selter, D D; Auhuber, T; Gehweiler, D; Roeder, N; Siebert, H; Mahlke, L

    2014-10-01

    Since 2004 the German diagnosis-related groups (DRG) system has been applied nationwide in all German somatic hospitals. The G-DRG system is updated annually in order to increase the quality of case allocation. What developments have occurred since 2004 from the perspective of orthopedics and trauma surgery? This article takes stock of the developments between 2004 and 2014. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2004 and 2014 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). The number of G-DRGs in the whole system increased by 45.1 % between 2004 and 2014. The number of G-DRGs in the major diagnostic category (MDC) 08 that contains the majority of orthopedic and trauma surgery categories increased in the same period by 61.6 %. The reduction of variance of inlier costs in the MDC 08 category, a statistical measure of the performance of the G-DRG system, was below the corresponding value of the total system in 2004 as well in 2014. However, the reduction of variance of inlier costs in MDC 08 (+ 30.0 %) rose more from 2004 to 2014 than the corresponding value of the overall system (+ 21.5 %). Many modifications of the classification systems of diagnoses (ICD-10-GM) and medical procedures (OPS) and the structures of the G-DRG system could significantly improve the quality of case allocation from the perspective of orthopedics and trauma surgery between 2004 and 2014. Th assignment of cases could be differentiated so that complex cases with more utilization of resources were allocated to higher rated G-DRGs and vice versa. However, further improvements of the G-DRG system are necessary. Only correct and complete documentation and coding can provide a high quality of calculation of costs as a basis for a correct case allocation in future G-DRG systems.

  2. [Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system].

    Science.gov (United States)

    Schnabel, M; Mann, D; Efe, T; Schrappe, M; V Garrel, T; Gotzen, L; Schaeg, M

    2004-10-01

    The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

  3. The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

    Science.gov (United States)

    Yan, Yu-Hua; Kung, Chih-Ming; Chen, Yi

    2017-11-09

    This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

  4. The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups

    Directory of Open Access Journals (Sweden)

    Yu-Hua Yan

    2017-11-01

    Full Text Available Abstract Background This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs on medical resource utilization in inguinal hernia repair (IHR in hospitals with different ownership to provide suitable reference information for hospital administrators. Methods The 2010–2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. Results There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case was more efficient than that in the public hospital (US$902.7/case or nonprofit proprietary hospital (US$817.1/case surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%, while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Conclusions Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

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

    Science.gov (United States)

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

    2014-01-01

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

  6. Using Focus Group Research in Public Relations.

    Science.gov (United States)

    Grunig, Larissa A.

    1990-01-01

    Analyzes a recent instance of focus group research applied to a public relations case (rather than a marketing case). Reviews the advantages and disadvantages of this qualitative method, and describes the case of a county department of mental health relying on focus group research to help plan a program aimed at reducing the stigma of mental…

  7. [Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions].

    Science.gov (United States)

    Riessen, R; Hermes, C; Bodmann, K-F; Janssens, U; Markewitz, A

    2018-02-01

    The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

  8. Dental health economics and diagnosis related groups/casemix in Indonesian dentistry

    Directory of Open Access Journals (Sweden)

    Ronnie Rivany

    2009-12-01

    Full Text Available Background: Dental Health Economics is a branch of transdiciplinary science that refers to the Economic and Public Health science. On the other hand, in other developed countries, Diagnosis Related Groups (DRG’s /Casemix has been used as a basic in creating the same perception between providers, patients and insurance companies in many aspects such as health planning, healthcare financing and quality assurance. Purpose: The objective of this review is to propose a new paradigm of economics to be applied in Indonesian Dentistry. Reviews: The Dental Health Economics should be considered as an important aspect in Indonesian Dentistry, which is used to determine the dental treatment fee based on unit cost, cost containment, and cost recovery rate analysis. Referring to Australian Refined Diagnosis Related Group, health care industry in Indonesia has starting to try a more structured way in grouping disease pattern in order to come up with more precise health care services to their patients. The on going development of Indonesian DRG’s is meant to confirm the disease pattern and partition. Conclusion: The development of Indonesian DRG’s concept, especially the Dental & Oral Disorders, needs a new paradigm, so the practitioners and academics could group and calculate the unit cost from each dental treatment according to the Indonesian DRG version (INA-DRG’s.

  9. [Innovative culture and diagnosis related groups in a high complexity hospital, Colombia].

    Science.gov (United States)

    Gorbanev, Iouri; Agudelo-Londoño, Sandra; Cortes, Ariel; Yepes, Francisco J

    2016-04-01

    Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.

  10. 42 CFR 412.515 - LTC-DRG weighting factors.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false LTC-DRG weighting factors. 412.515 Section 412.515 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE...-Term Care Hospitals § 412.515 LTC-DRG weighting factors. For each LTC-DRG, CMS assigns an appropriate...

  11. Adult Mouse DRG Explant and Dissociated Cell Models to Investigate Neuroplasticity and Responses to Environmental Insults Including Viral Infection.

    Science.gov (United States)

    Fornaro, Michele; Sharthiya, Harsh; Tiwari, Vaibhav

    2018-03-09

    This protocol describes an ex vivo model of mouse-derived dorsal root ganglia (DRG) explant and in vitro DRG-derived co-culture of dissociated sensory neurons and glial satellite cells. These are useful and versatile models to investigate a variety of biological responses associated with physiological and pathological conditions of the peripheral nervous system (PNS) ranging from neuron-glial interaction, neuroplasticity, neuroinflammation, and viral infection. The usage of DRG explant is scientifically advantageous compared to simplistic single cells models for multiple reasons. For instance, as an organotypic culture, the DRG explant allows ex vivo transfer of an entire neuronal network including the extracellular microenvironment that play a significant role in all the neuronal and glial functions. Further, DRG explants can also be maintained ex vivo for several days and the culture conditions can be perturbed as desired. In addition, the harvested DRG can be further dissociated into an in vitro co-culture of primary sensory neurons and satellite glial cells to investigate neuronal-glial interaction, neuritogenesis, axonal cone interaction with the extracellular microenvironment, and more general, any aspect associated with the neuronal metabolism. Therefore, the DRG-explant system offers a great deal of flexibility to study a wide array of events related to biological, physiological, and pathological conditions in a cost-effective manner.

  12. The Effects of IGF-1 on Trk Expressing DRG Neurons with HIV-gp120- Induced Neurotoxicity.

    Science.gov (United States)

    Li, Hao; Liu, Zhen; Chi, Heng; Bi, Yanwen; Song, Lijun; Liu, Huaxiang

    2016-01-01

    HIV envelope glycoprotein gp120 is the main protein that causes HIVassociated sensory neuropathy. However, the underlying mechanisms of gp120-induced neurotoxicity are still unclear. There are lack effective treatments for relieving HIV-related neuropathic symptoms caused by gp120-induced neurotoxicity. In the present study, tyrosine kinase receptor (Trk)A, TrkB, and TrkC expression in primary cultured dorsal root ganglion (DRG) neurons with gp120-induced neurotoxicity was investigated. The effects of IGF-1 on distinct Trk-positive DRG neurons with gp120-induced neurotoxicity were also determined. The results showed that gp120 not only dose-dependently induced DRG neuronal apoptosis and inhibited neuronal survival and neurite outgrowth, but also decreased distinct Trk expression levels. IGF-1 rescued DRG neurons from apoptosis and improved neuronal survival of gp120 neurotoxic DRG neurons in vitro. IGF-1 also improved TrkA and TrkB, but not TrkC, expression in gp120 neurotoxic conditions. The effects of IGF-1 could be blocked by preincubation with the phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002. These results suggested that gp120 may have a wide range of neurotoxicity on different subpopulations of DRG neurons, while IGF-1 might only relieve some subpopulations of DRG neurons with gp120-induced neurotoxicity. These data provide novel information of mechanisms of gp120 neurotoxicity on primary sensory neurons and the potential therapeutic effects of IGF-1 on gp120-induced neurotoxicity.

  13. The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

    Science.gov (United States)

    Antioch, Kathryn M; Walsh, Michael K

    2004-06-01

    Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

  14. Policy trends and reforms in the German DRG-based hospital payment system.

    Science.gov (United States)

    Klein-Hitpaß, Uwe; Scheller-Kreinsen, David

    2015-03-01

    A central structural point in all DRG-based hospital payment systems is the conversion of relative weights into actual payments. In this context policy makers need to address (amongst other things) (a) how the price level of DRG-payments from one period to the following period is changed and (b) whether and how hospital payments based on DRGs are to be differentiated beyond patient characteristics, e.g. by organizational, regional or state-level factors. Both policy problems can be and in international comparison often are empirically addressed. In Germany relative weights are derived from a highly sophisticated empirical cost calculation, whereas the annual changes of DRG-based payments (base rates) as well as the differentiation of DRG-based hospital payments beyond patient characteristics are not empirically addressed. Rather a complex set of regulations and quasi-market negotiations are applied. There were over the last decade also timid attempts to foster the use of empirical data to address these points. However, these reforms failed to increase the fairness, transparency and rationality of the mechanism to convert relative weights into actual DRG-based hospital payments. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Using DRG to analyze hospital production: a re-classification model based on a linear tree-network topology

    Directory of Open Access Journals (Sweden)

    Achille Lanzarini

    2014-09-01

    Full Text Available Background: Hospital discharge records are widely classified through the Diagnosis Related Group (DRG system; the version currently used in Italy counts 538 different codes, including thousands of diagnosis and procedures. These numbers reflect the considerable effort of simplification, yet the current classification system is of little use to evaluate hospital production and performance.Methods: As the case-mix of a given Hospital Unit (HU is driven by its physicians’ specializations, a grouping of DRGs into a specialization-driven classification system has been conceived through the analysis of HUs discharging and the ICD-9-CM codes. We propose a three-folded classification, based on the analysis of 1,670,755 Hospital Discharge Cards (HDCs produced by Lombardy Hospitals in 2010; it consists of 32 specializations (e.g. Neurosurgery, 124 sub-specialization (e.g. skull surgery and 337 sub-sub-specialization (e.g. craniotomy.Results: We give a practical application of the three-layered approach, based on the production of a Neurosurgical HU; we observe synthetically the profile of production (1,305 hospital discharges for 79 different DRG codes of 16 different MDC are grouped in few groups of homogeneous DRG codes, a more informative production comparison (through process-specific comparisons, rather than crude or case-mix standardized comparisons and a potentially more adequate production planning (considering the Neurosurgical HUs of the same city, those produce a limited quote of the whole neurosurgical production, because the same activity can be realized by non-Neurosugical HUs.Conclusion: Our work may help to evaluate the hospital production for a rational planning of available resources, blunting information asymmetries between physicians and managers. 

  16. Allotransplanted DRG neurons or Schwann cells affect functional recovery in a rodent model of sciatic nerve injury.

    Science.gov (United States)

    Dayawansa, Samantha; Wang, Ernest W; Liu, Weimin; Markman, John D; Gelbard, Harris A; Huang, Jason H

    2014-11-01

    In this study, the functional recoveries of Sprague-Dawley rats following repair of a complete sciatic nerve transection using allotransplanted dorsal root ganglion (DRG) neurons or Schwann cells were examined using a number of outcome measures. Four groups were compared: (1) repair with a nerve guide conduit seeded with allotransplanted Schwann cells harvested from Wistar rats, (2) repair with a nerve guide conduit seeded with DRG neurons, (3) repair with solely a nerve guide conduit, and (4) sham-surgery animals where the sciatic nerve was left intact. The results corroborated our previous reported histology findings and measures of immunogenicity. The Wistar-DRG-treated group achieved the best recovery, significantly outperforming both the Wistar-Schwann group and the nerve guide conduit group in the Von Frey assay of touch response (P DRG and Wistar-Schwann seeded repairs showed lower frequency and severity in an autotomy measure of the self-mutilation of the injured leg because of neuralgia. These results suggest that in complete peripheral nerve transections, surgical repair using nerve guide conduits with allotransplanted DRG and Schwann cells may improve recovery, especially DRG neurons, which elicit less of an immune response.

  17. Daidzein induces neuritogenesis in DRG neuronal cultures

    Directory of Open Access Journals (Sweden)

    Yang Shih-Hung

    2012-08-01

    Full Text Available Absract Background Daidzein, a phytoestrogen found in isoflavone, is known to exert neurotrophic and neuroprotective effects on the nervous system. Using primary rat dorsal root ganglion (DRG neuronal cultures, we have examined the potential neurite outgrowth effect of daidzein. Methods Dissociated dorsal root ganglia (DRG cultures were used to study the signaling mechanism of daidzein-induced neuritogenesis by immunocytochemistry and Western blotting. Results In response to daidzein treatment, DRG neurons showed a significant increase in total neurite length and in tip number per neuron. The neuritogenic effect of daidzein was significantly hampered by specific blockers for Src, protein kinase C delta (PKCδ and mitogen-activated protein kinase/extracellular signal-regulated kinase kinases (MEK/ERK, but not by those for estrogen receptor (ER. Moreover, daidzein induced phosphorylation of Src, PKCδ and ERK. The activation of PKCδ by daidzein was attenuated in the presence of a Src kinase inhibitor, and that of ERK by daidzein was diminished in the presence of either a Src or PKCδ inhibitor. Conclusion Daidzein may stimulate neurite outgrowth of DRG neurons depending on Src kinase, PKCδ and ERK signaling pathway.

  18. Is the timing of radiological intervention and treatment day associated with economic outcomes in DRG-financed health care systems: a case study.

    Science.gov (United States)

    Napierala, Christoph; Boes, Stefan

    2017-02-28

    In 2012, Switzerland has introduced a diagnosis related group (DRG) system for hospital financing to increase the efficiency and transparency of hospital services and to reduce costs. However, little is known about the efficiency of specific processes within hospitals. The objective of this study is to describe the relationship between timing of radiological interventions, in particular scan and treatment day, and the length of stay (LOS) compliance in a hospital. This is a cross-sectional observational study based on administrative records of all DRG cases in a Swiss university hospital in 2013, enriched by data from the radiology information system and accounting details. The data are analysed using descriptive statistics and regression methods. Radiology and related treatment on a weekend is associated with a higher LOS compliance of approximately 22.12% (pDRG and attempts to explain how this is linked to standardised operating procedures. Our results have implications regarding potential cost savings in hospital care through alignment of care processes, infrastructure planning and guidance of patient flows.

  19. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital.

    Science.gov (United States)

    Goldfield, Norbert

    2010-01-01

    Policymakers are searching for ways to control health care costs and improve quality. Diagnosis-related groups (DRGs) are by far the most important cost control and quality improvement tool that governments and private payers have implemented. This article reviews why DRGs have had this singular success both in the hospital sector and, over the past 10 years, in ambulatory and managed care settings. Last, the author reviews current trends in the development and implementation of tools that have the key ingredients of DRG success: categorical clinical model, separation of the clinical model from payment weights, separate payment adjustments for nonclinical factors, and outlier payments. Virtually all current tools used to manage health care costs and improve quality do not have these characteristics. This failure explains a key reason for the failure, for example, of the Medicare Advantage program to control health care costs. This article concludes with a discussion of future developments for DRG-type models outside the hospital sector.

  20. Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

    Science.gov (United States)

    Shin, Y S; Yeom, Y K; Hwang, H

    1993-02-01

    This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

  1. Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix.

    Science.gov (United States)

    Ghaffari, S; Doran, C; Wilson, A; Aisbett, C

    2010-05-01

    This paper examines the quality of routinely collected information in an Iranian hospital in a trial of casemix classification. Australian Refined Diagnosis Related Groups (AR-DRG) were used to classify patient episodes. There were 327 DRGs identified, of which 20% had only 1 case. The grouper program identified invalid records for 4% of total separations. Approximately 4.5% of cases were classified into error DRGs and 3.4% were ungroupable. No complication and comorbidity effects were identified with 93% of total cases. R2 (variance in length of stay explained) was 44% for untrimmed cases, increasing to 63%, 57% and 58% after trimming by L3H3, IQR and 10th-95th percentile methods respectively.

  2. Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol

    Science.gov (United States)

    Spirig, Rebecca; Spichiger, Elisabeth; Martin, Jacqueline S.; Frei, Irena Anna; Müller, Marianne; Kleinknecht, Michael

    2014-01-01

    Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. Background: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. Methods/Design: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting

  3. Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.

    Science.gov (United States)

    Spirig, Rebecca; Spichiger, Elisabeth; Martin, Jacqueline S; Frei, Irena Anna; Müller, Marianne; Kleinknecht, Michael

    2014-01-01

    With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings

  4. What can we learn from international comparisons of costs by DRG?

    Science.gov (United States)

    Pirson, M; Schenker, L; Martins, D; Dung, Duong; Chalé, J J; Leclercq, P

    2013-02-01

    The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries. Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries. The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices. It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.

  5. [Hand surgery in the German DRG System 2007].

    Science.gov (United States)

    Franz, D; Windolf, J; Kaufmann, M; Siebert, C H; Roeder, N

    2007-05-01

    Hand surgery often needs only a short length of stay in hospital. Patients' comorbidity is low. Many hand surgery procedures do not need inpatient structures. Up until 2006 special procedures of hand surgery could not be coded. The DRG structure did not separate very complex and less complex operations. Specialized hospitals needed a proper case allocation of their patients within the G-DRG system. The DRG structure concerning hand surgery increased in version 2007 of the G-DRG system. The main parameter of DRG splitting is the complexity of the operation. Furthermore additional criteria such as more than one significant OR procedure, the patients' age, or special diagnoses influence case allocation. A special OPS code for complex cases treated with hand surgery was implemented. The changes in the DRG structure and the implementation of the new OPS code for complex cases establish a strong basis for the identification of different patient costs. Different case allocation leads to different economic impacts on departments of hand surgery. Whether the new OPS code becomes a DRG splitting parameter has to be calculated by the German DRG Institute for further DRG versions.

  6. Group as social microcosm: Within-group interpersonal style is congruent with outside group relational tendencies.

    Science.gov (United States)

    Goldberg, Simon B; Hoyt, William T

    2015-06-01

    The notion that individuals' interpersonal behaviors in the context of therapy reflects their interpersonal behaviors outside of therapy is a fundamental hypothesis underlying numerous systems of psychotherapy. The social microcosm hypothesis, in particular, claims the interpersonal therapy group becomes a reflection of group members' general tendencies, and can thus be used as information about members' interpersonal functioning as well as an opportunity for learning and behavior change. The current study tested this hypothesis using data drawn from 207 individuals participating in 22 interpersonal process groups. Ratings were made on 2 key interpersonal domains (Dominance and Affiliation) at baseline and at Weeks 2, 5, and 8 of the group. Two-level multilevel models (with participants nested within groups) were used to account for the hierarchical structure, and the social relations model (SRM; Kenny, 1994) was used to estimate peer ratings (target effects in SRM) unconfounded with rater bias. Participants showed consensus at all time points during the interpersonal process groups on one another's levels of dominance and affiliation. In addition, self- and peer ratings were stable across time and correlated with one another. Importantly, self-ratings made prior to group significantly predicted ratings (self- and peer) made within the group, with effect sizes within the medium range. Taken together, these results provide robust support for the social microcosm hypothesis and the conjecture that interpersonal style within-group therapy is reflective of broader interpersonal tendencies. (c) 2015 APA, all rights reserved).

  7. Speaking the same language: underestimating financial impact when using diagnosis-related group versus ICD-9-based definitions for trauma inclusion criteria.

    Science.gov (United States)

    Deppe, Sharon; Truax, Christopher B; Opalek, Judy M; Santanello, Steven A

    2009-04-01

    Hospital accounting methods use diagnosis-related group (DRG) data to identify patients and derive financial analyses and reports. The National Trauma Data Bank and trauma programs identify patients with trauma by International Classification of Diseases, Ninth Edition (ICD-9)-based definitions for inclusion criteria. These differing methods of identifying patients result in economic reports that vary significantly and fail to accurately identify the financial impact of trauma services. Routine financial data were collected for patients admitted to our Trauma Service from July 1, 2005 to June 30, 2006 using two methods of identifying the cases; by trauma DRGs and by trauma registry database inclusion criteria. The resulting data were compared and stratified to define the financial impact on hospital charges, reimbursement, costs, contribution to margin, downstream revenue, and estimated profit or loss. The results also defined the impact on supporting services, market share and total revenue from trauma admissions, return visits, discharged trauma alerts, and consultations. A total of 3,070 patients were identified by the trauma registry as meeting ICD-9 inclusion criteria. Trauma-associated DRGs accounted for 871 of the 3,070 admissions. The DRG-driven data set demonstrated an estimated profit of $800,000 dollars; the ICD-9 data set revealed an estimated 4.8 million dollar profit, increased our market share, and showed substantial revenue generated for other hospital service lines. Trauma DRGs fail to account for most trauma admissions. Financial data derived from DRG definitions significantly underestimate the trauma service line's financial contribution to hospital economics. Accurately identifying patients with trauma based on trauma database inclusion criteria better defines the business of trauma.

  8. Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia.

    Science.gov (United States)

    Zafirah, S A; Nur, Amrizal Muhammad; Puteh, Sharifa Ezat Wan; Aljunid, Syed Mohamed

    2018-01-25

    The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG ® ) Casemix System in a teaching hospital in Malaysia. Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG ® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG ® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG ® code was RM654,303.91. The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

  9. Relating Functional Groups to the Periodic Table

    Science.gov (United States)

    Struyf, Jef

    2009-01-01

    An introduction to organic chemistry functional groups and their ionic variants is presented. Functional groups are ordered by the position of their specific (hetero) atom in the periodic table. Lewis structures are compared with their corresponding condensed formulas. (Contains 5 tables.)

  10. [The G-DRG system 2008. Relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Hülsemann, J L; Roeder, N

    2008-05-01

    The G-DRG system 2008 once again brings many changes to rheumatological departments in Germany. The following article presents the main general and specific changes in the G-DRG system, as well as in the classification systems for diagnoses and procedures and in invoicing for 2008. Since the G-DRG system is only a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative effects from the system's application. The strain placed on hospitals by the inadequate funding of increased costs needs to be assessed separately from the effects of redistribution by the G-DRG system.

  11. Introduction of a Diagnosis Related Groups’ Case Flat Rate System: Hopes and Fears (einfuerhrng eines drg-fallpauschalensystems - hoffnungen und aengste)

    Science.gov (United States)

    2000-06-01

    Anwendung und Pflege des neuen Systems dienen soil, wenn die entscheidenden Vorgaben bereits durch die Deckelung gegeben sind. Oder denkt man an den...Software und die da- mit verbundenen Lizenzgebuhren, sondern auch in der Folge um die Schulung der Mitarbeiter sowie die Pflege und Weiterentwicklung...sung an die medizinische Entwicklung" sowie von "Verfahren zur laufen- den Pflege des VergOtungssystems" gesprochen. Es mossen jedoch klare

  12. Stress activates pronociceptive endogenous opioid signalling in DRG neurons during chronic colitis.

    Science.gov (United States)

    Guerrero-Alba, Raquel; Valdez-Morales, Eduardo E; Jimenez-Vargas, Nestor N; Lopez-Lopez, Cintya; Jaramillo-Polanco, Josue; Okamoto, Takanobu; Nasser, Yasmin; Bunnett, Nigel W; Lomax, Alan E; Vanner, Stephen J

    2017-12-01

    Psychological stress accompanies chronic inflammatory diseases such as IBD, and stress hormones can exacerbate pain signalling. In contrast, the endogenous opioid system has an important analgesic action during chronic inflammation. This study examined the interaction of these pathways. Mouse nociceptive dorsal root ganglia (DRG) neurons were incubated with supernatants from segments of inflamed colon collected from patients with chronic UC and mice with dextran sodium sulfate (cDSS)-induced chronic colitis. Stress effects were studied by adding stress hormones (epinephrine and corticosterone) to dissociated neurons or by exposing cDSS mice to water avoidance stress. Changes in excitability of colonic DRG nociceptors were measured using patch clamp and Ca 2+ imaging techniques. Supernatants from patients with chronic UC and from colons of mice with chronic colitis caused a naloxone-sensitive inhibition of neuronal excitability and capsaicin-evoked Ca 2+ responses. Stress hormones decreased signalling induced by human and mouse supernatants. This effect resulted from stress hormones signalling directly to DRG neurons and indirectly through signalling to the immune system, leading to decreased opioid levels and increased acute inflammation. The net effect of stress was a change endogenous opioid signalling in DRG neurons from an inhibitory to an excitatory effect. This switch was associated with a change in G protein-coupled receptor excitatory signalling to a pathway sensitive to inhibitors of protein kinase A-protein, phospholipase C-protein and G protein βϒ subunits. Stress hormones block the inhibitory actions of endogenous opioids and can change the effect of opioid signalling in DRG neurons to excitation. Targeting these pathways may prevent heavy opioid use in IBD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Reduction of voltage gated sodium channel protein in DRG by vector mediated miRNA reduces pain in rats with painful diabetic neuropathy.

    Science.gov (United States)

    Chattopadhyay, Munmun; Zhou, Zhigang; Hao, Shuanglin; Mata, Marina; Fink, David J

    2012-03-22

    Painful neuropathy is a common complication of diabetes. Previous studies have identified significant increases in the amount of voltage gated sodium channel isoforms Na(V)1.7 and Na(V)1.3 protein in the dorsal root ganglia (DRG) of rats with streptozotocin (STZ)-induced diabetes. We found that gene transfer-mediated release of the inhibitory neurotransmitters enkephalin or gamma amino butyric acid (GABA) from DRG neurons in diabetic animals reduced pain-related behaviors coincident with a reduction in Na(V)1.7 protein levels in DRG in vivo. To further evaluate the role of Na(V)α subunit levels in DRG in the pathogenesis of pain in diabetic neuropathy, we constructed a non-replicating herpes simplex virus (HSV)-based vector expressing a microRNA (miRNA) against Na(V)α subunits. Subcutaneous inoculation of the miRNA-expressing HSV vector into the feet of diabetic rats to transduce DRG resulted in a reduction in Na(V)α subunit levels in DRG neurons, coincident with a reduction in cold allodynia, thermal hyperalgesia and mechanical hyperalgesia. These data support the role of increased Na(V)α protein in DRG in the pathogenesis of pain in diabetic neuropathy, and provide a proof-of-principle demonstration for the development of a novel therapy that could be used to treat intractable pain in patients with diabetic neuropathy.

  14. [Adjustment of the German DRG system in 2009].

    Science.gov (United States)

    Wenke, A; Franz, D; Pühse, G; Volkmer, B; Roeder, N

    2009-07-01

    The 2009 version of the German DRG system brought significant changes for urology concerning coding of diagnoses, medical procedures and the DRG structure. In view of the political situation and considerable economic pressure, a critical analysis of the 2009 German DRG system is warranted. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). The relevant diagnoses, medical procedures and German DRGs in the versions 2008 and 2009 were analysed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focus on the development of the DRG structure, DRG validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. The German DRG system again gained complexity. High demands are made on correct and complete coding of complex urology cases. The quality of case allocation in the German DRG system was improved. On the one hand some of the old problems (e.g. enterostomata) still persist, while on the other hand new problems evolved out of the attempt to improve the case allocation of highly complex and expensive cases. Time will tell whether the increase in highly specialized DRG with low case numbers will continue to endure and reach acceptable rates of annual fluctuations.

  15. Study of the damage rate caused by intervertebral foramen type inside and outside and the pass of the intervertebral DRG RF puncture way.

    Science.gov (United States)

    Sun, Jiashu; Zhang, Haitao

    2014-09-01

    This paper was to analyze and contrast the damage rate on the thoracic segment different position of the dorsal root ganglion(dorsal root ganglion, DRG) caused by different puncture path in radiofrequency ablation, thus the best RF target way for the thoracic segment of different types of DRG was confirmed. According to the difference of puncture and ablation damage way, 14 segmental spinal specimens were randomly divided into three groups, and then conducted DRG radiofrequency damage on percutaneous puncture path according to the type of DRG position.The damage effect of different puncture path by the judgment standard of the result of pathology analyzed. The experiment showed that RF damage of group A were 72.58 ± 18.88%, 54.16 ± 24.84% and 32.85 ± 28.11%; that of group B were 771.86 ± 15.15% and 72.02 ± 17.86%, 57.14 ± 18.02% and 52.47 ± 20.64%, 68.75 ± 14.63% and 71.78 ± 16.00%; and that of group C were 82.46 ± 14.10%, 81.53 ± 11.81% and 80.83 ± 13.33%. It was concluded that the singleness of DRG puncture route is one of the important reasons for the poor thoracic segments DRG radiofrequency (RF) ablation effect. While according to the type of DRG different positions with double joint puncture path can significantly improve the rate of DRG RF damage.

  16. [How does the German DRG system differentiate and reimburse vitreoretinal surgery in diabetic patients?].

    Science.gov (United States)

    Krause, M; Goldschmidt, A J; Berg, M; Kropf, S; Sachs, A; Gatzioufas, Z; Brückner, K; Seitz, B

    2008-10-01

    The German DRG system (G-DRG system) is required to assign medical cases with similar costs correctly into a particular group, each case within the group receiving the same amount of reimbursement. At the same time the system should allow all-inclusive reimbursement, not necessarily reflecting the exact costs of each case. These opposite goals and the so far limited calculation basis raise the question of how the G-DRG system actually processes and reimburses empirically collected in-hospital treatment data. In 2005, 112 patients were admitted to the University Eye Hospital, University of the Saarland. All patients had diabetic retinopathy and required at least one vitreoretinal procedure. Demographic and clinical data were collected by using the hospital information system and the coding software KODIP. For statistic evaluation, principal diagnoses, ancillary diagnoses and procedures were each reassigned to particular groups. Reimbursement was calculated based on the case data of the year 2005. Also, the case data were reassigned with respect to calculation of reimbursement for the years 2006 and 2007. The results were compared with federal G-DRG calculation data. Mean age of the patients was 65.8 +/- 11.1 years, length of stay in-hospital was 9.3 +/- 3.2 days. In the 66 patients requiring general anaesthesia the cumulative length of stay in the operation room was 148.4 +/- 39.5 minutes, the cumulative duration of surgery was 86.3 +/- 34.1 minutes. In the 50 patients requiring local anaesthesia the cumulative length of stay in the operation room was 137.8 +/- 51.8 minutes, the cumulative duration of surgery was 81.6 +/- 43.6 minutes. The patients had 1.9 +/- 0.8 principal diagnoses, 14.4 +/- 5.8 ancillary diagnoses and 3.4 +/- 1.6 procedures. Twenty-five of 112 patients (22.3 %) were assigned to DRG C 03Z (1), 82 of 112 patients (73.2 %) were assigned to DRG C 17Z (2). Five patients were assigned to other DRG. Compared with the federal calculation data, our own

  17. CFTR mediates noradrenaline-induced ATP efflux from DRG neurons.

    Science.gov (United States)

    Kanno, Takeshi; Nishizaki, Tomoyuki

    2011-09-24

    In our earlier study, noradrenaline (NA) stimulated ATP release from dorsal root ganglion (DRG) neurons as mediated via β(3) adrenoceptors linked to G(s) protein involving protein kinase A (PKA) activation, to cause allodynia. The present study was conducted to understand how ATP is released from DRG neurons. In an outside-out patch-clamp configuration from acutely dissociated rat DRG neurons, single-channel currents, sensitive to the P2X receptor inhibitor PPADS, were evoked by approaching the patch-electrode tip close to a neuron, indicating that ATP is released from DRG neurons, to activate P2X receptor. NA increased the frequency of the single-channel events, but such NA effect was not found for DRG neurons transfected with the siRNA to silence the cystic fibrosis transmembrane conductance regulator (CFTR) gene. In the immunocytochemical study using acutely dissociated rat DRG cells, CFTR was expressed in neurons alone, but not satellite cells, fibroblasts, or Schwann cells. It is concluded from these results that CFTR mediates NA-induced ATP efflux from DRG neurons as an ATP channel.

  18. 42 CFR 412.10 - Changes in the DRG classification system.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Changes in the DRG classification system. 412.10... § 412.10 Changes in the DRG classification system. (a) General rule. CMS issues changes in the DRG... after the same date the payment rates are effective. (b) Basis for changes in the DRG classification...

  19. [The G-DRG System 2009--relevant changes for rheumatology].

    Science.gov (United States)

    Fiori, W; Liedtke-Dyong, A; Lakomek, H-J; Buscham, K; Lehmann, H; Liman, W; Fuchs, A-K; Bessler, F; Roeder, N

    2010-05-01

    The following article presents the major general and specific changes in the G-DRG system, in the classification systems for diagnoses and procedures as well as for the billing process for 2010. Since the G-DRG system is primarily a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the changes by applying the G-DRG transition-grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative consequences from the adjustments. In addition, relevant current case law is considered.

  20. [Is DRG Coding too Important to be Left to Physicians? - Evaluation of Economic Efficiency by Health Economists in a University Medical Centre].

    Science.gov (United States)

    Burger, F; Walgenbach, M; Göbel, P; Parbs, S; Neugebauer, E

    2017-04-01

    Background: We investigated and evaluated the cost effectiveness of coding by health care economists in a centre for orthopaedics and trauma surgery in Germany, by quantifying and comparing the financial efficiency of physicians with basic knowledge of the DRG-system with the results of healthcare economists with in-depth knowledge (M.Sc.). In addition, a hospital survey was performed to establish how DRG-coding is being performed and the identity of the persons involved. Material and Methods: In a prospective and controlled study, 200 in-patients were coded by a healthcare economist (study group). Prior to that, the same cases were coded by physicians with basic training in the DRG-system, who made up the control group. All cases were picked randomly and blinded without informing the physicians coding the controls, in order to avoid any Hawthorne effect. We evaluated and measured the effective weighting within the G-DRG, the DRG returns per patient, the overall DRG return, and the additional time needed. For the survey, questionnaires were sent to 1200 German hospitals. The completed questionnaire was analysed using a statistical program. Results: The return difference per patient between controls and the study group was significantly greater (2472 ± 337 €; p DRG case reports was 1277 (2500-62,300). Coding was performed in 69 % of cases by doctors, 19 % by skilled specialists for DRG coding and in 8 % together. Overall satisfaction with the DRG was described by 61 % of respondents as good or excellent. Conclusion: Our prospective and controlled study quantifies the cost efficiency of health economists in a centre of orthopaedics and trauma surgery in Germany for the first time. We provide some initial evidence that health economists can enhance the CMI, the resulting DRG return per patient as well as the overall DRG return. Data from the survey shows that in many hospitals there is great reluctance to leave the coding to specialists only. Georg

  1. Digital Raster Graphics (DRG) UTM NAD 83 Clipped

    Data.gov (United States)

    Kansas Data Access and Support Center — The Digital Raster Graphic (DRG) is a raster image of a scanned USGS topographic map including the collar information, georeferenced to the UTM grid. For display...

  2. Digital Raster Graphics (DRG) UTM NAD 27 Clipped

    Data.gov (United States)

    Kansas Data Access and Support Center — The Digital Raster Graphic (DRG) is a raster image of a scanned USGS topographic map including the collar information, georeferenced to the UTM grid. For display...

  3. Digital Raster Graphics (DRG) UTM NAD 83 County

    Data.gov (United States)

    Kansas Data Access and Support Center — The Digital Raster Graphic (DRG) is a raster image of a scanned USGS topographic map including the collar information, georeferenced to the UTM grid and tiled by...

  4. O desenvolvimento dos "Diagnosis Related Groups"- DRGs. Metodologia de classificação de pacientes hospitalares The development of "Diagnosis Related Groups" - DRGs, a methodology for classifying hospital patients

    Directory of Open Access Journals (Sweden)

    Marina F. Noronha

    1991-06-01

    Full Text Available É descrito o processo de desenvolvimento do sistema de classificação de pacientes internados em hospitais que atendem casos agudos, denominada Diagnosis Relatd Group - DRGs, desenvolvido e difundido por pesquisadores da Universidade de Yale, USA. Esse sistema vem a ser um instrumento que permite a mensuração do produto hospitalar, principalmente sob o ponto de vista gerencial. São apresentadas considerações acerca do que é entendido como produto hospitalar, seguindo nos meandros do desenvolvimento dos primeiros DRGs, até a mais recente revisão do sistema. É descrita sua utilização em alguns países e diversos usos potenciais desse sistema, que abrangem desde o uso para pagamento a instrumento de controle de qualidade.The history of Diagnosis Related Groups (DRG's, a system for classifying patients in acute care hospitals, developed by researchers at Yale University, USA, is reviewed. DRGs are an instrument for measuring the hospital product, primarily from a management viewpoint. Starting with a review of the definitions of hospital product, the article follows the course from the first DRGs through the most recent revision, providing a summary of potential and current applications of the system in several countries, which range from payment mechanism to uses in quality control.

  5. When are emotions related to group-based appraisals? : A comparison between group-based emotions and general group emotions

    NARCIS (Netherlands)

    Kuppens, Toon; Yzerbyt, Vincent Y.

    2014-01-01

    In the literature on emotions in intergroup relations, it is not always clear how exactly emotions are group-related. Here, we distinguish between emotions that involve appraisals of immediate group concerns (i.e., group-based emotions) and emotions that do not. Recently, general group emotions,

  6. [The quality of patient care under the German DRG system using as example the inguinal hernia repair].

    Science.gov (United States)

    Rudroff, C; Schweins, M; Heiss, M M

    2008-02-01

    The DRG system in Germany was introduced to improve and at the same time simplify the reimbursement of costs in German hospitals. Cost effectiveness and economic efficiency were the declared goals. Structural changes and increased competition among different hospitals were the consequences. The effect on the qualitiy of patient care has been discussed with some concern. Furthermore, doubts have been expressed about the correct representation of the various diagnoses and treatments in the coding system and the financial revenue. Inguinal hernia repair serves as an example to illustrate some common problems with the reimbursement in the DRG system. Virtual patients were grouped using a "Web Grouper" and analysed using the cost accounting from the G-DRG-Browser of the InEK. Additionally, the reimbursement for ambulant hernia repair was estimated. The DRG coding did not differentiate the various operative procedures for inguinal hernia repair. They all generated the same revenues. For example, the increased costs for bilateral inguinal hernia repair are not represented in the payment. Furthermore, no difference is made between primary and recurrent inguinal hernia. In the case of a short-term hospital stay, part of the revenue is retained. In the case of ambulatory treatment of inguinal hernia, the reimbursement is by far not a real compensation for the actual costs. The ideal patient in the DRG system suffers from a primary inguinal hernia, undergoes an open hernia repair without mesh, and remains for 2-3 days in hospital. Minimally invasive procedures, repair of bilateral inguinal hernia and ambulant operation are by far less profitable--if at all. The current revenues for inguinal hernia repair require improvement and adjustment to reality in order to accomplish the goals which the DRG system in Germany aims at.

  7. Potenciais usos dos AP-DRG para discriminar o perfil da assistência de unidades hospitalares Potential uses of AP-DRG to describe the health care profile in hospital units

    Directory of Open Access Journals (Sweden)

    Marina Ferreira de Noronha

    2004-01-01

    Full Text Available Os All Patient Diagnosis Related Groups (AP-DRG constituem-se em um sistema de classificação de pacientes internados em hospitais gerais, que reúne pacientes em grupos, considerando diversas características com impacto no consumo de recursos hospitalares e critérios clínicos. O AP-DRG tem suas diversas versões utilizadas para a gerência e como unidade de pagamento a hospitais. O objetivo deste artigo foi descrever a classificação, explorando suas potencialidades para gerar informações para a gestão de hospitais. Foi utilizada a base de dados da região de Ribeirão Preto, São Paulo Brasil, de 1997, que inclui unidades hospitalares públicas, privadas e filantrópicas. Foram realizadas comparações entre Ribeirão Preto e Estados Unidos quanto ao tempo médio de permanência hospitalar de AP-DRGs selecionados. Utilizando-se os pesos relacionados ao custo relativo dos DRGs, construídos para o Estado de Nova York, Estados Unidos, foi possível verificar o perfil da atenção prestada por trinta hospitais da região de Ribeirão Preto e também o perfil dos pacientes pagos pelo SUS procedentes de outras localidades. Avalia-se que a classificação fornece informações acerca do perfil de complexidade da atenção hospitalar, tanto no que diz respeito à regionalização e sua organização em níveis de complexidade, como para subsidiar as decisões de composição dessa rede de assistência, auxiliar no seu monitoramento e contribuir para o aprimoramento do pagamento aos hospitais.The All Patient Diagnosis Related Groups (AP-DRG provide a classification system for general hospital inpatients, aggregating hospitalizations based on resource use and clinical criteria. The different versions of the AP-DRG have been applied to inpatient care management and reimbursement. This paper aimed to describe the classification and explore the potential for generating information on inpatient care management based on data from the Ribeirão Preto

  8. DRG and OPS-301: effects on the performed procedure capture in radiology; DRG und OPS-301: Auswirkungen auf die Leistungserfassung in der Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Nissen-Meyer, S.; Wieser, B.; Huber, S.; Wirth, S.; Treitl, M.; Hartmannsgruber, A.; Witt, C.; Kaysser, A.M.; Kuettner, B.; Hoffmann, R.T.; Reiser, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie (Germany); Werner, M. [Siemens AG, Geschaeftsfeld Medizintechnik, Wien (Austria)

    2005-08-01

    Reimbursement for inpatient services rendered based on comparable daily care rates, case-based flat rates, and special fees as practiced until now has been replaced by the system of diagnosis-related groups. Up until 2004, operation and procedure system (OPS 301) codes could be processed completely automatically by appropriate adaptation of the radiology information system (RIS). Because of further differentiation of OPS codes in the 2005 version, it is no longer possible to unambiguously determine OPS codes automatically. Our goal was to fulfill these additional requirements with as little extra effort as possible. In 36 of 2138 procedures during an observation period of 12 days, i.e., 4/day, manual input on the part of the radiology technical assistant and quality assurance by the diagnosing physician were necessary. This is only needed in complicated procedures for which the minor added effort is negligible in comparison to the entire effort expended for the procedure. We were thus able to achieve the goal of near automation of ascertaining OPS codes. (orig.) [German] Die bisherige Erstattung stationaerer Krankenhausleistungen auf Basis tagesgleicher Pflegesaetze, Fallpauschalen und Sonderentgelte ist durch das Diagnosis-related-groups- (DRG-)System abgeloest worden. Operationen- und Prozeduren- (OPS-)Schluessel 301 konnten in der Radiologie bis 2004 mit entsprechender Anpassung des ''Radiologie-Informations-System'' (RIS) vollautomatisiert erfasst werden. Durch die immer feinere Differenzierung der OPS-Codes in der Version 2005 ist eine eindeutige Ermittlung der OPS-Codes jedoch nicht mehr vollautomatisch moeglich. Ziel ist es, diese zusaetzlichen Aufgaben mit so wenig Mehraufwand wie moeglich zu erbringen. Bei 36 von 2138 Verfahren waren in einem Beobachtungszeitraum von 12 Tagen, d. h. 4/Tag, manuelle Eingaben durch die MTRA sowie eine Qualitaetskontrolle durch den befundenden Arzt notwendig. Dies ist nur bei aufwaendigen Verfahren noetig

  9. Inflammation-induced increase in nicotinic acetylcholine receptor current in cutaneous nociceptive DRG neurons from the adult rat.

    Science.gov (United States)

    Zhang, X-L; Albers, K M; Gold, M S

    2015-01-22

    The goals of the present study were to determine (1) the properties of the nicotinic acetylcholine receptor (nAChR) currents in rat cutaneous dorsal root ganglion (DRG) neurons; (2) the impact of nAChR activation on the excitability of cutaneous DRG neurons; and (3) the impact of inflammation on the density and distribution of nAChR currents among cutaneous DRG neurons. Whole-cell patch-clamp techniques were used to study retrogradely labeled DRG neurons from naïve and complete Freund's adjuvant inflamed rats. Nicotine-evoked currents were detectable in ∼70% of the cutaneous DRG neurons, where only one of two current types, fast or slow currents based on rates of activation and inactivation, was present in each neuron. The biophysical and pharmacological properties of the fast current were consistent with nAChRs containing an α7 subunit while those of the slow current were consistent with nAChRs containing α3/β4 subunits. The majority of small diameter neurons with fast current were IB4- while the majority of small diameter neurons with slow current were IB4+. Preincubation with nicotine (1 μM) produced a transient (1 min) depolarization and increase in the excitability of neurons with fast current and a decrease in the amplitude of capsaicin-evoked current in neurons with slow current. Inflammation increased the current density of both slow and fast currents in small diameter neurons and increased the percentage of neurons with the fast current. With the relatively selective distribution of nAChR currents in putative nociceptive cutaneous DRG neurons, our results suggest that the role of these receptors in inflammatory hyperalgesia is likely to be complex and dependent on the concentration and timing of acetylcholine release in the periphery. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  10. Predictors of High Profit and High Deficit Outliers under SwissDRG of a Tertiary Care Center.

    Directory of Open Access Journals (Sweden)

    Tarun Mehra

    Full Text Available Case weights of Diagnosis Related Groups (DRGs are determined by the average cost of cases from a previous billing period. However, a significant amount of cases are largely over- or underfunded. We therefore decided to analyze earning outliers of our hospital as to search for predictors enabling a better grouping under SwissDRG.28,893 inpatient cases without additional private insurance discharged from our hospital in 2012 were included in our analysis. Outliers were defined by the interquartile range method. Predictors for deficit and profit outliers were determined with logistic regressions. Predictors were shortlisted with the LASSO regularized logistic regression method and compared to results of Random forest analysis. 10 of these parameters were selected for quantile regression analysis as to quantify their impact on earnings.Psychiatric diagnosis and admission as an emergency case were significant predictors for higher deficit with negative regression coefficients for all analyzed quantiles (p<0.001. Admission from an external health care provider was a significant predictor for a higher deficit in all but the 90% quantile (p<0.001 for Q10, Q20, Q50, Q80 and p = 0.0017 for Q90. Burns predicted higher earnings for cases which were favorably remunerated (p<0.001 for the 90% quantile. Osteoporosis predicted a higher deficit in the most underfunded cases, but did not predict differences in earnings for balanced or profitable cases (Q10 and Q20: p<0.00, Q50: p = 0.10, Q80: p = 0.88 and Q90: p = 0.52. ICU stay, mechanical and patient clinical complexity level score (PCCL predicted higher losses at the 10% quantile but also higher profits at the 90% quantile (p<0.001.We suggest considering psychiatric diagnosis, admission as an emergency case and admission from an external health care provider as DRG split criteria as they predict large, consistent and significant losses.

  11. Predictors of High Profit and High Deficit Outliers under SwissDRG of a Tertiary Care Center.

    Science.gov (United States)

    Mehra, Tarun; Müller, Christian Thomas Benedikt; Volbracht, Jörk; Seifert, Burkhardt; Moos, Rudolf

    2015-01-01

    Case weights of Diagnosis Related Groups (DRGs) are determined by the average cost of cases from a previous billing period. However, a significant amount of cases are largely over- or underfunded. We therefore decided to analyze earning outliers of our hospital as to search for predictors enabling a better grouping under SwissDRG. 28,893 inpatient cases without additional private insurance discharged from our hospital in 2012 were included in our analysis. Outliers were defined by the interquartile range method. Predictors for deficit and profit outliers were determined with logistic regressions. Predictors were shortlisted with the LASSO regularized logistic regression method and compared to results of Random forest analysis. 10 of these parameters were selected for quantile regression analysis as to quantify their impact on earnings. Psychiatric diagnosis and admission as an emergency case were significant predictors for higher deficit with negative regression coefficients for all analyzed quantiles (p<0.001). Admission from an external health care provider was a significant predictor for a higher deficit in all but the 90% quantile (p<0.001 for Q10, Q20, Q50, Q80 and p = 0.0017 for Q90). Burns predicted higher earnings for cases which were favorably remunerated (p<0.001 for the 90% quantile). Osteoporosis predicted a higher deficit in the most underfunded cases, but did not predict differences in earnings for balanced or profitable cases (Q10 and Q20: p<0.00, Q50: p = 0.10, Q80: p = 0.88 and Q90: p = 0.52). ICU stay, mechanical and patient clinical complexity level score (PCCL) predicted higher losses at the 10% quantile but also higher profits at the 90% quantile (p<0.001). We suggest considering psychiatric diagnosis, admission as an emergency case and admission from an external health care provider as DRG split criteria as they predict large, consistent and significant losses.

  12. Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand.

    Science.gov (United States)

    Annear, Peter Leslie; Kwon, Soonman; Lorenzoni, Luca; Duckett, Stephen; Huntington, Dale; Langenbrunner, John C; Murakami, Yuki; Shon, Changwoo; Xu, Ke

    2018-05-07

    Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand. We reviewed the design of case-based payment systems, their experience with implementation, evidence about impact on service delivery, and lessons drawn for the Asian region. We found that countries must first establish adequate infrastructure, human resource capacity and information management systems. Capping of volumes and prices is sometimes essential along with a high degree of hospital autonomy. Rather than introduce a complete classification system in one stroke, these countries have phased in DRGs, in some cases with hospitals volunteering to participate as a first step (Korea), and in others using a blend of different units for hospital payment, including length of stay, and fee-for-service (Japan). Case-based payment systems are not a panacea. Their value is dependent on their design and implementation and the capacity of the health system. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. [Inpatient Salivary Gland Surgery in Germany: A DRG-Based Nationwide Analysis, 2007-2011].

    Science.gov (United States)

    Jensen, J E; Schlattmann, P; Guntinas-Lichius, O

    2016-09-01

    This is the first population-based analysis of inpatient salivary gland surgery across Germany. Nationwide Diagnosis-Related Groups (DRG) statistics for 2007 to 2011 were analyzed regarding indications for salivary gland surgery based on ICD-10 codes. Age specific surgery rates were calculated for both sexes. Inpatient salivary gland surgical rates in 2007-2011 amounted for incisions (OPS [Classification of Operations and Procedures] code 5-260) 1.43 per 100 000 population, for excisions (5-261) 2.06 per 100 000, for salivary gland resections (5-262) 2.06 per 100 000, and for external incisions (5-270) 0.43 per 100 000. Regarding the mentioned four OPS codes, the surgical rates for benign tumors accounted to 10.08 per 100 000, for sialadenitis (without sialoliths) to 4.00 per 100 000, for malignant tumors to 3.90 per 100 000, and for sialolithiasis to 2.09 per 100 000. The increase of surgical rates from 2007 to 2011 was significant for malignant and benign tumors as well as for salivary stones. The surgical rates were highest for patients>60 years. Especially surgery for malignant tumors was more frequent than expected. In spite of the introduction of minimal invasive technique the rates for salivary gland resections in case of sialadenitis or sialolithiasis still seem to be high. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Nilpotent groups related to an automorphism 1 Introduction

    Indian Academy of Sciences (India)

    29

    The extension of a nilpotent group has been studied by different authors. .... study absolute normal subgroups of some finite groups. ...... follows from the relations ... To prove H3 is absolute normal we should investigate four following cases.

  15. Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: a matrix of ethical implications.

    Science.gov (United States)

    Fourie, Carina; Biller-Andorno, Nikola; Wild, Verina

    2014-04-01

    Swiss hospitals were required to implement a prospective payment system for reimbursement using a diagnosis-related groups (DRGs) classification system by the beginning of 2012. Reforms to a health care system should be assessed for their impact, including their impact on ethically relevant factors. Over a number of years and in a number of countries, questions have been raised in the literature about the ethical implications of the implementation of DRGs. However, despite this, researchers have not attempted to identify the major ethical issues associated with DRGs systematically. To address this gap in the literature, we have developed a matrix for identifying the ethical implications of the implementation of DRGs. It was developed using a literature review, and empirical studies on DRGs, as well as a review and analysis of existing ethics frameworks. The matrix consists of the ethically relevant parameters of health care systems on which DRGs are likely to have an impact; the ethical values underlying these parameters; and examples of specific research questions associated with DRGs to illustrate how the matrix can be applied. While the matrix has been developed in light of the Swiss health care reform, it could be used as a basis for identifying the ethical implications of DRG-based systems worldwide and for highlighting the ethical implications of other kinds of provider payment systems (PPS). Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Pharmaco-economic evaluation of antibiotic therapy strategies in DRG-based healthcare systems - a new approach

    Directory of Open Access Journals (Sweden)

    Wilke MH

    2010-11-01

    Full Text Available Abstract The cost of treatments especially in conditions where multiresistant bacteria are involved are a major issue in times where in most developed countries in the world payment systems based on diagnoses-related-groups (DRG are in place. There is great evidence that especially the length of stay in hospital (LOS, the time in the intensive care unit (ICU-days and the hours of mechanical ventilation (HMV are major cost drivers. While established methods of pharmacoeconomical analyses focus on the efficiency of drugs from healthcare system perspective, these data are often not sufficient for improving treatment strategies in a given hospital context. We developed a system that allows the analysis of patients with severe infections on the basis of routine data that is also used for reimbursement. These data contain a lot of information concerning the clinical conditions. By using the ICD-coding we developed an algorithm which allows the detection of patients with infections and gives information on the potential financial outcome of these patients. By using the analysis it is possible to identify subsets of infections and the patient records that had a potentially negative DRG-result, i.e. the costs are higher than the reimbursement. When identified the patient records undergo a peer review, where the clinical situation and the antibiotic therapy are reviewed by medical experts. In case simulations it is possible to find out if a different therapeutic approach, e.g. by different choices in initial (empirical antibiotic treatment would have caused other outcomes. Data driven analyses together with peer reviews of patient records are a useful tool to examine antibiotic treatment strategies and to establish changes that again can be reviewed on a regular basis. Doing this a continous improvement process can be established in hospitals which can lead to a better balance of clinical and economical outcomes in patients with severe infections

  17. Mouse DRG Cell Line with Properties of Nociceptors.

    Science.gov (United States)

    Doran, Ciara; Chetrit, Jonathan; Holley, Matthew C; Grundy, David; Nassar, Mohammed A

    2015-01-01

    In vitro cell lines from DRG neurons aid drug discovery because they can be used for early stage, high-throughput screens for drugs targeting pain pathways, with minimal dependence on animals. We have established a conditionally immortal DRG cell line from the Immortomouse. Using immunocytochemistry, RT-PCR and calcium microfluorimetry, we demonstrate that the cell line MED17.11 expresses markers of cells committed to the sensory neuron lineage. Within a few hours under differentiating conditions, MED17.11 cells extend processes and following seven days of differentiation, express markers of more mature DRG neurons, such as NaV1.7 and Piezo2. However, at least at this time-point, the nociceptive marker NaV1.8 is not expressed, but the cells respond to compounds known to excite nociceptors, including the TRPV1 agonist capsaicin, the purinergic receptor agonist ATP and the voltage gated sodium channel agonist, veratridine. Robust calcium transients are observed in the presence of the inflammatory mediators bradykinin, histamine and norepinephrine. MED17.11 cells have the potential to replace or reduce the use of primary DRG culture in sensory, pain and developmental research by providing a simple model to study acute nociception, neurite outgrowth and the developmental specification of DRG neurons.

  18. Implementation of DRG Payment in France: issues and recent developments.

    Science.gov (United States)

    Or, Zeynep

    2014-08-01

    In France, a DRG-based payment system was introduced in 2004/2005 for funding acute services in all hospitals with the objectives of improving hospital efficiency, transparency and fairness in payments to public and private hospitals. Despite the initial consensus on the necessity of the reform, providers have become increasingly critical of the system because of the problems encountered during the implementation. In 2012 the government announced its intention to modify the payment model to better deal with its adverse effects. The paper reports on the issues raised by the DRG-based payment in the French hospital sector and provides an overview of the main problems with the French DRG payment model. It also summarises the evidence on its impact and presents recent developments for reforming the current model. DRG-based payment addressed some of the chronic problems inherent in the French hospital market and improved accountability and productivity of health-care facilities. However, it has also created new problems for controlling hospital activity and ensuring that care provided is medically appropriate. In order to alter its adverse effects the French DRG model needs to better align greater efficiency with the objectives of better quality and effectiveness of care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. DSR Theories, Conformal Group and Generalized Commutation Relation

    International Nuclear Information System (INIS)

    Leiva, Carlos

    2006-01-01

    In this paper the relationship of DSR theories and Conformal Group is reviewed. On the other hand, the relation between DSR Magueijo Smolin generators and generalized commutation relations is also shown

  20. When are emotions related to group-based appraisals? A comparison between group-based emotions and general group emotions.

    Science.gov (United States)

    Kuppens, Toon; Yzerbyt, Vincent Y

    2014-12-01

    In the literature on emotions in intergroup relations, it is not always clear how exactly emotions are group-related. Here, we distinguish between emotions that involve appraisals of immediate group concerns (i.e., group-based emotions) and emotions that do not. Recently, general group emotions, measured by asking people how they feel "as a group member" but without specifying an object for these emotions, have been conceptualized as reflecting appraisals of group concerns. In contrast, we propose that general group emotions are best seen as emotions about belonging to a group. In two studies, general group emotions were closely related to emotions that are explicitly measured as belonging emotions. Two further studies showed that general group emotions were not related to appraisals of immediate group concerns, whereas group-based emotions were. We argue for more specificity regarding the group-level aspects of emotion that are tapped by emotion measures. © 2014 by the Society for Personality and Social Psychology, Inc.

  1. The political economy of diagnosis-related groups.

    Science.gov (United States)

    Bertoli, Paola; Grembi, Veronica

    2017-10-01

    A well-established political economic literature has shown as multi-level governance affects the inefficiency of public expenditures. Yet, this expectation has not been empirically tested on health expenditures. We provide a political economy interpretation of the variation in the prices of 6 obstetric DRGs using Italy as a case study. Italy offers a unique institutional setting since its 21 regional governments can decide whether to adopt the national DRG system or to adjust/waive it. We investigate whether the composition and characteristics of regional governments do matter for the average DRG level and, if so, why. To address both questions, we first use a panel fixed effects model exploiting the results of 66 elections between 2000 and 2013 (i.e., 294 obs) to estimate the link between DRGs and the composition and characteristics of regional governments. Second, we investigate these results exploiting the implementation of a budget constraint policy through a difference-in-differences framework. The incidence of physicians in the regional government explains the variation of DRGs with low technological intensity, such as normal newborn, but not of those with high technological intensity, as severely premature newborn. We also observe a decrease in the average levels of DRGs after the budget constraint implementation, but the magnitude of this decrease depends primarily on the presence of physicians among politicians and the political alignment between the regional and the national government. To understand which kind of role the relevance of the political components plays (i.e., waste vs. better defined DRGs), we check whether any of the considered political economy variables have a positive impact on the quality of regional obstetric systems finding no effect. These results are a first evidence that a system of standardized prices, such as the DRGs, is not immune to political pressures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. The Protective Effects of IGF-1 on Different Subpopulations of DRG Neurons with Neurotoxicity Induced by gp120 and Dideoxycytidine In Vitro.

    Science.gov (United States)

    Lu, Lin; Dong, Haixia; Liu, Guixiang; Yuan, Bin; Li, Yizhao; Liu, Huaxiang

    2014-11-01

    Peripheral neuropathy induced by human immunodeficiency virus (HIV) infection and antiretroviral therapy is not only difficult to distinguish in clinical practice, but also difficult to relieve the pain symptoms by analgesics because of the severity of the disease at the later stage. Hence, to explore the mechanisms of HIV-related neuropathy and find new therapeutic options are particularly important for relieving neuropathic pain symptoms of the patients. In the present study, primary cultured embryonic rat dorsal root ganglion (DRG) neurons were used to determine the neurotoxic effects of HIV-gp120 protein and/or antiretroviral drug dideoxycytidine (ddC) and the therapeutic actions of insulin-like growth factor-1 (IGF-1) on gp120- or ddC-induced neurotoxicity. DRG neurons were exposed to gp120 (500 pmol/L), ddC (50 μmol/L), gp120 (500 pmol/L) plus ddC (50 μmol/L), gp120 (500 pmol/L) plus IGF-1 (20 nmol/L), ddC (50 μmol/L) plus IGF-1 (20 nmol/L), gp120 (500 pmol/L) plus ddC (50 μmol/L) plus IGF-1 (20 nmol/L), respectively, for 72 hours. The results showed that gp120 and/or ddC caused neurotoxicity of primary cultured DRG neurons. Interestingly, the severity of neurotoxicity induced by gp120 and ddC was different in different subpopulation of DRG neurons. gp120 mainly affected large diameter DRG neurons (>25 μm), whereas ddC mainly affected small diameter DRG neurons (≤25 μm). IGF-1 could reverse the neurotoxicity induced by gp120 and/or ddC on small, but not large, DRG neurons. These data provide new insights in elucidating the pathogenesis of HIV infection- or antiretroviral therapy-related peripheral neuropathy and facilitating the development of novel treatment strategies.

  3. [Significance of expert-guided groups for relatives in psychiatry].

    Science.gov (United States)

    Plessen, U; Postzich, M; Wilkmann, M

    1985-03-01

    Psychiatric interest in relatives of patients was concentrated in the past on their pathogenetic and etiological influence on mental illness. The medical paradigma of mental illness did not account for relatives affliction in psychic disturbance of their family member. Against this a community care oriented approach involves relatives into psychiatric care, particularly under the aspects of coping strategies and rehabilitative sources. Practicability and effects of this approach were explored in expert-guided relative groups at the Psychiatric Hospital Gütersloh (FRG). Results indicated that relatives are concerned with a series of problems. Participating in relative groups facilitates coping with these problems. Expert-guided and relative centered groups were found helpful, discharging and encouraging for relatives.

  4. Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery.

    Science.gov (United States)

    Nunley, Pierce D; Mundis, Gregory M; Fessler, Richard G; Park, Paul; Zavatsky, Joseph M; Uribe, Juan S; Eastlack, Robert K; Chou, Dean; Wang, Michael Y; Anand, Neel; Frank, Kelly A; Stone, Marcus B; Kanter, Adam S; Shaffrey, Christopher I; Mummaneni, Praveen V

    2017-12-01

    OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

  5. 42 CFR 478.15 - QIO review of changes resulting from DRG validation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false QIO review of changes resulting from DRG validation... review of changes resulting from DRG validation. (a) General rules. (1) A provider or practitioner dissatisfied with a change to the diagnostic or procedural coding information made by a QIO as a result of DRG...

  6. 42 CFR 476.84 - Changes as a result of DRG validation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Changes as a result of DRG validation. 476.84... § 476.84 Changes as a result of DRG validation. A provider or practitioner may obtain a review by a QIO... in DRG assignment as a result of QIO validation activities. ...

  7. 78 FR 10579 - TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims

    Science.gov (United States)

    2013-02-14

    ... 0720-AB58 TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims AGENCY... change TRICARE's current regulatory provision for hospital claims priced under the DRG-based payment... under the DRG- based payment system from the beneficiary's date of admission, to pricing such claims...

  8. Absolute and Relative Socioeconomic Health Inequalities across Age Groups.

    Science.gov (United States)

    van Zon, Sander K R; Bültmann, Ute; Mendes de Leon, Carlos F; Reijneveld, Sijmen A

    2015-01-01

    The magnitude of socioeconomic health inequalities differs across age groups. It is less clear whether socioeconomic health inequalities differ across age groups by other factors that are known to affect the relation between socioeconomic position and health, like the indicator of socioeconomic position, the health outcome, gender, and as to whether socioeconomic health inequalities are measured in absolute or in relative terms. The aim is to investigate whether absolute and relative socioeconomic health inequalities differ across age groups by indicator of socioeconomic position, health outcome and gender. The study sample was derived from the baseline measurement of the LifeLines Cohort Study and consisted of 95,432 participants. Socioeconomic position was measured as educational level and household income. Physical and mental health were measured with the RAND-36. Age concerned eleven 5-years age groups. Absolute inequalities were examined by comparing means. Relative inequalities were examined by comparing Gini-coefficients. Analyses were performed for both health outcomes by both educational level and household income. Analyses were performed for all age groups, and stratified by gender. Absolute and relative socioeconomic health inequalities differed across age groups by indicator of socioeconomic position, health outcome, and gender. Absolute inequalities were most pronounced for mental health by household income. They were larger in younger than older age groups. Relative inequalities were most pronounced for physical health by educational level. Gini-coefficients were largest in young age groups and smallest in older age groups. Absolute and relative socioeconomic health inequalities differed cross-sectionally across age groups by indicator of socioeconomic position, health outcome and gender. Researchers should critically consider the implications of choosing a specific age group, in addition to the indicator of socioeconomic position and health outcome

  9. WenTong HuoXue Cream Can Inhibit the Reduction of the Pain-Related Molecule PLC-β3 in the Dorsal Root Ganglion of a Rat Model of Diabetic Peripheral Neuropathy.

    Science.gov (United States)

    Feng, Chengcheng; Xu, Lijuan; Guo, Shiyun; Chen, Qian; Shen, Yuguo; Zang, Deng; Ma, Li

    2018-01-01

    WenTong HuoXue Cream (WTHX-Cream) has been shown to effectively alleviate clinical symptoms of diabetic peripheral neuropathy (DPN). This study investigated the gene and protein expression of the pain-related molecule PLC- β 3 in the dorsal root ganglion (DRG) of DPN rats. 88 specific pathogen-free male Wistar rats were randomly divided into placebo (10 rats) and DPN model (78 rats) groups, and the 78 model rats were used to establish the DPN model by intraperitoneal injection of streptozotocin and were then fed a high-fat diet for 8 weeks. These rats were randomly divided into the model group, the high-, medium-, and low-dose WTHX-Cream + metformin groups, the metformin group, the capsaicin cream group, and the capsaicin cream + metformin group. After 4 weeks of continuous drug administration, the blood glucose, body weight, behavioral indexes, and sciatic nerve conduction velocity were measured. The pathological structure of the DRG and the sciatic nerve were observed. PLC- β 3 mRNA and protein levels in the DRG of rats were measured. Compared with the model group, the high-dose WTHX-Cream group showed increased sciatic nerve conduction velocity, improved sciatic nerve morphological changes, and increased expression of PLC- β 3 mRNA and protein in the DRG. This study showed that WTHX-Cream improves hyperalgesia symptoms of DPN by inhibiting the reduction of PLC- β 3 mRNA and protein expression in the diabetic DRG of DPN rats.

  10. 'When psychology and economics meet: Relational goods in training groups

    Directory of Open Access Journals (Sweden)

    Alessandra Di Caccamo

    2014-09-01

    Full Text Available The development of the concept of relational goods is an innovation in the economy as opposed to the predominant instrumental logic and the ultimate aim of achieving profit. By facilitating the process of remodeling and reconfiguration the modalities of entering into a relationship, and allowing a new connection between different dimension of one's family, relational and cultural experience, median training groups are a place of choice for developing relational good in different contexts.Keywords: Relational good; Median training group; Social well-being

  11. Absolute and Relative Socioeconomic Health Inequalities across Age Groups

    NARCIS (Netherlands)

    van Zon, Sander K. R.; Bultmann, Ute; de Leon, Carlos F. Mendes; Reijneveld, Sijmen A.

    2015-01-01

    Background The magnitude of socioeconomic health inequalities differs across age groups. It is less clear whether socioeconomic health inequalities differ across age groups by other factors that are known to affect the relation between socioeconomic position and health, like the indicator of

  12. 2017 Military Services Gender Relations Focus Groups: Active Duty

    Science.gov (United States)

    2018-04-30

    Office of People Analytics Office of People Analytics (OPA) Defense Research, Surveys, and Statistics Center 4800 Mark Center Drive, Suite 06E22...Relations (2017 MSGR) Focus Groups among active duty members. This is the third6 administration of gender relations focus groups. This introductory ...Enlisted, Male “It is true statistically , a majority of sexual assaults there is alcohol or drugs. In the military, it’s into the alcohol more than

  13. The group-as-a-whole-object relations model of group psychotherapy.

    Science.gov (United States)

    Rosen, D; Stukenberg, K W; Saeks, S

    2001-01-01

    The authors review the theoretical basis of group psychotherapy performed at The Menninger Clinic and demonstrate how the theory has been put into practice on two different types of inpatient units. The fundamental elements of the theory and practice used can be traced to object relations theory as originally proposed by Melanie Klein. Her work with individuals was directly applied to working with groups by Ezriel and Bion, who focused on interpreting group tension. More modern approaches have reintegrated working with individual concerns while also attending to the group-as-a-whole. Historically, these principles have been applied to long-term group treatment. The authors apply the concepts from the group-as-a-whole literature to short- and medium-length inpatient groups with open membership. They offer clinical examples of the application of these principles in short-term inpatient settings in groups with open membership.

  14. Nociceptive DRG neurons express muscle lim protein upon axonal injury.

    Science.gov (United States)

    Levin, Evgeny; Andreadaki, Anastasia; Gobrecht, Philipp; Bosse, Frank; Fischer, Dietmar

    2017-04-04

    Muscle lim protein (MLP) has long been regarded as a cytosolic and nuclear muscular protein. Here, we show that MLP is also expressed in a subpopulation of adult rat dorsal root ganglia (DRG) neurons in response to axonal injury, while the protein was not detectable in naïve cells. Detailed immunohistochemical analysis of L4/L5 DRG revealed ~3% of MLP-positive neurons 2 days after complete sciatic nerve crush and maximum ~10% after 4-14 days. Similarly, in mixed cultures from cervical, thoracic, lumbar and sacral DRG ~6% of neurons were MLP-positive after 2 days and maximal 17% after 3 days. In both, histological sections and cell cultures, the protein was detected in the cytosol and axons of small diameter cells, while the nucleus remained devoid. Moreover, the vast majority could not be assigned to any of the well characterized canonical DRG subpopulations at 7 days after nerve injury. However, further analysis in cell culture revealed that the largest population of MLP expressing cells originated from non-peptidergic IB4-positive nociceptive neurons, which lose their ability to bind the lectin upon axotomy. Thus, MLP is mostly expressed in a subset of axotomized nociceptive neurons and can be used as a novel marker for this population of cells.

  15. Individual and peer group normative beliefs about relational aggression.

    Science.gov (United States)

    Werner, Nicole E; Hill, Laura G

    2010-01-01

    Studies show that children who use relational aggression process social information in unique ways; however, findings have been inconsistent and limited by methodological weaknesses. This short-term longitudinal study examined developmental changes in 245 (49% female; ages 8-13) 3rd through 8th graders' normative beliefs about relational aggression and tested the hypothesis that individual and classroom-level norms predict relational aggression 1 year later. Results showed that the transition to middle school was marked by increased approval of relational aggression, and individual norms predicted future relational aggression. Importantly, a contextual model showed that students in peer groups highly supportive of relational aggression became increasingly aggressive. Findings extend social information processing theories of relational aggression to focus on the role of peer group cognitions.

  16. RELATIONAL GROUP PSYCHOTHERAPY: THE HEALING OF STRESS, NEGLECT AND TRAUMA

    Directory of Open Access Journals (Sweden)

    Richard G. Erskine

    2010-01-01

    Full Text Available This article is the Keynote Address given at the 4th International Integrative Psychotherapy Association Conference, April 17, 2009. In speaking to the conference theme of “Acute Trauma, Cumulative Neglect, and Chronic Stress” the article describes some of the principles of Relational Group Psychotherapy. The theory of methods is based on the concept that the healing of trauma, neglect and stress occurs through a contactful therapeutic relationship. Relational group psychotherapy draws from several developments in group therapy, particularly the cybernetic feedback and other-centered models. It emphasizes the healing power of relationships between group members and the importance of phenomenological inquiry, affective attunement, identification, and relational-needs. The leader’s tasks are to stimulate the flow of contactful dialogue and to teach about human needs and healthy relationships.

  17. Uncertainty relations, zero point energy and the linear canonical group

    Science.gov (United States)

    Sudarshan, E. C. G.

    1993-01-01

    The close relationship between the zero point energy, the uncertainty relations, coherent states, squeezed states, and correlated states for one mode is investigated. This group-theoretic perspective enables the parametrization and identification of their multimode generalization. In particular the generalized Schroedinger-Robertson uncertainty relations are analyzed. An elementary method of determining the canonical structure of the generalized correlated states is presented.

  18. 97. German Roentgen congress of the DRG. Program with abstracts; 97. Deutscher Roentgenkongress der DRG. Vollstaendiges Programm mit Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-05-15

    The Volume with program and abstracts of the 97. German Roentgen congress of the DRG covers the following issues: The future of radiology - where are we heading? Cardiovascular imaging - the future; brain imaging - the essentials; chest imaging - not only nodules; abdominal imaging - the liver and beyond; muscoskeletal imaging - joints and bones; head and neck radiology - made easy.

  19. Quantum group and Manin plane related to a coloured braid group representation

    International Nuclear Information System (INIS)

    Basu Mallick, B.

    1993-07-01

    By considering 'coloured' braid group representation we have obtained a quantum group, which reduces to the standards GL q (2) and GL pq (2) cases at some particular limits of the 'colour' parameters. In spite of quite complicated nature, all of these new quantum group relations can be expressed neatly in the Heisenberg-Weyl form, for a nontrivial choice of the basis elements. Furthermore, it is possible to associate invariant Manin planes, parametrized by the 'colour' variables, with such quantum group structure. (author). 26 refs

  20. Oxaliplatin-induced loss of phosphorylated heavy neurofilament subunit neuronal immunoreactivity in rat DRG tissue

    Directory of Open Access Journals (Sweden)

    Connor Bronwen

    2009-11-01

    Full Text Available Abstract Background Oxaliplatin and related chemotherapeutic drugs cause painful chronic peripheral neuropathies in cancer patients. We investigated changes in neuronal size profiles and neurofilament immunoreactivity in L5 dorsal root ganglion (DRG tissue of adult female Wistar rats after multiple-dose treatment with oxaliplatin, cisplatin, carboplatin or paclitaxel. Results After treatment with oxaliplatin, phosphorylated neurofilament heavy subunit (pNF-H immunoreactivity was reduced in neuronal cell bodies, but unchanged in nerve fibres, of the L5 DRG. Morphometric analysis confirmed significant changes in the number (-75%; P P P = 0.82, NF-M (-1%, P = 0.96 or NF-H (0%; P = 0.93 after oxaliplatin treatment, although the sizes of parvalbumin (-29%, P = 0.047, NF-M (-11%, P = 0.038 and NF-H (-28%; P = 0.0033 immunoreactive neurons were reduced. In an independent comparison of different chemotherapeutic agents, the number of pNF-H-immunoreactive neurons was significantly altered by oxaliplatin (-77.2%; P P = 0.03 but not by carboplatin or paclitaxel, and their mean cell body area was significantly changed by oxaliplatin (-31.1%; P = 0.008 but not by cisplatin, carboplatin or paclitaxel. Conclusion This study has demonstrated a specific pattern of loss of pNF-H immunoreactivity in rat DRG tissue that corresponds with the relative neurotoxicity of oxaliplatin, cisplatin and carboplatin. Loss of pNF-H may be mechanistically linked to oxaliplatin-induced neuronal atrophy, and serves as a readily measureable endpoint of its neurotoxicity in the rat model.

  1. Analysis of Ethnic Group Relations in Living Life

    Directory of Open Access Journals (Sweden)

    Rafael Grady Christianto

    2017-08-01

    Full Text Available This research uses qualitative method approach. The data is taken through semi structured interviews so that the researcher can get the deepest information from the subject but still use interview and observation guidance. Aims to determine the perspectives between ethnic groups by looking at how the interactions or relationships that occur in everyday activities, the management of conflicts, what activities are usually done together, and the attachment that exists between various ethnic groups in Kelurahan Pengasinan Kota Bekasi to meet Practical needs. The theory used is the group definition theory of Joseph S. Roucek, Major Polak, and Wila Huky, inter-group relations of Kinloch and Stanley Liberson, social interaction theory of Soekanto, Sunarto-majority minority relations theory, Budiman, Suparlan and Edward M Bruner, and the inter-ethnic perspective theory of Setiaman. Social relations itself has a sense of relationship in which there are interactions that occur in society in order to prevent the emergence of conflict. Based on the results of research and discussion that has been done, it can be concluded that, good interaction among ethnic groups is the key in maintaining relationships among ethnic groups. This will affect the survival, social behavior, and perspectives that arise and develop among others.

  2. Adolescents' perception of peer groups: Psychological, behavioral, and relational determinants.

    Science.gov (United States)

    Lee, Seungyoon; Foote, Jeremy; Wittrock, Zachary; Xu, Siyu; Niu, Li; French, Doran C

    2017-07-01

    Adolescents' social cognitive understanding of their social world is often inaccurate and biased. Focusing on peer groups, this study examines how adolescents' psychological, behavioral, and relational characteristics influence the extent to which they accurately identify their own and others' peer groups. Analyses were conducted with a sample of 1481 seventh- and tenth-grade Chinese students who are embedded with 346 peer groups. Overall, females and older students had more accurate perceptions. In addition, lower self-esteem, higher indegree centrality, and lower betweenness centrality in the friendship network predicted more accurate perception of one's own groups, whereas higher academic performance and lower betweenness centrality in the friendship network predicted more accurate perception of others' groups. Implications for understanding the connection between adolescents' psychological and behavioral traits, social relationships, and social cognition are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Cultural styles, relational schemas, and prejudice against out-groups.

    Science.gov (United States)

    Sanchez-Burks, J; Nisbett, R E; Ybarra, O

    2000-08-01

    Two studies provide evidence that Latins (i.e., Mexicans and Mexican Americans) are guided by a concern with socioemotional aspects of workplace relations to a far greater degree than are Anglo-Americans. The focus on socioemotional considerations results in Latins having a relatively greater preference for workgroups having a strong interpersonal orientation. Preferred relational style had a far greater impact on preferences for workgroups and judgments about their likely success than did the ethnic composition of the workgroups for both Latins and Anglo-Americans. Evidence that the two groups differ markedly in relational schemas comes from examination of suggestions about how group performance could be improved, judgments about whether a focus on socioemotional concerns necessarily entails a reduction in task focus, and recall for socioemotional aspects of workgroup interactions. Implications for the dynamics of intercultural contact are discussed.

  4. The Poincare group as the symmetry group of canonical general relativity

    International Nuclear Information System (INIS)

    Beig, R.; Murchadha, N. o

    1986-01-01

    This work reconsiders the formulation, due to Regge and Teitelboim, of the phase space approach to General Relativity in the asymptotically flat context, phrasing it in the language of symplectic geometry. The necessary boundary conditions at spatial infinity are spelled out in detail. Precise meaning is given to the statement that, as a result of these boundary conditions, the Poincare group acts as a symmetry group on the phase space of G.R. This situation is compared with the spi-picture of Ashtekar and Hansen, where a larger asymptotic symmetry group is obtained. (Author)

  5. Content-Related Interactions in Self-initiated Study Groups

    Science.gov (United States)

    Christian, Karen; Talanquer, Vicente

    2012-09-01

    The central goal of the present exploratory study was to investigate the nature of the content-related interactions in study groups independently organized by college organic chemistry students. We were particularly interested in the identification of the different factors that affected the emergence of opportunities for students to co-construct understanding and engage in higher levels of cognitive processing. Our results are based on the analysis of in situ observations of 34 self-initiated study sessions involving over a 100 students in three academic semesters. The investigation revealed three major types of social regulation processes, teaching, tutoring, and co-construction in the observed study sessions. However, the extent to which students engaged in each of them varied widely from one session to another. This variability was mostly determined by the specific composition of the study groups and the nature of the study tasks in which they were engaged. Decisions about how to organize the study session, the relative content knowledge and conceptual understanding expressed by the participants, as well as the cognitive level of the problems that guided group work had a strong impact on the nature of student interactions. Nevertheless, group talk in the observed study groups was mostly focused on low-level cognitive processes. The results of our work provide insights on how to better support students' productive engagement in study groups.

  6. Comparing EU hospital efficiency using diagnosis-related groups

    NARCIS (Netherlands)

    Rhodes, G.; Wiley, M.; Tomas, R.; Casas, M.; Leidl, R.

    1997-01-01

    This article considers the feasibility of comparing the differences in efficiency and price in the provision of hospital products defined on the basis of diagnosis-related groups (DRGs). Two measures of resource use are compared, the length of stay and the administrative price, both independently

  7. [The German DRG system 2003-2010 from the perspective of intensive care medicine].

    Science.gov (United States)

    Franz, Dominik; Bunzemeier, Holger; Roeder, Norbert; Reinecke, Holger

    2010-01-01

    Intensive care medicine is extremely heterogeneous, expensive and can only be partially planned and controlled. A correct and fair representation of intensive care medicine in the G-DRG system is an essential requirement for the use as a pricing system. From the perspective of intensive care medicine, pertinent changes of the DRG structure and differentiation of relevant parameters have been established within the G-DRG systems 2003-2010. Analysis of relevant diagnoses, medical procedures, co-payment structures and G-DRGs in the versions 2003-2010 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Since the first G-DRG system version 2003, numerous measures improved quality of case allocation of intensive care medicine. Highly relevant to the system version 2010 are duration of mechanical ventilation, the intensive care treatment complex and complicating constellations. The number of G-DRGs relevant to intensive medical care increased from n = 3 (2003) to n = 58 (2010). For standard cases, quality of case allocation and G-DRG reimbursement are adequate in 2010. The G-DRG system gained complexity again. High demands are made on correct and complete coding of complex cases. Nevertheless, further adjustments of the G-DRG system especially for cases with extremely high costs are necessary. Where the G-DRG system is unable to cover extremely high-cost cases, reimbursement solutions beyond the G-DRG structure should be taken into account.

  8. The role of sense of coherence in group relations training

    Directory of Open Access Journals (Sweden)

    Frans Cilliers

    2001-09-01

    Full Text Available This research measured the role that sense of coherence (SOC plays on an individual and group level during group relations training, presented to fifty-eight managers, using Antonovsky’s scale and an semi-structured interview. The individual measuring high on SOC showed more understanding of group dynamics,made more use of own existing resources to cope with anxiety and found the experience challenging and meaningful, than the low measuring individual. On the group level, the split between high and lowled to projective identification: the high SOC individuals contain competence and the low, incompetence.Recommendations for future group relations training are formulated. Opsomming Hierdie navorsing meet die rol wat sin vir koherensie (SOC op individuele en groepvlak tydens groepverhoudinge opleiding speel soos aangebied vir agt-en-vyftig bestuurders, en gemeet met Antonovsky se skaal en ’n semi-gestruktureerde onderhoud. Die individuwat hoogmeet op SOC toon’n beter begrip van groepdinamika, maak meer gebruik van eie bestaande hulpbronne om met angs te cope, en vind die ervaringmeer uitdagend en betekenisvol, as die individu wat laag meet. Op groepsvlak lei die verdeling tussen hoog en laag na projektiewe identifikasie: die hoe SOC individue ‘‘behou’’ bevoegdheid en die lae, onbevoegdheid. Aanbevelings vir toekomstige groepsverhoudinge opleiding word geformuleer.

  9. Committees and groups related to the EURATOM treaty

    International Nuclear Information System (INIS)

    Marcus, F.R.

    1997-09-01

    The EURATOM Treaty has not been modified since its creation (Rome, 25 March 1957) but has simply been adapted to take account of the fusion of the executive bodies of the three original European Treaties and the enlargement with new Member States. The EURATOM Treaty is in existence simultaneously with the 1992 Maastricht Treaty. No changes in the EURATOM Treaty that influence the practical working conditions were brought about in the 1997 intergovernmental conference. This edition of the survey of groups related to the EURATOM Treaty is an update of earlier versions issued in Danish language. It is sponsored by the Nordic Committee for Nuclear Safety Research (NKS) in conjunction with the Swedish Nuclear Power Inspectorate (SKI). The main purpose is to informally provide those circles in the Nordic countries who want to get acquainted with the groups involved in work related to EURATOM with a simplified overview. The present edition is not different from earlier issues in that it contains an outline without the intent to go into details, and without the ambition to be complete. It thus does not represent an official picture of the committees and groups. Nor should it be seen as an organisation chart of related Commission services. The information is mostly based on personal contacts with persons having knowledge from work with the groups in question. The author would be grateful for corrections and suggestions in order to improve the picture given

  10. Committees and groups related to the EURATOM treaty

    Energy Technology Data Exchange (ETDEWEB)

    Marcus, F.R. [comp.] [Nordic Nuclear Safety Research, Roskilde (Denmark)

    1997-09-01

    The EURATOM Treaty has not been modified since its creation (Rome, 25 March 1957) but has simply been adapted to take account of the fusion of the executive bodies of the three original European Treaties and the enlargement with new Member States. The EURATOM Treaty is in existence simultaneously with the 1992 Maastricht Treaty. No changes in the EURATOM Treaty that influence the practical working conditions were brought about in the 1997 intergovernmental conference. This edition of the survey of groups related to the EURATOM Treaty is an update of earlier versions issued in Danish language. It is sponsored by the Nordic Committee for Nuclear Safety Research (NKS) in conjunction with the Swedish Nuclear Power Inspectorate (SKI). The main purpose is to informally provide those circles in the Nordic countries who want to get acquainted with the groups involved in work related to EURATOM with a simplified overview. The present edition is not different from earlier issues in that it contains an outline without the intent to go into details, and without the ambition to be complete. It thus does not represent an official picture of the committees and groups. Nor should it be seen as an organisation chart of related Commission services. The information is mostly based on personal contacts with persons having knowledge from work with the groups in question. The author would be grateful for corrections and suggestions in order to improve the picture given. 15 figs.

  11. Group-by Skyline Query Processing in Relational Engines

    DEFF Research Database (Denmark)

    Yiu, Man Lung; Luk, Ming-Hay; Lo, Eric

    2009-01-01

    the missing cost model for the BBS algorithm. Experimental results show that our techniques are able to devise the best query plans for a variety of group-by skyline queries. Our focus is on algorithms that can be directly implemented in today's commercial database systems without the addition of new access......The skyline operator was first proposed in 2001 for retrieving interesting tuples from a dataset. Since then, 100+ skyline-related papers have been published; however, we discovered that one of the most intuitive and practical type of skyline queries, namely, group-by skyline queries remains...

  12. High-voltage-activated calcium current subtypes in mouse DRG neurons adapt in a subpopulation-specific manner after nerve injury.

    Science.gov (United States)

    Murali, Swetha S; Napier, Ian A; Mohammadi, Sarasa A; Alewood, Paul F; Lewis, Richard J; Christie, MacDonald J

    2015-03-01

    Changes in ion channel function and expression are characteristic of neuropathic pain. Voltage-gated calcium channels (VGCCs) are integral for neurotransmission and membrane excitability, but relatively little is known about changes in their expression after nerve injury. In this study, we investigate whether peripheral nerve ligation is followed by changes in the density and proportion of high-voltage-activated (HVA) VGCC current subtypes in dorsal root ganglion (DRG) neurons, the contribution of presynaptic N-type calcium channels in evoked excitatory postsynaptic currents (EPSCs) recorded from dorsal horn neurons in the spinal cord, and the changes in expression of mRNA encoding VGCC subunits in DRG neurons. Using C57BL/6 mice [8- to 11-wk-old males (n = 91)] for partial sciatic nerve ligation or sham surgery, we performed whole cell patch-clamp recordings on isolated DRG neurons and dorsal horn neurons and measured the expression of all VGCC subunits with RT-PCR in DRG neurons. After nerve injury, the density of P/Q-type current was reduced overall in DRG neurons. There was an increase in the percentage of N-type and a decrease in that of P/Q-type current in medium- to large-diameter neurons. No changes were found in the contribution of presynaptic N-type calcium channels in evoked EPSCs recorded from dorsal horn neurons. The α2δ-1 subunit was upregulated by 1.7-fold and γ-3, γ-2, and β-4 subunits were all downregulated 1.7-fold in injured neurons compared with sham-operated neurons. This comprehensive characterization of HVA VGCC subtypes in mouse DRG neurons after nerve injury revealed changes in N- and P/Q-type current proportions only in medium- to large-diameter neurons. Copyright © 2015 the American Physiological Society.

  13. FPGA platform for MEMS Disc Resonance Gyroscope (DRG) control

    Science.gov (United States)

    Keymeulen, Didier; Peay, Chris; Foor, David; Trung, Tran; Bakhshi, Alireza; Withington, Phil; Yee, Karl; Terrile, Rich

    2008-04-01

    Inertial navigation systems based upon optical gyroscopes tend to be expensive, large, power consumptive, and are not long lived. Micro-Electromechanical Systems (MEMS) based gyros do not have these shortcomings; however, until recently, the performance of MEMS based gyros had been below navigation grade. Boeing and JPL have been cooperating since 1997 to develop high performance MEMS gyroscopes for miniature, low power space Inertial Reference Unit applications. The efforts resulted in demonstration of a Post Resonator Gyroscope (PRG). This experience led to the more compact Disc Resonator Gyroscope (DRG) for further reduced size and power with potentially increased performance. Currently, the mass, volume and power of the DRG are dominated by the size of the electronics. This paper will detail the FPGA based digital electronics architecture and its implementation for the DRG which will allow reduction of size and power and will increase performance through a reduction in electronics noise. Using the digital control based on FPGA, we can program and modify in real-time the control loop to adapt to the specificity of each particular gyro and the change of the mechanical characteristic of the gyro during its life time.

  14. DRG systém v ČR

    OpenAIRE

    Hodyc, Daniel MUDr.

    2007-01-01

    Diplomová práce hodnotí historický proces implementace klasifikačního systému DRG v České republice a srovnává jej s vývojem analogických systémů v ostatních zemích světa. Na podkladě platné metodiky IR DRG užívané v ČR v roce 2006 analyzuje hospitalizační část lékařské péče poskytované ve Fakultní nemocnici v Motole. Zkoumá rozdíly v nákladovosti při srovnání rozdílných pacientských skupin (děti – dospělí, operovaní – léčení konzervativně) a ukazuje výhody užití DRG systému pro hodnocení kva...

  15. [ENT and head and neck surgery in the German DRG system 2007].

    Science.gov (United States)

    Franz, D; Roeder, N; Hörmann, K; Alberty, J

    2007-07-01

    The German DRG system has been further developed into version 2007. For ENT and head and neck surgery, significant changes in the coding of diagnoses and medical operations as well as in the the DRG structure have been made. New ICD codes for sleep apnoea and acquired tracheal stenosis have been implemented. Surgery on the acoustic meatus, removal of auricle hyaline cartilage for transplantation (e. g. rhinosurgery) and tonsillotomy have been coded in the 2007 version. In addition, the DRG structure has been improved. Case allocation of more than one significant operation has been established. The G-DRG system has gained in complexity. High demands are made on the coding of complex cases, whereas standard cases require mostly only one specific diagnosis and one specific OPS code. The quality of case allocation for ENT patients within the G-DRG system has been improved. Nevertheless, further adjustments of the G-DRG system are necessary.

  16. Feature-based morphometry: discovering group-related anatomical patterns.

    Science.gov (United States)

    Toews, Matthew; Wells, William; Collins, D Louis; Arbel, Tal

    2010-02-01

    This paper presents feature-based morphometry (FBM), a new fully data-driven technique for discovering patterns of group-related anatomical structure in volumetric imagery. In contrast to most morphometry methods which assume one-to-one correspondence between subjects, FBM explicitly aims to identify distinctive anatomical patterns that may only be present in subsets of subjects, due to disease or anatomical variability. The image is modeled as a collage of generic, localized image features that need not be present in all subjects. Scale-space theory is applied to analyze image features at the characteristic scale of underlying anatomical structures, instead of at arbitrary scales such as global or voxel-level. A probabilistic model describes features in terms of their appearance, geometry, and relationship to subject groups, and is automatically learned from a set of subject images and group labels. Features resulting from learning correspond to group-related anatomical structures that can potentially be used as image biomarkers of disease or as a basis for computer-aided diagnosis. The relationship between features and groups is quantified by the likelihood of feature occurrence within a specific group vs. the rest of the population, and feature significance is quantified in terms of the false discovery rate. Experiments validate FBM clinically in the analysis of normal (NC) and Alzheimer's (AD) brain images using the freely available OASIS database. FBM automatically identifies known structural differences between NC and AD subjects in a fully data-driven fashion, and an equal error classification rate of 0.80 is achieved for subjects aged 60-80 years exhibiting mild AD (CDR=1). Copyright (c) 2009 Elsevier Inc. All rights reserved.

  17. Conjugacy in relatively extra-large Artin groups

    Directory of Open Access Journals (Sweden)

    Arye Juhasz

    2015-09-01

    Full Text Available Let A be an Artin group with standard generators X={x 1 ,…,x n } , n≥1 and defining graph Γ A . A \\emph{standard parabolic subgroup} of A is a subgroup generated by a subset of X . For elements u and v of A we say (as usual that u is conjugate to v by an element h of A if h −1 uh=v holds in A . Similarly, if K and L are subsets of A then K is conjugate to L by an element h of A if h −1 Kh=L . In this work we consider the conjugacy of elements and standard parabolic subgroups of a certain type of Artin groups. Results in this direction occur in occur in papers by Duncan, Kazachkov, Remeslennikov, Fenn, Dale, Jun, Godelle, Gonzalez-Meneses, Wiest, Paris, Rolfsen, for example. Of particular interest are centralisers of elements, and of standard parabolic subgroups, normalisers of standard parabolic subgroups and commensurators of parabolic subgroups. In this work we consider similar problems in a new class of Artin groups, introduced in the paper "On relatively extralarge Artin groups and their relative asphericity", by Juhasz, where the word problem is solved, among other things. Also, intersections of parabolic subgroups and their conjugates are considered.

  18. Role of laser fluence in protein synthesis of cultured DRG neurons following low-level laser irradiation

    Science.gov (United States)

    Zheng, Liqin; Qiu, Caimin; Wang, Yuhua; Zeng, Yixiu; Yang, Hongqin; Zhang, Yanding; Xie, Shusen

    2014-11-01

    Low-level lasers have been used to relieve pain in clinical for many years. But the mechanism is not fully clear. In animal models, nitric oxide (NO) has been reported involving in the transmission and modulation of nociceptive signals. So the objective of this study was to establish whether low-level laser with different fluence could stimulate the production of nitric oxide synthese (NOS), which produces NO in cultured primary dorsal root ganglion neurons (DRG neurons). The primary DRG neurons were isolated from healthy Sprague Dawley rats (8-12 weeks of age) and spread on 35 mm culture dishes specially used for confocal microscopy. 24 hours after spreading, cells were irradiated with 658 nm laser for two consecutive days at the energy density of 20, 40, 60 and 80 mJ·cm-2 respectively. Control groups were not exposed to the laser, but were kept under the same conditions as the irradiated ones. The synthesis of NOS after laser irradiation was detected by immunofluorescence assay, and the changes of NOS were evaluated using confocal microscopy and Image J software. The results showed that all the laser fluence could promote the production of NOS in DRG neurons, especially the 60 mJ·cm-2 . These results demonstrated that low-level laser irradiation could modify protein synthesis in a dose- or fluence- dependent manner, and indicated that low-level laser irradiation might achieve the analgesic effect through modulation of NO production.

  19. 96. German Roentgen congress of the DRG. Program with abstracts; 96. Deutscher Roentgenkongress der DRG. Vollstaendiges Program mit Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-05-15

    The volume contains the program and the abstracts of the 96th German Roentgen congress of the DRG covering the following issues: profession and environment caused diseases, medical imaging - image processing - software, experimental radiology, whole-body diagnostics, gastro- and abdomen diagnostics, vascular diagnostics, device technology, heart diagnostics, interventional radiology (vascular diseases, oncology, others), pediatric radiology, contrast agents, head- and neck diagnostics, molecular imaging, musco-skeletal diagnostics, neuroradiology, emergency diagnostics - intensive care, oncologic imaging, quality management, radiation protection, thorax diagnostics.

  20. Wnt3 and Gata4 regulate axon regeneration in adult mouse DRG neurons.

    Science.gov (United States)

    Duan, Run-Shan; Liu, Pei-Pei; Xi, Feng; Wang, Wei-Hua; Tang, Gang-Bin; Wang, Rui-Ying; Saijilafu; Liu, Chang-Mei

    2018-05-05

    Neurons in the adult central nervous system (CNS) have a poor intrinsic axon growth potential after injury, but the underlying mechanisms are largely unknown. Wingless-related mouse mammary tumor virus integration site (WNT) family members regulate neural stem cell proliferation, axon tract and forebrain development in the nervous system. Here we report that Wnt3 is an important modulator of axon regeneration. Downregulation or overexpression of Wnt3 in adult dorsal root ganglion (DRG) neurons enhances or inhibits their axon regeneration ability respectively in vitro and in vivo. Especially, we show that Wnt3 modulates axon regeneration by repressing mRNA translation of the important transcription factor Gata4 via binding to the three prime untranslated region (3'UTR). Downregulation of Gata4 could restore the phenotype exhibited by Wnt3 downregulation in DRG neurons. Taken together, these data indicate that Wnt3 is a key intrinsic regulator of axon growth ability of the nervous system. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. DRG-Based CubeSat Inertial Reference Unit (DCIRU), Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — CubeSats currently lack adequate inertial attitude knowledge and control required for future sophisticated science missions. Boeing's Disc Resonator Gyro (DRG)...

  2. Functional interaction of TRPV4 channel protein with annexin A2 in DRG.

    Science.gov (United States)

    Ning, Liping; Wang, Chuanwei; Ding, Xinli; Zhang, Yang; Wang, Xuping; Yue, Shouwei

    2012-09-01

    Transient receptor potential vanilloid 4 (TRPV4) is a Ca(2+)-permeable, non-selective cation channel that is involved in the transmission of pain signals mediated by dorsal root ganglion (DRG). Annexin A2 belongs to a class of membrane-binding proteins that plays an important role in the regulation of ion channels. Nevertheless, little is known about the interaction between them in DRG. In this paper, we evaluated the functional interaction of TRPV4 with annexin A2 in DRG. We have used immunocytochemistry and co-immunoprecipitation assays to investigate the interaction between annexin A2 and TRPV4 in DRG. The role of annexin A2 in the regulation of TRPV4 activity in DRG was further verified by measurement of intracellular free calcium concentrations ([Ca(2+)](i)) and substance P (SP) release. First, annexin A2 was showed partial co-localization with TRPV4 in DRG neurons. Then, annexin A2 and TRPV4 were co-precipitated with each other in DRG lysates. Furthermore, the downregulation of annexin A2 using specific small interfering RNA significantly inhibited Ca(2+) influx and SP mediated by TRPV4. Our results provide evidence that annexin A2 is associated with TRPV4 and regulates TRPV4-mediated Ca(2+) influx and SP release in DRG neurons. The objective of this work is to determine the influence of annexin A2 on TRPV4 in DRG neurons, which may be the basis for treatment of pain relief.

  3. [Evaluation of the appropriateness of hospital admissions using the iso-gravity classification systems APR-DRG and Disease Staging and the Italian version of Appropriateness Evaluation Protocol (AEP)].

    Science.gov (United States)

    D'Andrea, G; Capalbo, G; Volpe, M; Marchetti, M; Vicentini, F; Capelli, G; Cambieri, A; Cicchetti, A; Ricciardi, G; Catananti, C

    2006-01-01

    Our main purpose was to evaluate the organizational appropriateness of admissions made in a university hospital, by comparing two iso-gravity classification systems, APR-DRG and Disease Staging, with the Italian version of AEP (PRUO). Our analysis focused on admissions made in 2001, related to specific Diagnosis Related Groups (DRGs), which, according an Italian Law, would be considered at high risk of inappropriateness, if treated as ordinary admissions. The results obtained by using the 2 classification systems did not show statistically significant differences with respect to the total number of admissions. On the other hand, some DRGs showed statistically significant differences due to different algorithms of attribution of the severity levels used by the two systems. For almost all of the DRGs studied, the AEP-based analysis of a sample of medical records showed an higher number of inappropriate admissions in comparison with the number expected by iso-gravity classification methods. The difference is possibly due to the percentage limits of tolerability fixed by the Law for each DRG. Therefore, the authors suggest an integrated use of the two methods to evaluate organizational appropriateness of hospital admissions.

  4. Age groups related glioblastoma study based on radiomics approach.

    Science.gov (United States)

    Li, Zeju; Wang, Yuanyuan; Yu, Jinhua; Guo, Yi; Zhang, Qi

    2017-12-01

    Glioblastoma is the most aggressive malignant brain tumor with poor prognosis. Radiomics is a newly emerging and promising technique to reveal the complex relationships between high-throughput medical image features and deep information of disease including pathology, biomarkers and genomics. An approach was developed to investigate the internal relationship between magnetic resonance imaging (MRI) features and the age-related origins of glioblastomas based on a quantitative radiomics method. A fully automatic image segmentation method was applied to segment the tumor regions from three dimensional MRI images. 555 features were then extracted from the image data. By analyzing large numbers of quantitative image features, some predictive and prognostic information could be obtained by the radiomics approach. 96 patients diagnosed with glioblastoma pathologically have been divided into two age groups (age groups (T test, p age difference (T test, p= .006). In conclusion, glioblastoma in different age groups present different radiomics-feature patterns with statistical significance, which indicates that glioblastoma in different age groups should have different pathologic, protein, or genic origins.

  5. Hesitant Probabilistic Multiplicative Preference Relations in Group Decision Making

    Directory of Open Access Journals (Sweden)

    Zia Bashir

    2018-03-01

    Full Text Available The preference of one alternative over another is a useful way to express the opinion of the decision-maker. In the process of group decision-making, preference relations are used in preference modeling of the alternatives under given criteria. The probability is an important tool to deal with uncertainty and, in many scenarios of decision-making problems, the probabilities of different events affect the decision-making process directly. In order to deal with this issue, the hesitant probabilistic multiplicative preference relation (HPMPR is defined in this paper. Furthermore, consistency of the HPMPR and consensus among decision makers are studied here. In this respect, many algorithms are developed to achieve consistency of HPMPRs, reasonable consensus between decision-makers and a final algorithm is proposed comprehending all other algorithms, presenting a complete decision support model for group decision-making. Lastly, we present a case study with complete illustration of the proposed model and discuss the effects of probabilities on decision-making validating the importance of the introduction of probability in hesitant multiplicative preference relations.

  6. Perception of radiation related risks among three population groups

    International Nuclear Information System (INIS)

    Mihai, L.T.; Milu, C.; Voicu, B.; Enachescu, D.

    2003-01-01

    A questionnaire survey was conducted among three groups that mainly differ in socioeconomic status and professional exposure to ionizing radiations. Seventy-seven (26.3%) of the respondents were professionally exposed to radiation, 35 (11.9%) were medical doctors without professional exposure and 177 (68.4%) belonged to the general population group. The level of anxiety toward radiation, expressed as a concernedness index, is significantly lower in people who are professionally exposed to radiation compared to medical doctors and general population (0.81±0.94, 1.42±1.21 and 1.72±1.34 respectively, p < 0.001). In a similar manner, concernedness index values varied with the education status, with lowest values among medical university graduates and highest among public school graduates (p < 0.001). Both university-graduated groups significantly differ from the non-university groups (p < 0.05). Knowledge about radiation and knowledge about emergency plans in nuclear accident/incident were also checked in relation with concernedness, the results confirming the hypothesis that better knowledge associates lower concernedness. The extent to which people accept the civil utilization of nuclear power is also related to concernedness and knowledge, significant associations having been found. The results suggest that a political decision in radiation matter requires a valid analysis of the public's understanding and acceptance. For that reason, it is important that radiological protection authorities develop new plans and materials for communicating with people, in order to improve knowledge upon ionizing radiation, irradiation risks and safety of nuclear energy application for civil purposes. (author)

  7. [Curcumin down-regulates CX3CR1 expression in spinal cord dorsal horn and DRG in neuropathic pain rats].

    Science.gov (United States)

    Zheng, Jinwei; Zheng, Changjian; Cao, Hong; Li, Jun; Lian, Qingquan

    2011-09-01

    To investigate the effects of curcumin on the behavior of chronic constrictive injury (CCI) rats and the CX3CR1 expression in spinal cord dorsal horn and dorsal root ganglia (DRG). Seventy-two male SD rats were randomly divided into 4 groups: 1) Sham operation group (Sham); 2) Chronic constrictive injury group (CCI); 3) Curcumin treated group (Cur), administrated with curcumin 100 mg x kg(-1) x d(-1) ip for 14 days after CCI; 4) Solvent contrast group (SC), administrated with an equal volume of solvent for 14 days after CCI. Paw thermal withdrawal (PTWL) and paw mechanical withdrawal threshold (PMWT) were measured on 2 pre-operative and 1, 3, 5, 7, 10, 14 post-operative days respectively. The lumbar segments L4-5 of the spinal cord and the L4, L5 DRG were removed at 3, 7, 14 days after surgery. The expression of CX3CR1 was determined by immunohistochemical staining. Compared with Sham group, PTWL and PMWT in CCI group were significantly lower on each post-operative day (PDRG. In Cur group, PTWL were higher than in CCI group on 7, 10, 14 post-operative day (Pdorsal root ganglia.

  8. [Operative treatment of diabetics with vascular complications : Secondary data analysis of diagnosis-related groups statistics from 2005 to 2014 in Germany].

    Science.gov (United States)

    Olm, M; Kühnl, A; Knipfer, E; Salvermoser, M; Eckstein, H-H; Zimmermann, A

    2018-03-27

    In Germany approximately 40,000 amputations per year are performed on patients with diabetes mellitus, often with accompanying vascular complications. The aim of this study was to present the various degrees of severity of the vascular complications and the temporal changes of the treatment options in diabetics with vascular complications in Germany. The microdata of the diagnosis-related groups (DRG) statistics of the Federal Statistical Office were analyzed over the period from 2005 to 2014. All cases were included in which the main or secondary diagnosis of diabetes mellitus with concurrent vascular complications (diabetic angiopathy and peripheral arterial disease) was encrypted. The median age of the 1,811,422 cases was 73 years and 62% were male. While the total number of amputations remained stable over time, there was a 41% reduction in knee-preserving and a 31% reduction in non-knee preserving major amputations with an 18% increase in minor amputations. Revascularization increased by 33% from 36 procedures in 2005 to 48 procedures per 100,000 inhabitants. The increase in revascularization was evident in the area of endovascular therapy alone where there was an increase of 78%. Due to the significant increase in endovascular revascularization measures, there was a significant increase in the proportion of diabetes patients with vascular pathologies in whom revascularization was carried out. As a result, improved limb preservation was achieved despite equally high amputation rates due to increasing minor amputation rates.

  9. DRG Spinal Cord Stimulation as Solution for Patients With Severe Pain Due to Anterior Cutaneous Nerve Entrapment Syndrome: A Case Series.

    Science.gov (United States)

    Mol, Frédérique Mathilde Ulrike; Roumen, Rudi M H

    2018-04-01

    Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a debilitating neuropathic pain condition. A small portion of patients do not respond to any currently available treatment modalities. These patients, often young women, might benefit from targeted spinal cord stimulation of the dorsal root ganglion (DRG). This retrospective case series describes five ACNES patients who were referred from a Dutch dedicated tertiary referral center to collaborating sites with extensive experience in DRG stimulation to be implanted with a DRG Axium System (St. Jude/Abbott, IL, USA) in the period of 2013-2016. Numeric pain rating scores at routine 6- and 12-month follow-up visits were analyzed. Three patients experienced >50% pain reduction at 12 months follow-up. Four patients experienced device-related complications, such as lead dislocation, lead breakage, pain at the battery site, and overstimulation. This case series suggests DRG spinal cord stimulation can be safe and effective for some patients with persistent pain due to ACNES. © 2017 International Neuromodulation Society.

  10. [Orthopedic and trauma surgery in the German-DRG-System 2009].

    Science.gov (United States)

    Franz, D; Windolf, J; Siebert, C H; Roeder, N

    2009-01-01

    The German DRG-System was advanced into version 2009. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2009 focussed on the development of DRG-structure, DRG-validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. G-DRG-System gained complexity again. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case-allocation within the G-DRG-System was improved. Nevertheless, further adjustments of the G-DRG-System especially for cases with severe injuries are necessary.

  11. [ENT medicine and head and neck surgery in the G-DRG system 2008].

    Science.gov (United States)

    Franz, D; Roeder, N; Hörmann, K; Alberty, J

    2008-09-01

    Further developments in the German DRG system have been incorporated into the 2008 version. For ENT medicine and head and neck surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes for 2008 focussed on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. The G-DRG system has gained in complexity again. High demands are made on correct and complete coding of complex ENT and head and neck surgery cases. Quality of case allocation within the G-DRG system has been improved. For standard cases quality of case allocation is adequate. Nevertheless, further adjustments of the G-DRG system especially for cases with complex neck surgery are necessary.

  12. 42 CFR 476.94 - Notice of QIO initial denial determination and changes as a result of a DRG validation.

    Science.gov (United States)

    2010-10-01

    ... changes as a result of a DRG validation. 476.94 Section 476.94 Public Health CENTERS FOR MEDICARE... changes as a result of a DRG validation. (a) Notice of initial denial determination—(1) Parties to be... retrospective review, (excluding DRG validation and post procedure review), within 3 working days of the initial...

  13. 42 CFR 476.93 - Opportunity to discuss proposed initial denial determination and changes as a result of a DRG...

    Science.gov (United States)

    2010-10-01

    ... determination and changes as a result of a DRG validation. 476.93 Section 476.93 Public Health CENTERS FOR... initial denial determination and changes as a result of a DRG validation. Before a QIO reaches an initial denial determination or makes a change as a result of a DRG validation, it must— (a) Promptly notify the...

  14. 42 CFR 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

    Science.gov (United States)

    2010-10-01

    ... determinations and changes as a result of DRG validations. 476.85 Section 476.85 Public Health CENTERS FOR... denial determinations and changes as a result of DRG validations. A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in...

  15. 42 CFR 476.96 - Review period and reopening of initial denial determinations and changes as a result of DRG...

    Science.gov (United States)

    2010-10-01

    ... determinations and changes as a result of DRG validations. 476.96 Section 476.96 Public Health CENTERS FOR... initial denial determinations and changes as a result of DRG validations. (a) General timeframe. A QIO or... initial denial determination or a change as a result of a DRG validation. (b) Extended timeframes. (1) An...

  16. ABO blood groups and malaria related clinical outcome.

    Science.gov (United States)

    Deepa; Alwar, Vanamala A; Rameshkumar, Karuna; Ross, Cecil

    2011-03-01

    The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. From October 2007 to September 2008, malaria positive patients' samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated. A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 - 'A' group, 42 - 'B' group, 35 - 'O' group and 1 was 'AB' group. When the clinical courses between different groups were compared using the following parameters for severe infection--a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin 101°F and other organ involvement, it was observed that 'O' group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different 'ABO' blood groups with a diminished rosetting potential in blood group 'O' red blood cells was due to the differential host susceptibility. 'O' group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group 'O' red blood cells is suggested as the basis for the differential host susceptibility.

  17. Inflammatory sensitization of nociceptors depends on activation of NMDA receptors in DRG satellite cells.

    Science.gov (United States)

    Ferrari, Luiz Fernando; Lotufo, Celina Monteiro; Araldi, Dionéia; Rodrigues, Marcos A; Macedo, Larissa P; Ferreira, Sérgio H; Parada, Carlos Amilcar

    2014-12-23

    The present study evaluated the role of N-methyl-D-aspartate receptors (NMDARs) expressed in the dorsal root ganglia (DRG) in the inflammatory sensitization of peripheral nociceptor terminals to mechanical stimulation. Injection of NMDA into the fifth lumbar (L5)-DRG induced hyperalgesia in the rat hind paw with a profile similar to that of intraplantar injection of prostaglandin E2 (PGE2), which was significantly attenuated by injection of the NMDAR antagonist D(-)-2-amino-5-phosphonopentanoic acid (D-AP-5) in the L5-DRG. Moreover, blockade of DRG AMPA receptors by the antagonist 6,7-dinitroquinoxaline-2,3-dione had no effect in the PGE2-induced hyperalgesia in the paw, showing specific involvement of NMDARs in this modulatory effect and suggesting that activation of NMDAR in the DRG plays an important role in the peripheral inflammatory hyperalgesia. In following experiments we observed attenuation of PGE2-induced hyperalgesia in the paw by the knockdown of NMDAR subunits NR1, NR2B, NR2D, and NR3A with antisense-oligodeoxynucleotide treatment in the DRG. Also, in vitro experiments showed that the NMDA-induced sensitization of cultured DRG neurons depends on satellite cell activation and on those same NMDAR subunits, suggesting their importance for the PGE2-induced hyperalgesia. In addition, fluorescent calcium imaging experiments in cultures of DRG cells showed induction of calcium transients by glutamate or NMDA only in satellite cells, but not in neurons. Together, the present results suggest that the mechanical inflammatory nociceptor sensitization is dependent on glutamate release at the DRG and subsequent NMDAR activation in satellite glial cells, supporting the idea that the peripheral hyperalgesia is an event modulated by a glutamatergic system in the DRG.

  18. Comparative functional expression of nAChR subtypes in rodent DRG neurons.

    Science.gov (United States)

    Smith, Nathan J; Hone, Arik J; Memon, Tosifa; Bossi, Simon; Smith, Thomas E; McIntosh, J Michael; Olivera, Baldomero M; Teichert, Russell W

    2013-01-01

    We investigated the functional expression of nicotinic acetylcholine receptors (nAChRs) in heterogeneous populations of dissociated rat and mouse lumbar dorsal root ganglion (DRG) neurons by calcium imaging. By this experimental approach, it is possible to investigate the functional expression of multiple receptor and ion-channel subtypes across more than 100 neuronal and glial cells simultaneously. Based on nAChR expression, DRG neurons could be divided into four subclasses: (1) neurons that express predominantly α3β4 and α6β4 nAChRs; (2) neurons that express predominantly α7 nAChRs; (3) neurons that express a combination of α3β4/α6β4 and α7 nAChRs; and (4) neurons that do not express nAChRs. In this comparative study, the same four neuronal subclasses were observed in mouse and rat DRG. However, the expression frequency differed between species: substantially more rat DRG neurons were in the first three subclasses than mouse DRG neurons, at all developmental time points tested in our study. Approximately 70-80% of rat DRG neurons expressed functional nAChRs, in contrast to only ~15-30% of mouse DRG neurons. Our study also demonstrated functional coupling between nAChRs, voltage-gated calcium channels, and mitochondrial Ca(2) (+) transport in discrete subsets of DRG neurons. In contrast to the expression of nAChRs in DRG neurons, we demonstrated that a subset of non-neuronal DRG cells expressed muscarinic acetylcholine receptors and not nAChRs. The general approach to comparative cellular neurobiology outlined in this paper has the potential to better integrate molecular and systems neuroscience by uncovering the spectrum of neuronal subclasses present in a given cell population and the functionally integrated signaling components expressed in each subclass.

  19. Attachment theory and group processes: the association between attachment style and group-related representations, goals, memories, and functioning.

    Science.gov (United States)

    Rom, Eldad; Mikulincer, Mario

    2003-06-01

    Four studies examined attachment-style differences in group-related cognitions and behaviors. In Studies 1-2, participants completed scales on group-related cognitions and emotions. In Studies 3-4, participants were divided into small groups, and their performance in group tasks as well as the cohesion of their group were assessed. Both attachment anxiety and avoidance in close relationships were associated with negative group-related cognitions and emotions. Anxiety was also related to the pursuit of closeness goals and impaired instrumental performance in group tasks. Avoidance was related to the pursuit of distance goals and deficits in socioemotional and instrumental performance. Group cohesion significantly moderated the effects of attachment anxiety. The discussion emphasizes the relevance of attachment theory within group contexts.

  20. Intergroup Discrimination in Positive and Negative Outcome Allocations: Impact of Stimulus Valence, Relative Group Status, and Relative Group Size.

    Science.gov (United States)

    Otten, Sabine; And Others

    1996-01-01

    Three studies investigated the determination of social discrimination by the valence of stimuli that are allocated between groups. The studies were based on either the minimal group paradigm or a more reality-based laboratory intergroup setting, with stimulus valence, group status, and group size as factors and with pull scores on Tajfel matrices…

  1. Group and Topic Discovery from Relations and Their Attributes

    National Research Council Canada - National Science Library

    Wang, Xuerui; Mohanty, Natasha; McCallum, Andrew

    2006-01-01

    The authors present a probabilistic generative model of entity relationships and their attributes that simultaneously discovers groups among the entities and topics among the corresponding textual attributes...

  2. Pulsed Radiofrequency Applied to the Sciatic Nerve Improves Neuropathic Pain by Down-regulating The Expression of Calcitonin Gene-related Peptide in the Dorsal Root Ganglion

    Science.gov (United States)

    Ren, Hao; Jin, Hailong; Jia, Zipu; Ji, Nan; Luo, Fang

    2018-01-01

    Background: Clinical studies have shown that applying pulsed radiofrequency (PRF) to the neural stem could relieve neuropathic pain (NP), albeit through an unclear analgesic mechanism. And animal experiments have indicated that calcitonin gene-related peptide (CGRP) expressed in the dorsal root ganglion (DRG) is involved in generating and maintaining NP. In this case, it is uncertain whether PRF plays an analgesic role by affecting CGRP expression in DRG. Methods: Rats were randomly divided into four groups: Groups A, B, C, and D. In Groups C and D, the right sciatic nerve was ligated to establish the CCI model, while in Groups A and B, the sciatic nerve was isolated without ligation. After 14 days, the right sciatic nerve in Groups B and D re-exposed and was treated with PRF on the ligation site. Thermal withdrawal latency (TWL) and hindpaw withdrawal threshold (HWT) were measured before PRF treatment (Day 0) as well as after 2, 4, 8, and 14 days of treatment. At the same time points of the behavioral tests, the right L4-L6 DRG was sampled and analyzed for CGRP expression using RT-qPCR and an enzyme-linked immunosorbent assay (ELISA). Results: Fourteen days after sciatic nerve ligation, rats in Groups C and D had a shortened TWL (P 0.05). On the 8th and 14th days, the mRNA levels in Group D were restored to those of Groups A and B. Meanwhile, the CGRP content of Group D gradually dropped over time, from 76.4 pg/mg (Day 0) to 57.5 pg/mg (Day 14). Conclusions: In this study, we found that, after sciatic nerve ligation, rats exhibited apparent hyperalgesia and allodynia, and CGRP mRNA and CGRP contents in the L4-L6 DRG increased significantly. Through lowering CGRP expression in the DRG, PRF treatment might relieve the pain behaviors of NP. PMID:29333099

  3. [Can Topical Negative Pressure Therapy be Performed as a Cost-Effective General Surgery Procedure in the German DRG System?].

    Science.gov (United States)

    Hirche, Z; Xiong, L; Hirche, C; Willis, S

    2016-04-01

    Topical negative pressure therapy (TNPT) has been established for surgical wound therapy with different indications. Nevertheless, there is only sparse evidence regarding its therapeutic superiority or cost-effectiveness in the German DRG system (G-DRG). This study was designed to analyse the cost-effectiveness of TNPT in the G-DRG system with a focus on daily treatment costs and reimbursement in a general surgery care setting. In this retrospective study, we included 176 patients, who underwent TNPT between 2007 and 2011 for general surgery indications. Analysis of the cost-effectiveness involved 149 patients who underwent a simulation to calculate the reimbursement with or without TNPT by a virtual control group in which the TNP procedure was withdrawn for DRG calculation. This was followed by a calculation of costs for wound dressings and TNPT rent and material costs. Comparison between the "true" and the virtual group enabled calculation of the effective remaining surplus per case. Total reimbursement by included TNPT cases was 2,323 ,70.04 €. Costs for wound dressings and TNPT rent were 102,669.20 €. In 41 cases there was a cost-effectiveness (27.5%) with 607,422.03 € with TNP treatment, while the control group without TNP generated revenues of 442,015.10 €. Costs for wound dressings and TNPT rent were 47,376.68 €. In the final account we could generate a cost-effectiveness of 6759 € in 5 years per 149 patients by TNPT. In 108 cases there was no cost-effectiveness (72.5%). TNPT applied in a representative general surgery setting allows for wound therapy without a major financial burden. Based on the costs for wound dressings and TNPT rent, a primarily medically based decision when to use TNPT can be performed in a balanced product cost accounting. This study does not analyse the superiority of TNPT in wound care, so further prospective studies are required which focus on therapeutic superiority and cost-effectiveness. Georg Thieme

  4. [The DRG responsible physician in trauma and orthopedic surgery. Surgeon, encoder, and link to medical controlling].

    Science.gov (United States)

    Ruffing, T; Huchzermeier, P; Muhm, M; Winkler, H

    2014-05-01

    Precise coding is an essential requirement in order to generate a valid DRG. The aim of our study was to evaluate the quality of the initial coding of surgical procedures, as well as to introduce our "hybrid model" of a surgical specialist supervising medical coding and a nonphysician for case auditing. The department's DRG responsible physician as a surgical specialist has profound knowledge both in surgery and in DRG coding. At a Level 1 hospital, 1000 coded cases of surgical procedures were checked. In our department, the DRG responsible physician who is both a surgeon and encoder has proven itself for many years. The initial surgical DRG coding had to be corrected by the DRG responsible physician in 42.2% of cases. On average, one hour per working day was necessary. The implementation of a DRG responsible physician is a simple, effective way to connect medical and business expertise without interface problems. Permanent feedback promotes both medical and economic sensitivity for the improvement of coding quality.

  5. Expression of mRNAs for PPT, CGRP, NF-200, and MAP-2 in cocultures of dissociated DRG neurons and skeletal muscle cells in administration of NGF or NT-3

    Directory of Open Access Journals (Sweden)

    Weiwei Zhang

    2012-07-01

    Full Text Available Both neurotrophins (NTs and target skeletal muscle (SKM cells are essential for the maintenance of the function of neurons and nerve-muscle communication. However, much less is known about the association of target SKM cells with distinct NTs on the expression of mRNAs for preprotachykinin (PPT, calcitonin-gene related peptide (CGRP, neurofilament 200 (NF-200, and microtubule associated protein 2 (MAP-2 in dorsal root ganglion (DRG sensory neurons. In the present study, a neuromuscular coculture model of dissociated dorsal root ganglion (DRG neurons and SKM cells was established. The morphology of DRG neurons and SKM cells in coculture was observed with an inverted phase contrast microscope. The effects of nerve growth factor (NGF or neurotrophin-3 (NT-3 on the expression of mRNAs for PPT, CGRP, NF-200, and MAP-2 was analyzed by real time-PCR assay. The morphology of DRG neuronal cell bodies and SKM cells in neuromuscular coculture at different conditions was similar. The neurons presented evidence of dense neurite outgrowth in the presence of distinct NTs in neuromuscular cocultures. NGF and NT-3 increased mRNA levels of PPT, CGRP, and NF-200, but not MAP-2, in neuromuscular cocultures. These results offer new clues towards a better understanding of the association of target SKM cells with distinct NTs on the expression of mRNAs for PPT, CGRP, NF-200 and MAP-2, and implicate the association of target SKM cells and NTs with DRG sensory neuronal phenotypes.

  6. National nostalgia : A group-based emotion that benefits the in-group but hampers intergroup relations

    NARCIS (Netherlands)

    Smeekes, A.N.

    2015-01-01

    Social psychological research on nostalgia has mainly considered this emotion at the individual level rather than the group level. The current paper proposes that group-based nostalgia for the nation (i.e., national nostalgia) is likely to be related to a positive in-group orientation and a negative

  7. 32 CFR 705.22 - Relations with community groups.

    Science.gov (United States)

    2010-07-01

    ... seminar is of principal importance and the use of mess facilities is incidental thereto. (2) Because of... unclear, pending advice from the Chief of Information. (d) Commands may make facilities, less housing and... of the Navy to do so. Mess facilities may not be used for meetings of civic groups or other...

  8. Separation and Relating in a Parent-Toddler Group Setting

    Science.gov (United States)

    Navridi, Evanthia; Navridis, Klimis; Midgley, Nick

    2012-01-01

    Parent-toddler groups constitute a primary intervention programme whose target is to support and encourage the parent-toddler relationship. Toddlerhood is a developmental period when major, crucial changes take place regarding how children function, as well as their relationship to their parents (especially to their mother). The present paper…

  9. Mycolactone-mediated neurite degeneration and functional effects in cultured human and rat DRG neurons: Mechanisms underlying hypoalgesia in Buruli ulcer.

    Science.gov (United States)

    Anand, U; Sinisi, M; Fox, M; MacQuillan, A; Quick, T; Korchev, Y; Bountra, C; McCarthy, T; Anand, P

    2016-01-01

    Mycolactone is a polyketide toxin secreted by the mycobacterium Mycobacterium ulcerans, responsible for the extensive hypoalgesic skin lesions characteristic of patients with Buruli ulcer. A recent pre-clinical study proposed that mycolactone may produce analgesia via activation of the angiotensin II type 2 receptor (AT2R). In contrast, AT2R antagonist EMA401 has shown analgesic efficacy in animal models and clinical trials for neuropathic pain. We therefore investigated the morphological and functional effects of mycolactone in cultured human and rat dorsal root ganglia (DRG) neurons and the role of AT2R using EMA401. Primary sensory neurons were prepared from avulsed cervical human DRG and rat DRG; 24 h after plating, neurons were incubated for 24 to 96 h with synthetic mycolactone A/B, followed by immunostaining with antibodies to PGP9.5, Gap43, β tubulin, or Mitotracker dye staining. Acute functional effects were examined by measuring capsaicin responses with calcium imaging in DRG neuronal cultures treated with mycolactone. Morphological effects: Mycolactone-treated cultures showed dramatically reduced numbers of surviving neurons and non-neuronal cells, reduced Gap43 and β tubulin expression, degenerating neurites and reduced cell body diameter, compared with controls. Dose-related reduction of neurite length was observed in mycolactone-treated cultures. Mitochondria were distributed throughout the length of neurites and soma of control neurons, but clustered in the neurites and soma of mycolactone-treated neurons. Functional effects: Mycolactone-treated human and rat DRG neurons showed dose-related inhibition of capsaicin responses, which were reversed by calcineurin inhibitor cyclosporine and phosphodiesterase inhibitor 3-isobutyl-1-Methylxanthine, indicating involvement of cAMP/ATP reduction. The morphological and functional effects of mycolactone were not altered by Angiotensin II or AT2R antagonist EMA401. Mycolactone induces toxic effects in DRG

  10. Uncertainty relations and semi-groups in B-algebras

    International Nuclear Information System (INIS)

    Papaloucas, L.C.

    1980-07-01

    Starting from a B-algebra which satisfies the conditions of a structure theorem, we obtain directly a Lie algebra for which the Lie ring satisfies automatically the Heisenberg uncertainty relations. (author)

  11. Religious Groups and Their Influence on Interstate Relations (The Case of U.S.-Israel Relations

    Directory of Open Access Journals (Sweden)

    Igor Istomin

    2014-01-01

    Full Text Available The impact of interest groups on foreign policy of the state up until today has not received substantial attention in the theory of international relations. In particular, activities of the entities shaped by the common religious affiliation of their members lack assessment in the academic literature. Meanwhile, their mobilization in the recent decades became significant aspect of political life both in developing and developed countries. The activity of religious groups in the United States forced deep transformation of the national political landscape, as they desire to affect not only internal debate, but external policies as well. Among other issues attention of such social and political bodies is also focused on the situation in the middle East. Their proactive standing facilitated advancement of the partnership between the United States and Israel, including growth of American diplomatic and military aid to Tel-Aviv. The supporters of such policy include not only small, but well organized Jewish community, but also representatives of the conservative Evangelical Protestants, which constitute the most numerous religious group in the U.S. Despite the fact that leaders of both group often use theological reasons to justify their support for Israel, the real motivation of the most regular members is primarily humanitarian and pragmatic. The diversity of the Pro-Israeli groups promotes bipartisan support of cooperation between the two countries, and enabled creation of both Democratic and Republican lobby on this issue. However the growing criticism of the current policy of Tel-Aviv on behalf of some of the adherents of American-Israeli cooperation leads to the erosion of impact of these groups.

  12. DRG-based CubeSat Inertial Reference Unit (DCIRU), Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — CubeSats currently lack adequate inertial attitude knowledge and control required for future sophisticated science missions. Boeing?s Disc Resonator Gyro (DRG)...

  13. [What changes for rheumatologists in the G-DRG system 2006?].

    Science.gov (United States)

    Liedtke-Dyong, A; Fiori, W; Lakomek, H-J; Hülsemann, J L; Köneke, N; Liman, W; Roeder, N

    2006-07-01

    Once more, the revision of the German DRG catalogue 2006 provides for more accurate reimbursement, particularly for specialised medical services. The newly established DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) for the complex and multimodal treatment of rheumatic diseases allows an accurate picture of clinical practice in specialized rheumatologic departments and hospitals. Using this specific DRG-description, it will be possible to reduce the financial pressure which results from the redistribution of budgets in the second year of the period of convergence. A precondition for the affected hospitals is to deal with budget planning and calculation of G-DRGs without calculated cost weights for 2006. In addition, this article discusses the relevance of other modifications to the G-DRG system, additional payments, the conditions for payment, the coding standards, and the classification systems for diagnosis and procedures.

  14. Humanness and (im)morality in group relations

    OpenAIRE

    Henriques, Ana Patrícia Matos

    2017-01-01

    Tese de Doutoramento em Psicologia na área de especialidade - Psicologia Social Morality is a valued dimension within and between groups (Ellemers, Pagliaro, & Barreto, 2013; Leach, Bilali, & Pagliaro, 2015), that has been consistently pointed out as part of what makes us uniquely human (Demoulin et al., 2004; Leyens et al., 2000; Haslam, 2006). On the other hand, the extent to which we see others as fully human also impacts on other’s moral status (Bastian, Laham, Wilson, Haslam, & Koval,...

  15. Recommendations for the classification of HIV associated neuromanifestations in the German DRG system.

    Science.gov (United States)

    Evers, Stefan; Fiori, W; Brockmeyer, N; Arendt, G; Husstedt, I-W

    2005-09-12

    HIV associated neuromanifestations are of growing importance in the in-patient treatment of HIV infected patients. In Germany, all in-patients have to be coded according to the ICD-10 classification and the German DRG-system. We present recommendations how to code the different primary and secondary neuromanifestations of HIV infection. These recommendations are based on the commentary of the German DRG procedures and are aimed to establish uniform coding of neuromanifestations.

  16. A framework for health-related nanomaterial grouping.

    Science.gov (United States)

    Gkika, D A; Nolan, J W; Vansant, E F; Vordos, N; Kontogoulidou, C; Mitropoulos, A Ch; Cool, P; Braet, J

    2017-06-01

    Nanotechnology has been in the limelight since its emergence and its products affect everyday lives. Nanomaterials are characterized by features such as size and shape, thus rendering their possible number essentially unlimited, which in turn makes them difficult to study and categorize regarding possible dangers. This work suggests that grouping could allow studying them with limited testing efforts without endangering safety. Initially, the materials are identified and grouped according to their applications in health/medicine, as well as on their environmentally-friendly potential. The materials are then categorized using various toxicity classification methods to identify those with highest risks and group them with others that demonstrate similar behavior. The materials studied show promising uses in diagnostics, drug delivery, biosensors, water purification, oil spill cleaning, emission control and other fields. The toxicity risk assessment shows that the majority pose little to moderate risk, however there are certain materials that can be extremely hazardous or even cause death under specific circumstances. A risk mitigation plan was also developed. Nanomaterials applications, including drug delivery, cancer treatment, waste treatment, solar energy generation etc. can be very beneficiary, but at the same time, these materials can be extremely harmful or even cause death, thus making the need to prioritize research on high risk materials crucial. A clear regulatory framework that addresses both benefits and risks and communicates that information effectively should play an important part in European and worldwide efforts. The risk analysis validated the impression that there is limited research on nanomaterial toxicity risks, which calls for a more organized approach. The framework outlined in this work can be utilized by researchers as well as government bodies, in order to form regulatory policies and adopt a universally accepted labeling system. This

  17. Groups of automorphisms of the canonical commutation and anticommutation relations

    International Nuclear Information System (INIS)

    Grosse, H.; Pittner, L.

    1987-01-01

    Observables of supersymmetric quantum mechanics are coded by taking the antisymmetric tensor product with anticommuting parameters. Next we define superunitary transformations, which mix bosonic and fermionic degrees of freedom, in order to construct automorphisms of the canonical (anti-) commutation relations. Conversely, every automorphism of the C(A)CR is implemented by an essentially unique superunitary transformation. 12 refs. (Author)

  18. Individual and Peer Group Normative Beliefs about Relational Aggression

    Science.gov (United States)

    Werner, Nicole E.; Hill, Laura G.

    2010-01-01

    Studies show that children who use relational aggression process social information in unique ways; however, findings have been inconsistent and limited by methodological weaknesses. This short-term longitudinal study examined developmental changes in 245 (49% female; ages 8-13) 3rd through 8th graders' normative beliefs about relational…

  19. Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

    Science.gov (United States)

    Notenbomer, Annette; Roelen, Corné A M; van Rhenen, Willem; Groothoff, Johan W

    2016-01-01

    Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R) model as theoretical framework. Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

  20. Indications for CT and MR arthrography. Recommendations of the Musculoskeletal Workgroup of the DRG; Indikationen der MR- und CT-Arthrografie. Empfehlungen der AG Muskuloskelettale Radiologie der DRG

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, W. [Hessingpark Clinic, Radiologengemeinschaft Augsburg (Germany); Bohndorf, K.; Zentner, J. [Zentralklinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie; Kreitner, K.F. [Universitaetsklinikum Mainz (Germany). Klinik und Poliklinik fuer Radiologie; Schmitt, R. [Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Woertler, K. [Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Roentgendiagnostik

    2009-05-15

    The ongoing discussion about CT and MR arthrography is at least in part due to the lack of definite guidelines. The intention of the musculoskeletal workgroup of the DRG (Deutsche Roentgengesellschaft) was the establishment of recommendations for general guidance. After review of the recent literature, the indications for arthrographic examinations were discussed during a consensus meeting. Since the published data are insufficient and partially contradictory, no precise statements could be extracted from the literature. Therefore, the proposed recommendations are mainly based on expert opinions. In this review the main statements of the published literature are summarized and the recommendations of the musculoskeletal workgroup of the DRG are presented. (orig.)

  1. Structure of some relative relation modules of finite p-groups

    International Nuclear Information System (INIS)

    Yamin, M.

    1990-06-01

    Let G be a finite p-group generated by (g i , 1 ≤ i ≤ d), G i the cyclic subgroup generated by g i , E the free product of the G i , 1 ≤ i ≤ d, and S the kernel of the natural epimorphism of E onto G. The largest elementary abelian p-quotient S-circumflex = S/S'S p , regarded as an IF p G-module via conjugation in E, is called a relative relation module of G. If d is the minimum number of generaters for G, the author has proved that S-circumflex is nonprojective and indecomposable. The aim of this paper is to give an alternative proof for the indecomposability of S-circumflex; the proof here is more informative as it deals with Loewy structure and generating sets of S-circumflex and other associated modules. (author). 9 refs

  2. Relatively hyperbolic extensions of groups and Cannon–Thurston ...

    Indian Academy of Sciences (India)

    In [6], the existence of a Cannon–Thurston map for the embedding i: K → G was proved, where K and G are respectively the Cayley graphs of K and G. In this paper, we will generalize these results to the case where the kernel is strongly hyperbolic relative to a cusp subgroup. One of our main theorems states: Theorem 2.10 ...

  3. WenTong HuoXue Cream Can Inhibit the Reduction of the Pain-Related Molecule PLC-β3 in the Dorsal Root Ganglion of a Rat Model of Diabetic Peripheral Neuropathy

    Directory of Open Access Journals (Sweden)

    Chengcheng Feng

    2018-01-01

    Full Text Available WenTong HuoXue Cream (WTHX-Cream has been shown to effectively alleviate clinical symptoms of diabetic peripheral neuropathy (DPN. This study investigated the gene and protein expression of the pain-related molecule PLC-β3 in the dorsal root ganglion (DRG of DPN rats. 88 specific pathogen-free male Wistar rats were randomly divided into placebo (10 rats and DPN model (78 rats groups, and the 78 model rats were used to establish the DPN model by intraperitoneal injection of streptozotocin and were then fed a high-fat diet for 8 weeks. These rats were randomly divided into the model group, the high-, medium-, and low-dose WTHX-Cream + metformin groups, the metformin group, the capsaicin cream group, and the capsaicin cream + metformin group. After 4 weeks of continuous drug administration, the blood glucose, body weight, behavioral indexes, and sciatic nerve conduction velocity were measured. The pathological structure of the DRG and the sciatic nerve were observed. PLC-β3 mRNA and protein levels in the DRG of rats were measured. Compared with the model group, the high-dose WTHX-Cream group showed increased sciatic nerve conduction velocity, improved sciatic nerve morphological changes, and increased expression of PLC-β3 mRNA and protein in the DRG. This study showed that WTHX-Cream improves hyperalgesia symptoms of DPN by inhibiting the reduction of PLC-β3 mRNA and protein expression in the diabetic DRG of DPN rats.

  4. Gabor frames on locally compact abelian groups and related topics

    DEFF Research Database (Denmark)

    Jakobsen, Mads Sielemann

    This thesis consists of four papers. The first one introduces generalized translation invariant systems and considers their frame properties, the second and third paper give new results on the theory of Gabor frames, and the fourth is a review paper with proofs and new results on the Feichtinger......- and shearlet-type and for (generalized) shift-invariant systems and their continuous formulations. This thesis advances the theory of both separable and non-separable, discrete, semicontinuous and continuous Gabor systems. In particular, the well established structure theory for separable lattice Gabor frames...... and Gabor Riesz bases. The theory of GTI systems and Gabor frames in this thesis is developed and presented in the setting of locally compact abelian groups, however, even in the euclidean setting the results given here improve the existing theory. Finally, the thesis contains a review paper with proofs...

  5. Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

    Directory of Open Access Journals (Sweden)

    Annette Notenbomer

    Full Text Available Research investigating frequent sickness absence (3 or more episodes per year is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves.We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R model as theoretical framework.Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills were regarded as solutions to reduce frequent sickness absence.The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

  6. National legal system in relation to vulnerable population groups

    Directory of Open Access Journals (Sweden)

    Sjeničić Marta

    2015-01-01

    Full Text Available Vulnerable social groups can be recognized in everyday life, and local legal regulations identify them as well. Strategies and laws clearly identify the increased needs of vulnerable groups. Local legislation, for example, observes comparative law trends and attempts to prevent discrimination of persons with disabilities, emphasizes their human rights and creates the legal framework for taking these persons out of the institutional form of protection and including them into the community. In Serbia however, strategies and laws, as well as by-laws, are written in sectors, and not in cross-sectors manner. Proper caring for persons with disabilities, including persons with mental disabilities, requires an integral approach, namely a mutual approach of the social, health, educational and other sectors. True enough, local regulations stress the need for an intersectional approach, but such an approach is scantily applied in practice, so the comprehensive care that would satisfy the multiple needs of persons with mental disabilities often turns out to be less than expected in the community. Pursuant to national laws and basic ethic principals, all citizens of the Republic of Serbia have the right to health protection without discrimination. Therefore, methods for using health protection, easier than the existing ones, should be found for certain vulnerable groups, depending on their characteristics, and so for the Roma as well, and bearing in mind that systemic health regulations in Serbia open the door to special treatment of these groups. The inaccessible approach to health care of the Roma population persists primarily due to insufficient basic health documentation and basic personal documentation. Personal documents are linked with the registered place of residence, which the Roma, largely do not have. The problem is thus on a wider scale and is not only focused on the health sector. As such, it requires a wider, intersectional approach and a

  7. Breast cancer surgery and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries.

    Science.gov (United States)

    Scheller-Kreinsen, David; Quentin, Wilm; Geissler, Alexander; Busse, Reinhard

    2013-10-01

    Researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with breast cancer surgery patients. DRG algorithms and indicators of resource consumption were assessed for those DRGs that individually contain at least 1% of all breast cancer surgery patients. Six standardised case vignettes were defined and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems classify breast cancer surgery patients according to different sets of classification variables into three to seven DRGs. Quasi prices for an index case treated with partial mastectomy range from €577 in Poland to €5780 in the Netherlands. Countries award their highest payments for very different kinds of patients. Breast cancer specialists and national DRG authorities should consider how other countries' DRG systems classify breast cancer patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. [Revenue and losses with vertebral augmentation under the G-DRG system 2012 - a comparison of supply costs in the context of vertebroplasty and kyphoplasty].

    Science.gov (United States)

    Krüger, A; Wollny, M; Oberkircher, L; Bornemann, R; Pflugmacher, R

    2012-10-01

    If clearly indicated and implemented, augmentations of vertebral bodies with cement are standardized, safe and low-risk procedures. However, the multiplicity of providers and systems are today more varied than ever. At present, the systems differ starkly from one another not only in specifications, possible applications and extensions of indications, but they are also extremely variable in price. Publications have shown that in times of medical-economic change, vertebral augmentations make sense not only medically, but also in terms of economics and the national economy. Our analysis targets the question of how insurance costs with vertebroplasty and kyphoplasty affect profit margins per G-DRG (German Diagnosis Related Groups) in consideration of the different system approaches of the providers. After reviewing the literature, extremely varied, minimally invasive augmentation methods and techniques for treating vertebral body fractures were identified and classified. These were grouped based also [sic: on] OPS and possibly further subdivisions. Material costs were gathered based on average price quotations of different providers and techniques and aligned with those from the literature. The inpatient costs per day were estimated as a lump sum according to published information, since our analysis was interested in less detailed process costs as these are difficult to transfer to other clinics due to parameters being unique to each facility. The G-DRGs concerned were likewise determined according to the case-based lump sum catalogue from 2012. Based on this, the material costs as well as the daily costs per day of inpatient stay according to the average length of stay per G-DRG were subtracted. Vertebral augmentation methods are classified into vertebroplasty and kyphoplasty according to OPS. In addition, according to current literature, a further subdivision of kyphoplasty into substance-conserving or direct cement injection techniques and substance-destroying or

  9. Hospital financing of ischaemic stroke: determinants of funding and usefulness of DRG subcategories based on severity of illness.

    Science.gov (United States)

    Dewilde, Sarah; Annemans, Lieven; Pincé, Hilde; Thijs, Vincent

    2018-05-11

    Several Western and Arab countries, as well as over 30 States in the US are using the "All-Patient Refined Diagnosis-Related Groups" (APR-DRGs) with four severity-of-illness (SOI) subcategories as a model for hospital funding. The aim of this study is to verify whether this is an adequate model for funding stroke hospital admissions, and to explore which risk factors and complications may influence the amount of funding. A bottom-up analysis of 2496 ischaemic stroke admissions in Belgium compares detailed in-hospital resource use (including length of stay, imaging, lab tests, visits and drugs) per SOI category and calculates total hospitalisation costs. A second analysis examines the relationship between the type and location of the index stroke, medical risk factors, patient characteristics, comorbidities and in-hospital complications on the one hand, and the funding level received by the hospital on the other hand. This dataset included 2513 hospitalisations reporting on 35,195 secondary diagnosis codes, all medically coded with the International Classification of Disease (ICD-9). Total costs per admission increased by SOI (€3710-€16,735), with severe patients costing proportionally more in bed days (86%), and milder patients costing more in medical imaging (24%). In all resource categories (bed days, medications, visits and imaging and laboratory tests), the absolute utilisation rate was higher among severe patients, but also showed more variability. SOI 1-2 was associated with vague, non-specific stroke-related ICD-9 codes as primary diagnosis (71-81% of hospitalisations). 24% hospitalisations had, in addition to the primary diagnosis, other stroke-related codes as secondary diagnoses. Presence of lung infections, intracranial bleeding, severe kidney disease, and do-not-resuscitate status were each associated with extreme SOI (p DRG with SOI subclassification is a useful funding model as it clusters stroke patients in homogenous groups in terms of

  10. Psychology of group relations: cultural and social dimensions.

    Science.gov (United States)

    Berry, J W

    2004-07-01

    Cross-cultural psychology attempts to understand the development and expression of human behavior in relation to the cultural contexts in which it occurs. It adopts the perspective of "universalism," which assumes that all human beings share basic psychological processes, but which are then shaped by cultural influences. This perspective allows for the comparison of individuals from different cultures (based on the process commonality), but also accepts behavioral variability (based on the cultural shaping). In the case of behavior that takes place during interactions between individuals coming from two (or more) cultures, the task is more complex; we now need to understand at least two sets of culture-behavior phenomena, as well as a third set--those that arise at the intersection of their relationships. In cross-cultural psychology, we have adopted concepts and methods from sociology and political science to inform work on "ethnic relations," and from cultural anthropology we have been informed in our work on the process and outcomes of "acculturation." In the former domain are phenomena such as prejudice and discrimination; in the latter are the strategies people use when in daily contact with people from other cultures (such as assimilation, integration, separation, and marginalization). These phenomena take place in cultural contexts, which need to be understood in terms of the core dimensions of cultural difference (such as diversity, equality, and conformity). During prolonged and intimate contact between persons of different cultural backgrounds, all these psychological concepts and processes, and cultural influences need to be taken into account when selecting, training, and monitoring individuals during their intercultural interactions.

  11. Comparison of the Revenue Situation in Interventional Radiology Based on the Example of Peripheral Artery Disease in the Case of a DRG Payment System and Various Internal Treatment Charges.

    Science.gov (United States)

    Vogt, Florian M; Hunold, Peter; Haegele, Julian; Stahlberg, Erik; Barkhausen, Jörg; Goltz, Jan Peter

    2018-04-01

     Calculation of process-orientated costs for inpatient endovascular treatment of peripheral artery disease (PAD) from an interventional radiology (IR) perspective. Comparison of revenue situations in consideration of different ways to calculate internal treatment charges (ITCs) and diagnosis-related groups (DRG) for an independent IR department.  Costs (personnel, operating, material, and indirect costs) for endovascular treatment of PAD patients in an inpatient setting were calculated on a full cost basis. These costs were compared to the revenue situation for IR for five different scenarios: 1) IR receives the total DRG amount. IR receives the following DRG shares using ITCs based on InEK shares for 2) "Radiology" cost center type, 3) "OP" cost center type, 4) "Radiology" and "OP" cost center type, and 5) based on DKG-NT (scale of charges of the German Hospital Society).  78 patients (mean age: 68.6 ± 11.4y) with the following DRGs were evaluated: F59A (n = 6), F59B (n = 14), F59C (n = 20) and F59 D (n = 38). The length of stay for these DRG groups was 15.8 ± 12.1, 9.4 ± 7.8, 2.8 ± 3.7 and 3.4 ± 6.5 days Material costs represented the bulk of all costs, especially if new and complex endovascular procedures were performed. Revenues for neither InEK shares nor ITCs based on DKG-NT were high enough to cover material costs. Contribution margins for the five scenarios were 1 = € 1,539.29, 2 = € -1,775.31, 3 = € -2,579.41, 4 = € -963.43, 5 = € -2,687.22 in F59A, 1 = € -792.67, 2 = € -2,685.00, 3 = € -2,600.81, 4 = € -1,618.94, 5 = € -3,060.03 in F59B, 1 = € -879.87, 2 = € -2,633.14, 3 = € -3,001.07, 4 = € -1,952.33, 5 = € -3,136.24 in F59C and 1 = € 703.65, 2 = € -106.35, 3 = € -773.86, 4 = € 205.14, 5 = € -647.22 in F59 D. InEK shares return on average

  12. Sensitization of capsaicin and icilin responses in oxaliplatin treated adult rat DRG neurons

    Directory of Open Access Journals (Sweden)

    Anand Praveen

    2010-11-01

    Full Text Available Abstract Background Oxaliplatin chemotherapy induced neuropathy is a dose related cumulative toxicity that manifests as tingling, numbness, and chronic pain, compromising the quality of life and leading to discontinued chemotherapy. Patients report marked hypersensitivity to cold stimuli at early stages of treatment, when sensory testing reveals cold and heat hyperalgesia. This study examined the morphological and functional effects of oxaliplatin treatment in cultured adult rat DRG neurons. Results 48 hour exposure to oxaliplatin resulted in dose related reduction in neurite length, density, and number of neurons compared to vehicle treated controls, using Gap43 immunostaining. Neurons treated acutely with 20 μg/ml oxaliplatin showed significantly higher signal intensity for cyclic AMP immunofluorescence (160.5 ± 13 a.u., n = 3, P Conclusions Oxaliplatin treatment induces TRP sensitization mediated by increased intracellular cAMP, which may cause neuronal damage. These effects may be mitigated by co-treatment with adenylyl cyclase inhibitors, like CB2 agonists, to alleviate the neurotoxic effects of oxaliplatin.

  13. DRG Voltage-Gated Sodium Channel 1.7 Is Upregulated in Paclitaxel-Induced Neuropathy in Rats and in Humans with Neuropathic Pain.

    Science.gov (United States)

    Li, Yan; North, Robert Y; Rhines, Laurence D; Tatsui, Claudio Esteves; Rao, Ganesh; Edwards, Denaya D; Cassidy, Ryan M; Harrison, Daniel S; Johansson, Caj A; Zhang, Hongmei; Dougherty, Patrick M

    2018-01-31

    Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect experienced by cancer patients receiving treatment with paclitaxel. The voltage-gated sodium channel 1.7 (Na v 1.7) plays an important role in multiple preclinical models of neuropathic pain and in inherited human pain phenotypes, and its gene expression is increased in dorsal root ganglia (DRGs) of paclitaxel-treated rats. Hence, the potential of change in the expression and function of Na v 1.7 protein in DRGs from male rats with paclitaxel-related CIPN and from male and female humans with cancer-related neuropathic pain was tested here. Double immunofluorescence in CIPN rats showed that Na v 1.7 was upregulated in small DRG neuron somata, especially those also expressing calcitonin gene-related peptide (CGRP), and in central processes of these cells in the superficial spinal dorsal horn. Whole-cell patch-clamp recordings in rat DRG neurons revealed that paclitaxel induced an enhancement of ProTx II (a selective Na v 1.7 channel blocker)-sensitive sodium currents. Bath-applied ProTx II suppressed spontaneous action potentials in DRG neurons occurring in rats with CIPN, while intrathecal injection of ProTx II significantly attenuated behavioral signs of CIPN. Complementarily, DRG neurons isolated from segments where patients had a history of neuropathic pain also showed electrophysiological and immunofluorescence results indicating an increased expression of Na v 1.7 associated with spontaneous activity. Na v 1.7 was also colocalized in human cells expressing transient receptor potential vanilloid 1 and CGRP. Furthermore, ProTx II decreased firing frequency in human DRGs with spontaneous action potentials. This study suggests that Na v 1.7 may provide a potential new target for the treatment of neuropathic pain, including chemotherapy (paclitaxel)-induced neuropathic pain. SIGNIFICANCE STATEMENT This work demonstrates that the expression and function of the voltage-gated sodium channel Na

  14. Sustained neurochemical plasticity in central terminals of mouse DRG neurons following colitis.

    Science.gov (United States)

    Benson, Jessica R; Xu, Jiameng; Moynes, Derek M; Lapointe, Tamia K; Altier, Christophe; Vanner, Stephen J; Lomax, Alan E

    2014-05-01

    Sensitization of dorsal root ganglia (DRG) neurons is an important mechanism underlying the expression of chronic abdominal pain caused by intestinal inflammation. Most studies have focused on changes in the peripheral terminals of DRG neurons in the inflamed intestine but recent evidence suggests that the sprouting of central nerve terminals in the dorsal horn is also important. Therefore, we examine the time course and reversibility of changes in the distribution of immunoreactivity for substance P (SP), a marker of the central terminals of DRG neurons, in the spinal cord during and following dextran sulphate sodium (DSS)-induced colitis in mice. Acute and chronic treatment with DSS significantly increased SP immunoreactivity in thoracic and lumbosacral spinal cord segments. This increase developed over several weeks and was evident in both the superficial laminae of the dorsal horn and in lamina X. These increases persisted for 5 weeks following cessation of both the acute and chronic models. The increase in SP immunoreactivity was not observed in segments of the cervical spinal cord, which were not innervated by the axons of colonic afferent neurons. DRG neurons dissociated following acute DSS-colitis exhibited increased neurite sprouting compared with neurons dissociated from control mice. These data suggest significant colitis-induced enhancements in neuropeptide expression in DRG neuron central terminals. Such neurotransmitter plasticity persists beyond the period of active inflammation and might contribute to a sustained increase in nociceptive signaling following the resolution of inflammation.

  15. Metabolic changes of cultured DRG neurons induced by adenosine using confocal microscopy imaging

    Science.gov (United States)

    Zheng, Liqin; Huang, Yimei; Chen, Jiangxu; Wang, Yuhua; Yang, Hongqin; Zhang, Yanding; Xie, Shusen

    2012-12-01

    Adenosine exerts multiple effects on pain transmission in the peripheral nervous system. This study was performed to use confocal microscopy to evaluate whether adenosine could affect dorsal root ganglia (DRG) neurons in vitro and test which adenosine receptor mediates the effect of adenosine on DRG neurons. After adding adenosine with different concentration, we compared the metabolic changes by the real time imaging of calcium and mitochondria membrane potential using confocal microscopy. The results showed that the effect of 500 μM adenosine on the metabolic changes of DRG neurons was more significant than others. Furthermore, four different adenosine receptor antagonists were used to study which receptor mediated the influences of adenosine on the cultured DRG neurons. All adenosine receptor antagonists especially A1 receptor antagonist (DPCPX) had effect on the Ca2+ and mitochondria membrane potential dynamics of DRG neurons. The above studies demonstrated that the effect of adenosine which may be involved in the signal transmission on the sensory neurons was dose-dependent, and all the four adenosine receptors especially the A1R may mediate the transmission.

  16. Diagnosis Related Groups as a Casemix/Management Tool for Hospice Patients

    Science.gov (United States)

    Johnson-Hürzeler, R.; Leary, Robert J.; Hill, Claire L.

    1983-01-01

    to control the costs of care, and to remain prepared for changes in reimbursement methodologies, health care organizations are beginning to analyze their casemix and their costs per case of providing care. Increasing importance is thus assigned to the search for valid casemix measures and to the construction of information systems which will support casemix investigations. After two years of information systems development, The Connecticut Hospice has begun its search for casemix measures that are applicable to the care of the dying. In this paper, we present our findings on the application of one casemix measure - the DRG - in the specialized area of nonsurgical care of the terminally ill.

  17. Transcriptome-Based Identification of the Desiccation Response Genes in Marine Red Algae Pyropia tenera (Rhodophyta) and Enhancement of Abiotic Stress Tolerance by PtDRG2 in Chlamydomonas.

    Science.gov (United States)

    Im, Sungoh; Lee, Ha-Nul; Jung, Hyun Shin; Yang, Sunghwan; Park, Eun-Jeong; Hwang, Mi Sook; Jeong, Won-Joong; Choi, Dong-Woog

    2017-06-01

    Pyropia tenera (Kjellman) are marine red algae that grow in the intertidal zone and lose more than 90% of water during hibernal low tides every day. In order to identify the desiccation response gene (DRG) in P. tenera, we generated 1,444,210 transcriptome sequences using the 454-FLX platform from the gametophyte under control and desiccation conditions. De novo assembly of the transcriptome reads generated 13,170 contigs, covering about 12 Mbp. We selected 1160 differentially expressed genes (DEGs) in response to desiccation stress based on reads per kilobase per million reads (RPKM) expression values. As shown in green higher plants, DEGs under desiccation are composed of two groups of genes for gene regulation networks and functional proteins for carbohydrate metabolism, membrane perturbation, compatible solutes, and specific proteins similar to higher plants. DEGs that show no significant homology with known sequences in public databases were selected as DRGs in P. tenera. PtDRG2 encodes a novel polypeptide of 159 amino acid residues locating chloroplast. When PtDRG2 was overexpressed in Chlamydomonas, the PtDRG2 confer mannitol and salt tolerance in transgenic cells. These results suggest that Pyropia may possess novel genes that differ from green plants, although the desiccation tolerance mechanism in red algae is similar to those of higher green plants. These transcriptome sequences will facilitate future studies to understand the common processes and novel mechanisms involved in desiccation stress tolerance in red algae.

  18. [How can the coding quality in the DRG system be determined?].

    Science.gov (United States)

    Kahlmeyer, A; Volkmer, B

    2014-01-01

    The permanent adjustments ​​since 2003 to the G-DRG system have made the system even less understandable, so that many users have the feeling of feeding data into a black box which gives them a result without them being able to actively use the system itself. While chief physicians, senior physicians, and nursing managers are responsible to management for the results of the billing, they are in most cases not involved in the steps of DRG coding and billing. From this situation, a common question arises: "How well does my department code?" This uncertainty is exploited by many commercial vendors, who offer a wide variety of approaches for DRG optimization. The goal of this work is to provide advice as to how coding quality can be determined.

  19. Solidarity through shared disadvantage: Highlighting shared experiences of discrimination improves relations between stigmatized groups.

    Science.gov (United States)

    Cortland, Clarissa I; Craig, Maureen A; Shapiro, Jenessa R; Richeson, Jennifer A; Neel, Rebecca; Goldstein, Noah J

    2017-10-01

    Intergroup relations research has largely focused on relations between members of dominant groups and members of disadvantaged groups. The small body of work examining intraminority intergroup relations, or relations between members of different disadvantaged groups, reveals that salient experiences of ingroup discrimination promote positive relations between groups that share a dimension of identity (e.g., 2 different racial minority groups) and negative relations between groups that do not share a dimension of identity (e.g., a racial minority group and a sexual minority group). In the present work, we propose that shared experiences of discrimination between groups that do not share an identity dimension can be used as a lever to facilitate positive intraminority intergroup relations. Five experiments examining relations among 4 different disadvantaged groups supported this hypothesis. Both blatant (Experiments 1 and 3) and subtle (Experiments 2, 3, and 4) connections to shared experiences of discrimination, or inducing a similarity-seeking mindset in the context of discrimination faced by one's ingroup (Experiment 5), increased support for policies benefiting the outgroup (Experiments 1, 2, and 4) and reduced intergroup bias (Experiments 3, 4, and 5). Taken together, these experiments provide converging evidence that highlighting shared experiences of discrimination can improve intergroup outcomes between stigmatized groups across dimensions of social identity. Implications of these findings for intraminority intergroup relations are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Comparison of the force exerted by hippocampal and DRG growth cones.

    Science.gov (United States)

    Amin, Ladan; Ercolini, Erika; Ban, Jelena; Torre, Vincent

    2013-01-01

    Mechanical properties such as force generation are fundamental for neuronal motility, development and regeneration. We used optical tweezers to compare the force exerted by growth cones (GCs) of neurons from the Peripheral Nervous System (PNS), such as Dorsal Root Ganglia (DRG) neurons, and from the Central Nervous System (CNS) such as hippocampal neurons. Developing GCs from dissociated DRG and hippocampal neurons were obtained from P1-P2 and P10-P12 rats. Comparing their morphology, we observed that the area of GCs of hippocampal neurons was 8-10 µm(2) and did not vary between P1-P2 and P10-P12 rats, but GCs of DRG neurons were larger and their area increased from P1-P2 to P10-P12 by 2-4 times. The force exerted by DRG filopodia was in the order of 1-2 pN and never exceeded 5 pN, while hippocampal filopodia exerted a larger force, often in the order of 5 pN. Hippocampal and DRG lamellipodia exerted lateral forces up to 20 pN, but lamellipodia of DRG neurons could exert a vertical force larger than that of hippocampal neurons. Force-velocity relationships (Fv) in both types of neurons had the same qualitative behaviour, consistent with a common autocatalytic model of force generation. These results indicate that molecular mechanisms of force generation of GC from CNS and PNS neurons are similar but the amplitude of generated force is influenced by their cytoskeletal properties.

  1. Neurotoxicity to DRG neurons varies between rodent strains treated with cisplatin and bortezomib.

    Science.gov (United States)

    Podratz, Jewel L; Kulkarni, Amit; Pleticha, Josef; Kanwar, Rahul; Beutler, Andreas S; Staff, Nathan P; Windebank, Anthony J

    2016-03-15

    Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose limiting side effect that can lead to long-term morbidity. Approximately one-third of patients receiving chemotherapy with taxanes, vinca alkaloids, platinum compounds or proteasome inhibitors develop this toxic side effect. It is not possible to predict who will get CIPN, however, genetic susceptibility may play a role. We explored this hypothesis using an established in vitro dorsal root ganglia neurite outgrowth (DRG-NOG) assay to assess possible genetic influences for cisplatin- and bortezomib-induced neurotoxicity. Almost all previous in vitro studies have used rats or mice. We compared DRG-NOG between four genetically defined, inbred mouse strains (C57BL/6J, DBA/2J, BALB/cJ, and C3H/HeJ) and one rat strain (Sprague Dawley). Our studies found differences in cisplatin and bortezomib-induced neurotoxicity between mouse and rat strains and between the different mouse strains. C57BL/6J and Balb/cJ DRG-NOG was more sensitive to cisplatin than DBA/2J and C3H/HeJ DRG-NOG, and all mouse strains were more sensitive to cisplatin than rat. Bortezomib induced a biphasic dose response in DBA/2J and C3H/H3J mice. C57BL/6J DRG-NOG was most sensitive and Balb/cJ DRG-NOG was least sensitive to bortezomib. Our animal data supports the hypothesis that genetic background may play a role in CIPN and care must be taken when rodent models are used to better understand the contribution of genetics in patient susceptibility to CIPN. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. [Evaluation of the capacity of the APR-DRG classification system to predict hospital mortality].

    Science.gov (United States)

    De Marco, Maria Francesca; Lorenzoni, Luca; Addari, Piero; Nante, Nicola

    2002-01-01

    Inpatient mortality has increasingly been used as an hospital outcome measure. Comparing mortality rates across hospitals requires adjustment for patient risks before making inferences about quality of care based on patient outcomes. Therefore it is essential to dispose of well performing severity measures. The aim of this study is to evaluate the ability of the All Patient Refined DRG system to predict inpatient mortality for congestive heart failure, myocardial infarction, pneumonia and ischemic stroke. Administrative records were used in this analysis. We used two statistics methods to assess the ability of the APR-DRG to predict mortality: the area under the receiver operating characteristics curve (referred to as the c-statistic) and the Hosmer-Lemeshow test. The database for the study included 19,212 discharges for stroke, pneumonia, myocardial infarction and congestive heart failure from fifteen hospital participating in the Italian APR-DRG Project. A multivariate analysis was performed to predict mortality for each condition in study using age, sex and APR-DRG risk mortality subclass as independent variables. Inpatient mortality rate ranges from 9.7% (pneumonia) to 16.7% (stroke). Model discrimination, calculated using the c-statistic, was 0.91 for myocardial infarction, 0.68 for stroke, 0.78 for pneumonia and 0.71 for congestive heart failure. The model calibration assessed using the Hosmer-Leme-show test was quite good. The performance of the APR-DRG scheme when used on Italian hospital activity records is similar to that reported in literature and it seems to improve by adding age and sex to the model. The APR-DRG system does not completely capture the effects of these variables. In some cases, the better performance might be due to the inclusion of specific complications in the risk-of-mortality subclass assignment.

  3. [Cost recovery for the treatment of retinal and vitreal diseases by pars plana vitrectomy under the German DRG system].

    Science.gov (United States)

    Framme, C; Franz, D; Mrosek, S; Helbig, H

    2007-10-01

    Since 2004 inpatient health care in Germany is paid according to calculated DRGs. Only a few university hospitals participated in distinct cost calculations of clinical treatment. It was the aim of this study to check the cost recovery at a University Eye Hospital for the surgical treatment of retinal and vitreal diseases by pars plana vitrectomy (ppV), which are included in DRGs C03Z and C17Z. The performance data for both DRGs were collected for the years 2005 and 2006 using the E1 sheets according to section 21 KHEntG. The mean duration of all procedures was collected by data from the internal controlling. Costs for single operations were calculated from fixed and variable costs for the operation theatre and the ward including costs for personnel and material. In the 2-year period of 4,721 inpatient procedures 1,307 ppVs were performed. Each ppV had fixed surgical costs of 130.60 EUR; personnel costs varied between 575 EUR (C03Z; including cataract surgery; mean OP duration: 85 min) and 510 EUR (C17Z; no cataract surgery; mean OP duration: 73 min) at a proportion between general anaesthesia and local anaesthesia of 80/20. For a pure ppV material costs were 255 EUR. Additional adjuncts such as an encircling band, perfluorcarbon, ICG, tPA, gas and silicon oil or cataract surgery led to extra costs between 51 EUR and 250 EUR per adjunct und were used in 56% (C03Z) and 74.5% (C17Z) of all procedures. Costs for hospitalisation were about 1765 EUR at a mean residence time of 6.5 days. Thus, the overall costs of a pure basic ppV amounted to 2975 EUR (C03Z) and 2661 EUR (C17Z). In consideration of the current relative DRG weights of 1.08 and 0.957 and a current base rate of 2787.19 EUR in Bavaria, cost recovery is only given for basic ppV but not for complex ppVs having higher material and personnel costs. Additionally, the costs for multiple surgeries as occur in 5.9% of cases are not compensated by the DRG system. The reimbursement for inpatient ppVs in a University

  4. In vitro activation of murine DRG neurons by CGRP-mediated mucosal mast cell degranulation

    NARCIS (Netherlands)

    De Jonge, F; De Laet, A; Van Nassauw, L; Miller, HRP; van Bogaert, PP; Timmermans, JP; Kroese, ABA

    Upregulation of CGRP-immunoreactive (IR) primary afferent nerve fibers accompanied by mastocytosis is characteristic for the Schistosoma mansoni-infected murine ileum. These mucosal mast cells (MMC) and CGRP-IR fibers, which originate from dorsal root (DRG) and nodose ganglia, are found in close

  5. CRISPR Epigenome Editing of AKAP150 in DRG Neurons Abolishes Degenerative IVD-Induced Neuronal Activation.

    Science.gov (United States)

    Stover, Joshua D; Farhang, Niloofar; Berrett, Kristofer C; Gertz, Jason; Lawrence, Brandon; Bowles, Robby D

    2017-09-06

    Back pain is a major contributor to disability and has significant socioeconomic impacts worldwide. The degenerative intervertebral disc (IVD) has been hypothesized to contribute to back pain, but a better understanding of the interactions between the degenerative IVD and nociceptive neurons innervating the disc and treatment strategies that directly target these interactions is needed to improve our understanding and treatment of back pain. We investigated degenerative IVD-induced changes to dorsal root ganglion (DRG) neuron activity and utilized CRISPR epigenome editing as a neuromodulation strategy. By exposing DRG neurons to degenerative IVD-conditioned media under both normal and pathological IVD pH levels, we demonstrate that degenerative IVDs trigger interleukin (IL)-6-induced increases in neuron activity to thermal stimuli, which is directly mediated by AKAP and enhanced by acidic pH. Utilizing this novel information on AKAP-mediated increases in nociceptive neuron activity, we developed lentiviral CRISPR epigenome editing vectors that modulate endogenous expression of AKAP150 by targeted promoter histone methylation. When delivered to DRG neurons, these epigenome-modifying vectors abolished degenerative IVD-induced DRG-elevated neuron activity while preserving non-pathologic neuron activity. This work elucidates the potential for CRISPR epigenome editing as a targeted gene-based pain neuromodulation strategy. Copyright © 2017 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.

  6. 76 FR 46677 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

    Science.gov (United States)

    2011-08-03

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services... regulations published July 19, 2010 with respect to group health plans and health insurance coverage offered... plans, and health insurance issuers providing group health insurance coverage. The text of those...

  7. Individual neuropsychological support and group sessions for relatives to TBI patients

    DEFF Research Database (Denmark)

    Siert, Lars

    TITLE: Individual neuropsychological support and group sessions for relatives to TBI patients. OBJECTIVE: To describe how the neuropsychologist work with early and ongoing individual support and group sessions for relatives to adult TBI patients in the acute and sub acute phase and after discharge...

  8. Boundaries of American Identity: Relations between Ethnic Group Prototypicality and Policy Attitudes.

    Science.gov (United States)

    Huynh, Que-Lam; Devos, Thierry; Altman, Hannah R

    2015-08-01

    We sought to document that the extent to which different ethnic groups are perceived as embodying the American identity is more strongly linked to anti-minority policy attitudes and acculturation ideologies among majority group members (European Americans) than among minority group members (Asian Americans or Latino/as). Participants rated 13 attributes of the American identity as they pertain to different ethnic groups, and reported their endorsement of policy attitudes and acculturation ideologies. We found a relative consensus across ethnic groups regarding defining components of the American identity. However, European Americans were perceived as more prototypical of this American identity than ethnic minorities, especially by European American raters. Moreover, for European Americans but not for ethnic minorities, relative ingroup prototypicality was related to anti-minority policy attitudes and acculturation ideologies. These findings suggest that for European Americans, perceptions of ethnic group prototypicality fulfill an instrumental function linked to preserving their group interests and limiting the rights afforded to ethnic minorities.

  9. Protease-Mediated Suppression of DRG Neuron Excitability by Commensal Bacteria.

    Science.gov (United States)

    Sessenwein, Jessica L; Baker, Corey C; Pradhananga, Sabindra; Maitland, Megan E; Petrof, Elaine O; Allen-Vercoe, Emma; Noordhof, Curtis; Reed, David E; Vanner, Stephen J; Lomax, Alan E

    2017-11-29

    Peripheral pain signaling reflects a balance of pronociceptive and antinociceptive influences; the contribution by the gastrointestinal microbiota to this balance has received little attention. Disorders, such as inflammatory bowel disease and irritable bowel syndrome, are associated with exaggerated visceral nociceptive actions that may involve altered microbial signaling, particularly given the evidence for bacterial dysbiosis. Thus, we tested whether a community of commensal gastrointestinal bacteria derived from a healthy human donor (microbial ecosystem therapeutics; MET-1) can affect the excitability of male mouse DRG neurons. MET-1 reduced the excitability of DRG neurons by significantly increasing rheobase, decreasing responses to capsaicin (2 μm) and reducing action potential discharge from colonic afferent nerves. The increase in rheobase was accompanied by an increase in the amplitude of voltage-gated K + currents. A mixture of bacterial protease inhibitors abrogated the effect of MET-1 effects on DRG neuron rheobase. A serine protease inhibitor but not inhibitors of cysteine proteases, acid proteases, metalloproteases, or aminopeptidases abolished the effects of MET-1. The serine protease cathepsin G recapitulated the effects of MET-1 on DRG neurons. Inhibition of protease-activated receptor-4 (PAR-4), but not PAR-2, blocked the effects of MET-1. Furthermore, Faecalibacterium prausnitzii recapitulated the effects of MET-1 on excitability of DRG neurons. We conclude that serine proteases derived from commensal bacteria can directly impact the excitability of DRG neurons, through PAR-4 activation. The ability of microbiota-neuronal interactions to modulate afferent signaling suggests that therapies that induce or correct microbial dysbiosis may impact visceral pain. SIGNIFICANCE STATEMENT Commercially available probiotics have the potential to modify visceral pain. Here we show that secretory products from gastrointestinal microbiota derived from a human

  10. Distinguishing between tertiary and secondary facilities: a case study of cardiac diagnostic-related groups (DRGs).

    Science.gov (United States)

    Rouse, Paul; Arulambalam, Ajit; Correa, Ralph; Ullman, Cornelia

    2010-05-14

    To develop a classification of tertiary cardiac DRGs in order to investigate differences in tertiary/secondary product mix across New Zealand district health boards (DHBs). 67 DRGs from 85,442 cardiac cases were analysed using cost weights and patient comorbidity complexity levels, which were used as a proxy for complexity. The research found high variability of severity within some DRGs. 5 DHBs are the main providers of 27 DRGs which are high cost and identified as tertiary by several ADHB clinicians; the same 5 DHBs have on average higher severity by DRG than the other DHBs. NZ tertiary hospitals have a product mix of DRGs with higher complexity than secondary hospitals. Funding based on case weights needs to recognise the additional resource requirements for this higher complexity.

  11. Relation Entropy and Transferable Entropy Think of Aggregation on Group Decision Making

    Institute of Scientific and Technical Information of China (English)

    CHENG Qi-yue; QIU Wan-hua; LIU Xiao-feng

    2002-01-01

    In this paper, aggregation question based on group decision making and a single decision making is studied. The theory of entropy is applied to the sets pair analysis. The system of relation entropy and the transferable entropy notion are put. The character is studied. An potential by the relation entropy and transferable entropy are defined. It is the consistency measure on the group between a single decision making. We gained a new aggregation effective definition on the group misjudge.

  12. Characterization of human dopamine responsive protein DRG-1 that binds to p75NTR-associated cell death executor NADE.

    Science.gov (United States)

    Yu, Yao; Wang, Jiadong; Yuan, Hanying; Qin, Feng; Wang, Jing; Zhang, Nailing; Li, Yu-Yang; Liu, Jianping; Lu, Hong

    2006-07-19

    Expression of human dopamine responsive gene-1 (DRG-1) is up-regulated in response to treatment of dopamine in the rat astrocytes. However, its functions are not clear up to now. In the presented studies, DRG-1 was identified to be a conserved gene in the vertebrate and expressed abundantly in human testis, brain and skeletal muscle. DRG-1 was shown to interact with human p75NTR-associated cell death executor (NADE) in vivo and in vitro, and the interaction occurred in cytoplasm. The regions required for the interaction were subsequently mapped to the N-terminal of DRG-1 and the C-terminal of NADE. Furthermore, MTT assay showed that stable expression of DRG-1 in 293 cells could promote cell proliferation, and this promotion was suppressed by overexpression of NADE. In flow cytometry cell cycle analysis, overexpression of DRG-1 in 293 or PC12 cells increased the population of cells in the S phase with a concomitant decrease in G0/G1 population. These findings suggest that DRG-1 may contribute to the dopamine-induced cell growth, which is negatively regulated by NADE.

  13. Identification of DRG-1 As a Melanoma-Associated Antigen Recognized by CD4+ Th1 Cells.

    Directory of Open Access Journals (Sweden)

    Yukiko Kiniwa

    Full Text Available Immunotherapy has emerged as a promising strategy for the treatment of metastatic melanoma. Clinical studies have demonstrated the feasibility of cancer immunotherapy using tumor antigens recognized by CD8(+ T cells. However, the overall immune responses induced by these antigens are too weak and transient to induce tumor regression in the majority of patients who received immunization. A growing body of evidence suggests that CD4(+ T helper (Th cells play an important role in antitumor immunity. Therefore, the identification of MHC class II-restricted tumor antigens capable of stimulating CD4(+ T cells may provide opportunities for developing effective cancer vaccines. To this end, we describe the identification of developmentally regulated GTP-binding protein 1 (DRG-1 as a melanoma-associated antigen recognized by HLA-DR11-restricted CD4(+ Th1 cells. Epitope mapping analysis showed that the DRG1248-268 epitope of DRG-1 was required for T cell recognition. Reverse transcription-polymerase chain reaction revealed that DRG-1 was highly expressed in melanoma cell lines but not in normal tissues. DRG-1 knockdown by lentiviral-based shRNA suppressed melanoma cell proliferation and soft agar colony formation. Taken together, these data suggest that DRG-1 plays an important role in melanoma cell growth and transformation, indicating that DRG1 may represent a novel target for CD4(+ T cell-mediated immunotherapy in melanoma.

  14. Identification of DRG-1 As a Melanoma-Associated Antigen Recognized by CD4+ Th1 Cells.

    Science.gov (United States)

    Kiniwa, Yukiko; Li, Jiang; Wang, Mingjun; Sun, Chuang; Lee, Jeffrey E; Wang, Rong-Fu; Wang, Helen Y

    2015-01-01

    Immunotherapy has emerged as a promising strategy for the treatment of metastatic melanoma. Clinical studies have demonstrated the feasibility of cancer immunotherapy using tumor antigens recognized by CD8(+) T cells. However, the overall immune responses induced by these antigens are too weak and transient to induce tumor regression in the majority of patients who received immunization. A growing body of evidence suggests that CD4(+) T helper (Th) cells play an important role in antitumor immunity. Therefore, the identification of MHC class II-restricted tumor antigens capable of stimulating CD4(+) T cells may provide opportunities for developing effective cancer vaccines. To this end, we describe the identification of developmentally regulated GTP-binding protein 1 (DRG-1) as a melanoma-associated antigen recognized by HLA-DR11-restricted CD4(+) Th1 cells. Epitope mapping analysis showed that the DRG1248-268 epitope of DRG-1 was required for T cell recognition. Reverse transcription-polymerase chain reaction revealed that DRG-1 was highly expressed in melanoma cell lines but not in normal tissues. DRG-1 knockdown by lentiviral-based shRNA suppressed melanoma cell proliferation and soft agar colony formation. Taken together, these data suggest that DRG-1 plays an important role in melanoma cell growth and transformation, indicating that DRG1 may represent a novel target for CD4(+) T cell-mediated immunotherapy in melanoma.

  15. Diagnosis-Related Groups in Hand Surgery – a comparison of six European countries [Fallpauschalen in der Handchirurgie – ein Vergleich von sechs europäischen Ländern

    Directory of Open Access Journals (Sweden)

    Stahl, Stephane

    2012-04-01

    Full Text Available [english]
    Diagnosis-Related Group (DRG is a classification system, which groups patients according to their diagnosis and resource consumption. Common hand surgical diagnoses and procedures were processed using national DRG-groupers of six European countries. The upper thresholds of length of stay (LoS are indicated for every country with the exception of Spain. The mean value in the series was 9.9 days for Germany, 4.5 days for Austria, 10.7 days for Italy, 9.7 days for Sweden and 9.4 days for the United Kingdom (UK. Germany and Austria also have lower thresholds of LoS and the average LoS.Multiple finger replantation presented the highest single case reimbursement in Germany, Austria and the UK (13,825 €, 10,576 € and Scaphoid non-union had the highest single case reimbursement in Italy (2,676 €, flap coverage of wounds in Spain (5,506 € and trapeziometacarpal arthritis in Sweden (5,350 €. The mean values for single case reimbursement were as follows: Germany 3,211 €, Austria 2,821 €, Italy 1,947 €, Spain 3,594 €, Sweden 2,403 € and the UK 3,253 €. Ten out of 19 cases showed the highest reimbursement in Spain, followed by the UK (5 cases, Sweden (2 cases, Germany and Austria (1 case each. Applying the case numbers of our clinic to the reimbursement system of each country, total proceeds would be 2.25 million € in Spain, in Germany as well as the UK, 1.75 million € in Austria, in Sweden and 1.22 million € in Italy. The consequences of international differences in efficiency and reimbursement are hard to assess as they are influenced by multiple factors that are seldom purely market-driven. However, the consideration of international data for benchmarking and refinement of national compensation systems should be a useful instrument. [german]
    Diagnosis-Related Groups (DRG bezeichnet ein Klassifikationssystem, welches Patienten anhand ihrer Diagnosen und des Ressourcenverbrauchs einteilt. H

  16. Reactive oxygen species mediate TNFR1 increase after TRPV1 activation in mouse DRG neurons

    Directory of Open Access Journals (Sweden)

    Westlund Karin N

    2009-06-01

    Full Text Available Abstract Background Transient receptor potential vanilloid subtype 1 (TRPV1 is activated by low pH/protons and is well known to be involved in hyperalgesia during inflammation. Tumor necrosis factor α (TNF-α, a proinflammatory cytokine, is involved in nociceptive responses causing hyperalgesia through TNF receptor type 1 (TNFR1 activation. Reactive oxygen species (ROS production is also prominently increased in inflamed tissue. The present study investigated TNFR1 receptors in primary cultured mouse dorsal root ganglion (DRG neurons after TRPV1 activation and the involvement of ROS. C57BL/6 mice, both TRPV1 knockout and wild type, were used for immunofluorescent and live cell imaging. The L4 and L5 DRGs were dissected bilaterally and cultured overnight. TRPV1 was stimulated with capsaicin or its potent analog, resiniferatoxin. ROS production was measured with live cell imaging and TNFR1 was detected with immunofluorescence in DRG primary cultures. The TRPV1 knockout mice, TRPV1 antagonist, capsazepine, and ROS scavenger, N-tert-Butyl-α-phenylnitrone (PBN, were employed to explore the functional relationship among TRPV1, ROS and TNFR1 in these studies. Results The results demonstrate that TRPV1 activation increases TNFR1 receptors and ROS generation in primary cultures of mouse DRG neurons. Activated increases in TNFR1 receptors and ROS production are absent in TRPV1 deficient mice. The PBN blocks increases in TNFR1 and ROS production induced by capsaicin/resiniferatoxin. Conclusion TRPV1 activation increases TNFR1 in cultured mouse DRG neurons through a ROS signaling pathway, a novel sensitization mechanism in DRG neurons.

  17. Microstimulation of the lumbar DRG recruits primary afferent neurons in localized regions of lower limb.

    Science.gov (United States)

    Ayers, Christopher A; Fisher, Lee E; Gaunt, Robert A; Weber, Douglas J

    2016-07-01

    Patterned microstimulation of the dorsal root ganglion (DRG) has been proposed as a method for delivering tactile and proprioceptive feedback to amputees. Previous studies demonstrated that large- and medium-diameter afferent neurons could be recruited separately, even several months after implantation. However, those studies did not examine the anatomical localization of sensory fibers recruited by microstimulation in the DRG. Achieving precise recruitment with respect to both modality and receptive field locations will likely be crucial to create a viable sensory neuroprosthesis. In this study, penetrating microelectrode arrays were implanted in the L5, L6, and L7 DRG of four isoflurane-anesthetized cats instrumented with nerve cuff electrodes around the proximal and distal branches of the sciatic and femoral nerves. A binary search was used to find the recruitment threshold for evoking a response in each nerve cuff. The selectivity of DRG stimulation was characterized by the ability to recruit individual distal branches to the exclusion of all others at threshold; 84.7% (n = 201) of the stimulation electrodes recruited a single nerve branch, with 9 of the 15 instrumented nerves recruited selectively. The median stimulation threshold was 0.68 nC/phase, and the median dynamic range (increase in charge while stimulation remained selective) was 0.36 nC/phase. These results demonstrate the ability of DRG microstimulation to achieve selective recruitment of the major nerve branches of the hindlimb, suggesting that this approach could be used to drive sensory input from localized regions of the limb. This sensory input might be useful for restoring tactile and proprioceptive feedback to a lower-limb amputee. Copyright © 2016 the American Physiological Society.

  18. [Epidemiological data for uterine fibroids in France in 2010-2012 in medical center--analysis from the French DRG-based information system (PMSI)].

    Science.gov (United States)

    Fernandez, H; Chabbert-Buffet, N; Koskas, M; Nazac, A

    2014-10-01

    Uterine fibroids are a common disorder, responsible for menorrhagia/metrorrhagia and pelvic pain and remain the leading reason for hysterectomy in France. Although it is common disorder, French epidemiological data are locking. The objective of this study was to realize an epidemiological analysis from the medicalized information system program (PMSI). The diagnosis codes were selected from 10th version of the International Classification Disease. The medical procedures concerning uterine fibroids were selected (so called: procedures listed). A descriptive analysis was performed from hospitals stays, patients' characteristics and medical procedures (mean, standard distribution, median, range, quartile). In 2012, 46,126 patients (median age: 46 years old) were admitted in hospital (public or private hospitals) due to uterine fibroid corresponding to 47,690 hospital stays (hospital stays for surgery: 32,397). Diagnosis of anemia was reported in approximately 8% of patients and 7.1% of patients hospitalized in 2012 had already been hospitalized between 2004-2012. The median length of hospital stay was 4 days. In 2012, 16,070 hospital stays were reported for total or subtotal hysterectomy, 16,384 hospitals stays for myomectomy and 1376 hospital stays for embolization. In terms of management care, among 46,126 patients with uterine fibroids (principal or related diagnosis), 31,846 patients received a procedure listed in a surgical diagnostic related groups (DRG). To conclude, the study permits to update the epidemiological data concerning uterine fibroid management between 2010-2011-2012 in final. Because the PMSI collects partially information regarding epidemiological data, a clear epidemiological study is needed either with database from health insurance or with dedicated study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Social media in communicating health information: an analysis of Facebook groups related to hypertension.

    Science.gov (United States)

    Al Mamun, Mohammad; Ibrahim, Hamza M; Turin, Tanvir Chowdhury

    2015-01-29

    We studied Facebook groups related to hypertension to characterize their objectives, subject matter, member sizes, geographical boundaries, level of activity, and user-generated content. We performed a systematic search among open Facebook groups using the keywords "hypertension," "high blood pressure," "raised blood pressure," and "blood pressure." We extracted relevant data from each group's content and developed a coding and categorizing scheme for the whole data set. Stepwise logistic regression was used to explore factors independently associated with each group's level of activity. We found 187 hypertension-related Facebook groups containing 8,966 members. The main objective of most (59.9%) Facebook groups was to create hypertension awareness, and 11.2% were created primarily to support patients and caregivers. Among the top-displayed, most recent posts (n = 164), 21.3% were focused on product or service promotion, whereas one-fifth of posts were related to hypertension-awareness information. Each Facebook group's level of activity was independently associated with group size (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 1.01-1.03), presence of "likes" on the most recent wall post (AOR, 3.55, 95% CI, 1.41-8.92), and presence of attached files on the group wall (AOR, 5.01, 95% CI, 1.25-20.1). The primary objective of most of the hypertension-related Facebook groups observed in this study was awareness creation. Compared with the whole Facebook community, the total number of hypertension-related Facebook groups and their users was small and the groups were less active.

  20. Relation of ABO Blood Groups to the Plaque Characteristic of Coronary Atherosclerosis.

    Science.gov (United States)

    Huang, Xingtao; Zou, Yongpeng; Li, Lulu; Chen, Shuyuan; Hou, Jingbo; Yu, Bo

    2017-01-01

    The ABO blood types related to morphological characteristics of atherosclerosis plaque are not clear. We aimed to evaluate the relationship between ABO blood groups and the coronary plaque characteristic. We retrospectively identified the target lesions in 392 acute coronary syndrome patients who underwent optical coherence tomography examination before stenting. Subjects were divided into different groups according to different blood types. The fibrous cap thickness was significantly thicker in O type compared with non-O type (0.075 ± 0.033 mm versus 0.061 ± 0.024, p blood type groups even between O type and non-O type group ( p > 0.05). The plaques of O type blood group were exhibited more stably compared with non-O type blood group. Moreover, the non-O type blood group have more serious coronary artery stenosis than O type blood group.

  1. Bridges or Barriers? Conceptualization of the Role of Multiple Identity Gateway Groups in Intergroup Relations

    Directory of Open Access Journals (Sweden)

    Aharon Levy

    2017-06-01

    Full Text Available The modern era of globalization has been accompanied by a massive growth in interconnections between groups, and has led to the sharing of multiple identities by individuals and groups. Following these developments, research has focused on the issue of multiple identities, and has shed important light on how individuals who hold these complex forms of identity feel and behave, and on the reactions they elicit from members of other groups. However, the potential of groups with such multiple identities (e.g., biracials, immigrants, etc. to affect the intergroup relations between the groups that represent the respective sources of the different identities (e.g., Blacks and Whites, country of origin and country of residence, etc. has not been examined to date. Accordingly, in this paper, we first systematically explore the potential of groups in which people identify with multiple social categories, or groups that are perceived as such by others, to play a role in intergroup dynamics. Next, we offer a theoretical framework outlining what functions groups of people with shared multiple identities may serve (as bridges or barriers by proposing how their presence may facilitate or deteriorate intergroup relations. Finally, we present recent empirical research examining how groups of people with shared multiple identities can act as gateways and bridge the cleft between two separate groups that represent the respective sources of their different identities, and discuss the theoretical and practical implications for the field of intergroup relations.

  2. Special relativity and quantum theory: a collection of papers on the Poincari Group

    International Nuclear Information System (INIS)

    Noz, M.E.; Kim, Y.S.

    1988-01-01

    When the present form of quantum mechanics was formulated in 1927, the most pressing problem was how to make it consistent with special relativity. This still remains a most important and urgent theoretical problem in physics. The underlying language for both disciplines is group theory, and E.P. Wigner's 1939 paper on the Poincari group laid the foundation for unifying the concepts and algorithms of quantum mechanics and special relativity. This volume comprises forty-five papers, including those by P.A.M. Dirac, R.P. Feynman, S. Weinberg, E.P. Wigner and H. Yukawa, covering representations of the Poincari group, time-energy uncertainty relation, covariant pictures of quantum bound states, Lorentz-Dirac deformation in high-enery physics, gauge degrees of freedom for massless particles, group contractions applied to the large-momentum/zero-mass limit, localization problems, and physical applications of the Lorentz group

  3. Opportunities knock: Mediation of peer-relations during meal-time in toddler groups

    Directory of Open Access Journals (Sweden)

    Ellen Os

    2013-11-01

    Full Text Available According to socio-cultural perspectives, adults are seen as mediators of cultural believes, values and practices. Qualitative analyses of teachers’ mediation of peer relations based on video-recordings in 9 toddler-groups indicate that meal-time represents opportunities for teachers to facilitate togetherness and peer-relations between toddlers. The teachers might facilitate sharing, passing food, routinized practices such as singing, and conversations. The results indicate variations between child- and group-oriented approaches, and accomplishing meals in an effective way. The child- and group-oriented approaches are marked by encouragement of toddlers’ initiatives and teachers supporting peer-interactions. Raising teachers’ consciousness about their contributions to children’s development of peer-relations and togetherness in group settings might contribute to enhance reflected practices in working with toddlers in groups.

  4. Oral health and related factors in a group of children with cystic ...

    African Journals Online (AJOL)

    Oral health and related factors in a group of children with cystic fibrosis in Istanbul, Turkey. ... presented as a marker of wound healing and bleeding tendency of oral cavity. ... Caries experience, oral hygiene, and dental erosion were assessed.

  5. Coherent states related with SU(N) and SU(N,1) groups

    International Nuclear Information System (INIS)

    Gitman, D.M.; Shelepin, A.L.

    1990-01-01

    The basis of coherent state (CS) for symmetric presentations of groups SU(N) and SU(N,1) is plotted, its properties being investigated. Evolution of CS is considered. Relation between CS of groups SU(N) and Glauber is ascertained

  6. Exploring a Relational Cultural Group Trainee Model for Master's Level Counseling Students

    Science.gov (United States)

    Hall, Brenda S.; Harper, Irene; Korcuska, James

    2018-01-01

    We explored students' experiences of a graduate level group course infused with components of the Relational Cultural Theory (RCT). During the didactic and experiential aspects of 2 semester-long group courses, the faculty instructors and students focused on creating an environment of safety, connection, and empowerment. The instructor and…

  7. Physicians Mutual Aid Group: A Response to AIDS-Related Burnout.

    Science.gov (United States)

    Garside, Bruce

    1993-01-01

    Describes origins and functioning of physician's mutual aid group for physicians providing primary care to people with Acquired Immune Deficiency Syndrome (AIDS). Offers suggestions related to overcoming resistance physicians might have to participating in such a group and reviews modalities that were helpful in facilitating participants' ability…

  8. Social groups preferences relation to motivations and ability levels of whitewater kayakers

    Science.gov (United States)

    Seth Turner; Rod Zwick

    2002-01-01

    Social groups play an important role in many adventure recreation activities. The purpose of this study was to examine the social group preference relation to motives and ability levels of whitewater kayakers. When participants go out on a kayaking trip they are seeking varying degrees of experiences, a major contributor to that experience comes from the members of...

  9. 75 FR 66125 - Federal Land Managers' Air Quality Related Values Work Group (FLAG)

    Science.gov (United States)

    2010-10-27

    ... pollutants that could affect the health and status of resources in areas managed by the three agencies... Work Group (FLAG) AGENCY: National Park Service, Interior. ACTION: Notice of availability of final... Public Comments document. The Federal Land Managers' Air Quality Related Values Work Group (FLAG) was...

  10. Renormalization group and relations between scattering amplitudes in a theory with different mass scales

    International Nuclear Information System (INIS)

    Gulov, A.V.; Skalozub, V.V.

    2000-01-01

    In the Yukawa model with two different mass scales the renormalization group equation is used to obtain relations between scattering amplitudes at low energies. Considering fermion-fermion scattering as an example, a basic one-loop renormalization group relation is derived which gives possibility to reduce the problem to the scattering of light particles on the external field substituting a heavy virtual state. Applications of the results to problem of searching new physics beyond the Standard Model are discussed [ru

  11. The importance of role distribution in working groups : an evaluation of two different groups working in the same environment based on self-evaluation and observer-reported data by the use of SPGR-Systematizing the Person Group Relation

    OpenAIRE

    Nyheim, Linda

    2007-01-01

    ABSTRACT The present thesis examines personal and group relations. Two groups served as the study context: one group of doctors and one group of nurses. SPGR – Systematizing the Person Group Relation – was used as a framework. SPGR is a theory on how behaviour and relations develop in groups and organizations. The purpose of the study was to investigate typical tendencies in groups to identify the prevailing functions based on the formative SPGR dimensions Nurture, Dependency, Contro...

  12. The effectiveness of therapeutic group and behavior for illogical belief and quality of peoples life related

    Directory of Open Access Journals (Sweden)

    Akram Dastjani, F

    2014-02-01

    Full Text Available Objective: This research with purpose of impression of recognition–manner group iatrical is done on change to invertebrate extinct beliefs and person`s life quality related to amphetamine. Method: thus have inspected 127 reference diseased to matters abusing iatrical centers of Arak city with questionnaire help of Jonz invertebrate extinguish (with 0.71 cronbakh alpha of persons to high marks and life quality questionnaire (with 0.7 cronbakh alpha of persons to low marks. Then selected 30 diseased as situations possessing and holding and they reset to random replacing in two groups of examination and control (15 bodies in every group. So the method of recognition–manner group iatrical applied on examination group and the end again both groups have assessment with mentioned questionnaires. Obtained information of questionnaires, have been analysis through multi-parameter covariance analysis test. The obtains shown to difference of marks and scours of recognition–manner group iatrical is meaning in comparison to control group on reducing invertebrate extinct beliefs and increasing of person’s life quality related to amphetamine. The results of the research shown that recognition–manner group iatrical is effective to management to parameters of invertebrate extinct beliefs and person’ life quality related to amphetamine.

  13. Neto2 Assembles with Kainate Receptors in DRG Neurons during Development and Modulates Neurite Outgrowth in Adult Sensory Neurons.

    Science.gov (United States)

    Vernon, Claire G; Swanson, Geoffrey T

    2017-03-22

    Peripheral sensory neurons in the dorsal root ganglia (DRG) are the initial transducers of sensory stimuli, including painful stimuli, from the periphery to central sensory and pain-processing centers. Small- to medium-diameter non-peptidergic neurons in the neonatal DRG express functional kainate receptors (KARs), one of three subfamilies of ionotropic glutamate receptors, as well as the putative KAR auxiliary subunit Neuropilin- and tolloid-like 2 (Neto2). Neto2 alters recombinant KAR function markedly but has yet to be confirmed as an auxiliary subunit that assembles with and alters the function of endogenous KARs. KARs in neonatal DRG require the GluK1 subunit as a necessary constituent, but it is unclear to what extent other KAR subunits contribute to the function and proposed roles of KARs in sensory ganglia, which include promotion of neurite outgrowth and modulation of glutamate release at the DRG-dorsal horn synapse. In addition, KARs containing the GluK1 subunit are implicated in modes of persistent but not acute pain signaling. We show here that the Neto2 protein is highly expressed in neonatal DRG and modifies KAR gating in DRG neurons in a developmentally regulated fashion in mice. Although normally at very low levels in adult DRG neurons, Neto2 protein expression can be upregulated via MEK/ERK signaling and after sciatic nerve crush and Neto2 -/- neurons from adult mice have stunted neurite outgrowth. These data confirm that Neto2 is a bona fide KAR auxiliary subunit that is an important constituent of KARs early in sensory neuron development and suggest that Neto2 assembly is critical to KAR modulation of DRG neuron process outgrowth. SIGNIFICANCE STATEMENT Pain-transducing peripheral sensory neurons of the dorsal root ganglia (DRG) express kainate receptors (KARs), a subfamily of glutamate receptors that modulate neurite outgrowth and regulate glutamate release at the DRG-dorsal horn synapse. The putative KAR auxiliary subunit Neuropilin- and

  14. Courtesy stigma--a focus group study of relatives of schizophrenia patients.

    Science.gov (United States)

    Angermeyer, Matthias C; Schulze, Beate; Dietrich, Sandra

    2003-10-01

    Stigmatization of people with mental illness has been investigated in numerous studies. Little research, however, has been done to explore how relatives of people with schizophrenia perceive and experience stigmatization and how they can fight such stigmatization. Aiming to explore stigma from the perspective of relatives of people with schizophrenia, focus group interviews were conducted with 122 members of advocacy groups from different parts of Germany. Focus group sessions were tape- and video-recorded and transcribed. Transcripts were coded using an inductive method, generating categories (domains) from the material. The analysis of focus group data shows that, contrary to previous research findings, discrimination and disadvantages encountered by relatives of schizophrenia patients reach far beyond the spheres of direct social interaction and access to social roles. Our study revealed two additional domains in which relatives encounter stigmatization: structural discrimination and public images of mental illness. Furthermore, psychiatry has been identified as one important source of stigma. Relatives also suggested numerous anti-stigma interventions. These can be grouped into five main categories: communication measures, support for the ill and their relatives, changes in mental health care, education and training, and control and supervision. Based on our findings,ways of how relatives of schizophrenia patients and mental health professionals can fight against stigma are discussed.

  15. Group behavioral therapy for adolescents with tic-related and non-tic-related obsessive-compulsive disorder.

    Science.gov (United States)

    Himle, Joseph A; Fischer, Daniel J; Van Etten, Michelle L; Janeck, Amy S; Hanna, Gregory L

    2003-01-01

    Prior research supports the distinction between tic-related and non-tic-related obsessive-compulsive disorder (OCD) based on phenomenologic, etiologic, and neurobehavioral data. The present study examines whether response to psychosocial treatment differs in adolescents, depending on the presence of comorbid tics. Nineteen adolescents, 12-17 years of age, participated in 7-week, uncontrolled trial of group cognitive-behavioral treatment (CBT) for OCD. Eight of the patients had tic-related and eleven had non-tic-related OCD. The group CBT program included psycho-education, exposure and response prevention, cognitive strategies, and family involvement. Significant improvement was observed for all subjects on the Yale-Brown Obsessive Compulsive Scale ratings of obsessions, compulsions, and total OCD symptoms. Outcomes were similar for subjects with tic-related and non-tic-related OCD. These preliminary results suggest that the presence of comorbid tic disorders may not attenuate response to behavioral group treatment among adolescents. Copyright 2003 Wiley-Liss, Inc.

  16. Overexpression of GDNF in the uninjured DRG exerts analgesic effects on neuropathic pain following segmental spinal nerve ligation in mice.

    Science.gov (United States)

    Takasu, Kumiko; Sakai, Atsushi; Hanawa, Hideki; Shimada, Takashi; Suzuki, Hidenori

    2011-11-01

    Glial cell line-derived neurotrophic factor (GDNF), a survival-promoting factor for a subset of nociceptive small-diameter neurons, has been shown to exert analgesic effects on neuropathic pain. However, its detailed mechanisms of action are still unknown. In the present study, we investigated the site-specific analgesic effects of GDNF in the neuropathic pain state using lentiviral vector-mediated GDNF overexpression in mice with left fifth lumbar (L5) spinal nerve ligation (SNL) as a neuropathic pain model. A lentiviral vector expressing both GDNF and enhanced green fluorescent protein (EGFP) was constructed and injected into the left dorsal spinal cord, uninjured fourth lumbar (L4) dorsal root ganglion (DRG), injured L5 DRG, or plantar skin of mice. In SNL mice, injection of the GDNF-EGFP-expressing lentivirus into the dorsal spinal cord or uninjured L4 DRG partially but significantly reduced the mechanical allodynia in association with an increase in GDNF protein expression in each virus injection site, whereas injection into the injured L5 DRG or plantar skin had no effects. These results suggest that GDNF exerts its analgesic effects in the neuropathic pain state by acting on the central terminals of uninjured DRG neurons and/or on the spinal cells targeted by the uninjured DRG neurons. This article shows that GDNF exerts its analgesic effects on neuropathic pain by acting on the central terminals of uninjured DRG neurons and/or on the spinal cells targeted by these neurons. Therefore, research focusing on these GDNF-dependent neurons in the uninjured DRG would provide a new strategy for treating neuropathic pain. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. Planning focus group interviews with asylum seekers: Factors related to the researcher, interpreter and asylum seekers.

    Science.gov (United States)

    Eklöf, Niina; Hupli, Maija; Leino-Kilpi, Helena

    2017-10-01

    The aim of this article was to discuss factors related to the researcher, interpreter and asylum seekers when planning focus group interviews with asylum seekers. Focus group interview is one of the basic data collection methods in descriptive nursing and health research. It has been used in multicultural research, allowing an opportunity to participate without literacy and to have linguistic and cultural support from other participants. Asylum seekers form a specific, vulnerable group, and the growing number of asylum seekers increases the need for research related to them. A culturally, methodologically and ethically high-quality focus group interview is based on the researcher's special knowledge and skills, acknowledgement of asylum seekers as both individuals and part of cultural and communal groups, and careful planning of the interpreter's role during the interviews. © 2017 John Wiley & Sons Ltd.

  18. General relation between the group delay and dwell time in multicomponent electron systems

    Science.gov (United States)

    Zhai, Feng; Lu, Junqiang

    2016-10-01

    For multicomponent electron scattering states, we derive a general relation between the Wigner group delay and the Bohmian dwell time. It is found that the definition of group delay should account for the phase of the spinor wave functions of propagating modes. The difference between the group delay and dwell time comes from both the interference delay and the decaying modes. For barrier tunneling of helical electrons on a surface of topological insulators, our calculations including the trigonal-warping term show that the decaying modes can contribute greatly to the group delay. The derived relation between the group delay and the dwell time is helpful to unify the two definitions of tunneling time in a quite general situation.

  19. Impact of the discovery of crude oil on inter-group relations between ...

    African Journals Online (AJOL)

    Impact of the discovery of crude oil on inter-group relations between Isoko and her immediate neighbours in the western Niger Delta of Nigeria. ... The article shows that the discovery of crude oil petroleum in the western Niger Delta marked a watershed in the history of intergroup relations in the area. Keywords: Discovery ...

  20. A Group Decision Framework with Intuitionistic Preference Relations and Its Application to Low Carbon Supplier Selection.

    Science.gov (United States)

    Tong, Xiayu; Wang, Zhou-Jing

    2016-09-19

    This article develops a group decision framework with intuitionistic preference relations. An approach is first devised to rectify an inconsistent intuitionistic preference relation to derive an additive consistent one. A new aggregation operator, the so-called induced intuitionistic ordered weighted averaging (IIOWA) operator, is proposed to aggregate individual intuitionistic fuzzy judgments. By using the mean absolute deviation between the original and rectified intuitionistic preference relations as an order inducing variable, the rectified consistent intuitionistic preference relations are aggregated into a collective preference relation. This treatment is presumably able to assign different weights to different decision-makers' judgments based on the quality of their inputs (in terms of consistency of their original judgments). A solution procedure is then developed for tackling group decision problems with intuitionistic preference relations. A low carbon supplier selection case study is developed to illustrate how to apply the proposed decision model in practice.

  1. The Social Relations of a Health Walk Group: An Ethnographic Study.

    Science.gov (United States)

    Grant, Gordon; Pollard, Nick; Allmark, Peter; Machaczek, Kasia; Ramcharan, Paul

    2017-09-01

    It is already well established that regular walks are conducive to health and well-being. This article considers the production of social relations of regular, organized weekly group walks for older people. It is based on an ethnographic study of a Walking for Health group in a rural area of the United Kingdom. Different types of social relations are identified arising from the walk experience. The social relations generated are seen to be shaped by organizational factors that are constitutive of the walks; the resulting culture having implications for the sustainability of the experience. As there appears to be no single uniting theory linking group walk experiences to the production of social relations at this time, the findings are considered against therapeutic landscape, therapeutic mobility, and social capital theorizing. Finally, implications for the continuance of walking schemes for older people and for further research are considered.

  2. Loop space representation of quantum general relativity and the group of loops

    International Nuclear Information System (INIS)

    Gambini, R.

    1991-01-01

    The action of the constraints of quantum general relativity on a general state in the loop representation is coded in terms of loop derivatives. These differential operators are related to the infinitesimal generators of the group of loops and generalize the area derivative first considered by Mandelstam. A new sector of solutions of the physical states space of nonperturbative quantum general relativity is found. (orig.)

  3. Dorsal Root Ganglion (DRG) Stimulation in the Treatment of Phantom Limb Pain (PLP).

    Science.gov (United States)

    Eldabe, Sam; Burger, Katja; Moser, Heinrich; Klase, Daniel; Schu, Stefan; Wahlstedt, Anders; Vanderick, Bernard; Francois, Eric; Kramer, Jeffery; Subbaroyan, Jeyakumar

    2015-10-01

    Phantom limb pain (PLP) is a neuropathic condition in which pain is perceived as arising from an amputated limb. PLP is distinct from, although associated with, pain in the residual limb and nonpainful phantom sensations of the missing limb. Its treatment is extremely challenging; pharmaceutical options, while commonly employed, may be insufficient or intolerable. Neuromodulatory interventions such as spinal cord stimulation have generated mixed results and may be limited by poor somatotopic specificity. It was theorized that dorsal root ganglion (DRG) neuromodulation may be more effective. Patients trialed a DRG neurostimulation system for their PLP and were subsequently implanted if results were positive. Retrospective chart review was completed, including pain ratings on a 100-mm visual analogue scale (VAS) and patient-reported outcomes. Across eight patients, the average baseline pain rating was 85.5 mm. At follow-up (mean of 14.4 months), pain was rated at 43.5 mm. Subjective ratings of quality of life and functional capacity improved. Some patients reduced or eliminated pain medications. Patients reported precise concordance of the paresthesia with painful regions, including in their phantom limbs; in one case, stimulation eliminated PLP as well as nonpainful phantom sensations. Three patients experienced a diminution of pain relief, despite good initial outcomes. DRG neuromodulation may be an effective tool in treating this pain etiology. Clinical outcomes in this report support recent converging evidence suggesting that the DRG may be the site of PLP generation and/or maintenance. Further research is warranted to elucidate mechanisms and optimal treatment pathways. © 2015 International Neuromodulation Society.

  4. TRICARE revision to CHAMPUS DRG-based payment system, pricing of hospital claims. Final rule.

    Science.gov (United States)

    2014-05-21

    This Final rule changes TRICARE's current regulatory provision for inpatient hospital claims priced under the DRG-based payment system. Claims are currently priced by using the rates and weights that are in effect on a beneficiary's date of admission. This Final rule changes that provision to price such claims by using the rates and weights that are in effect on a beneficiary's date of discharge.

  5. Contract-program evaluation: Impact of the DRG classification system on hospitals' outputs

    OpenAIRE

    Alves, Helder António Pereira Gomes

    2010-01-01

    A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics The present work project aims at evaluating the impact of contract-program implementation in 2003 and of incentives created in 2007 on hospital output, under the DRG inpatient classification system. A sample of five Portuguese acute public district hospitals was chosen as sample, between 2002 and 2007. Results of hypothesis testing ...

  6. Boundaries of American Identity: Relations between Ethnic Group Prototypicality and Policy Attitudes

    Science.gov (United States)

    Huynh, Que-Lam; Devos, Thierry; Altman, Hannah R.

    2014-01-01

    We sought to document that the extent to which different ethnic groups are perceived as embodying the American identity is more strongly linked to anti-minority policy attitudes and acculturation ideologies among majority group members (European Americans) than among minority group members (Asian Americans or Latino/as). Participants rated 13 attributes of the American identity as they pertain to different ethnic groups, and reported their endorsement of policy attitudes and acculturation ideologies. We found a relative consensus across ethnic groups regarding defining components of the American identity. However, European Americans were perceived as more prototypical of this American identity than ethnic minorities, especially by European American raters. Moreover, for European Americans but not for ethnic minorities, relative ingroup prototypicality was related to anti-minority policy attitudes and acculturation ideologies. These findings suggest that for European Americans, perceptions of ethnic group prototypicality fulfill an instrumental function linked to preserving their group interests and limiting the rights afforded to ethnic minorities. PMID:26347578

  7. A Bacterial Toxin with Analgesic Properties: Hyperpolarization of DRG Neurons by Mycolactone.

    Science.gov (United States)

    Song, Ok-Ryul; Kim, Han-Byul; Jouny, Samuel; Ricard, Isabelle; Vandeputte, Alexandre; Deboosere, Nathalie; Marion, Estelle; Queval, Christophe J; Lesport, Pierre; Bourinet, Emmanuel; Henrion, Daniel; Oh, Seog Bae; Lebon, Guillaume; Sandoz, Guillaume; Yeramian, Edouard; Marsollier, Laurent; Brodin, Priscille

    2017-07-18

    Mycolactone, a polyketide molecule produced by Mycobacterium ulcerans , is the etiological agent of Buruli ulcer. This lipid toxin is endowed with pleiotropic effects, presents cytotoxic effects at high doses, and notably plays a pivotal role in host response upon colonization by the bacillus. Most remarkably, mycolactone displays intriguing analgesic capabilities: the toxin suppresses or alleviates the pain of the skin lesions it inflicts. We demonstrated that the analgesic capability of mycolactone was not attributable to nerve damage, but instead resulted from the triggering of a cellular pathway targeting AT₂ receptors (angiotensin II type 2 receptors; AT₂R), and leading to potassium-dependent hyperpolarization. This demonstration paves the way to new nature-inspired analgesic protocols. In this direction, we assess here the hyperpolarizing properties of mycolactone on nociceptive neurons. We developed a dedicated medium-throughput assay based on membrane potential changes, and visualized by confocal microscopy of bis-oxonol-loaded Dorsal Root Ganglion (DRG) neurons. We demonstrate that mycolactone at non-cytotoxic doses triggers the hyperpolarization of DRG neurons through AT₂R, with this action being not affected by known ligands of AT₂R. This result points towards novel AT₂R-dependent signaling pathways in DRG neurons underlying the analgesic effect of mycolactone, with the perspective for the development of new types of nature-inspired analgesics.

  8. [Ten years of early complex geriatric rehabilitation therapy in the DRG system].

    Science.gov (United States)

    Kolb, G; Breuninger, K; Gronemeyer, S; van den Heuvel, D; Lübke, N; Lüttje, D; Wittrich, A; Wolff, J

    2014-01-01

    Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

  9. Improving patient-level costing in the English and the German 'DRG' system.

    Science.gov (United States)

    Vogl, Matthias

    2013-03-01

    The purpose of this paper is to develop ways to improve patient-level cost apportioning (PLCA) in the English and German inpatient 'DRG' cost accounting systems, to support regulators in improving costing schemes, and to give clinicians and hospital management sophisticated tools to measure and link their management. The paper analyzes and evaluates the PLCA step in the cost accounting schemes of both countries according to the impact on the key aspects of DRG introduction: transparency and efficiency. The goal is to generate a best available PLCA standard with enhanced accuracy and managerial relevance, the main requirements of cost accounting. A best available PLCA standard in 'DRG' cost accounting uses: (1) the cost-matrix from the German system; (2) a third axis in this matrix, representing service-lines or clinical pathways; (3) a scoring system for key cost drivers with the long-term objective of time-driven activity-based costing and (4) a point of delivery separation. Both systems have elements that the other system can learn from. By combining their strengths, regulators are supported in enhancing PLCA systems, improving the accuracy of national reimbursement and the managerial relevance of inpatient cost accounting systems, in order to reduce costs in health care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. The Impact of Merger Status and Relative Representation on Identification with a Merger Group

    Directory of Open Access Journals (Sweden)

    Filip Boen

    2005-12-01

    Full Text Available This experiment tested to what extent identification with a new merger group is determined by the status of that merger group and by the relative representation of the pre-merger ingroup. One hundred university students were assigned to a team of 'inductive' thinkers, and were later merged with a team of 'deductive' thinkers to form a team of 'analyst' thinkers. The status of the merger group (low, high and the relative representation of the ingroup into the novel merger group (low, high were manipulated. Participants identified more with the merger group in the high than in the low status condition, and they identified more in the high than in the low representation condition. The predicted interaction between relative representation and merger status was not significant. However, relative representation did interact with participants' pre-merger identification: Pre- and post-merger identification were positively related when the ingroup was highly represented, but 'negatively' when the ingroup was lowly represented.

  11. Intergroup conflict management strategies as related to perceptions of dual identity and separate groups.

    Science.gov (United States)

    Bizman, Aharon; Yinon, Yoel

    2004-04-01

    The authors examined the relations between (a) the perceptions of dual identity and separate groups and (b) intergroup conflict management strategies, in two contexts: the conflict between the secular and religious sectors in Israel and the allocation of resources among organizational subunits. In both contexts, contention (i.e., forcing one's will on the other party) was associated with the perception of separate groups. Only in the organizational context, avoidance (i.e., doing nothing or discontinuing participation in the conflict) was associated with the perception of dual identity. Problem solving (i.e., finding a solution that is acceptable to both parties) was related to the perception of dual identity in the secular-religious context. In the organizational context, this relation appeared only under a low perception of separate groups. Yielding (i.e., satisfying the other party's needs at the expense of one's own) was related to the perception of dual identity in the organizational context. In the secular-religious context, this relation appeared only under a high perception of separate groups. The authors discussed the varying pattern of the associations between (a) the perceptions of dual identity and separate groups and (b) the conflict management strategies in the two contexts in terms of the Dual Concern Model and the perceived feasibility of the strategies.

  12. On the relative role of different age groups in influenza epidemics.

    Science.gov (United States)

    Worby, Colin J; Chaves, Sandra S; Wallinga, Jacco; Lipsitch, Marc; Finelli, Lyn; Goldstein, Edward

    2015-12-01

    The identification of key "driver" groups in influenza epidemics is of much interest for the implementation of effective public health response strategies, including vaccination programs. However, the relative importance of different age groups in propagating epidemics is uncertain. During a communicable disease outbreak, some groups may be disproportionately represented during the outbreak's ascent due to increased susceptibility and/or contact rates. Such groups or subpopulations can be identified by considering the proportion of cases within the subpopulation occurring before (Bp) and after the epidemic peak (Ap) to calculate the subpopulation's relative risk, RR=Bp/Ap. We estimated RR for several subpopulations (age groups) using data on laboratory-confirmed US influenza hospitalizations during epidemics between 2009-2014. Additionally, we simulated various influenza outbreaks in an age-stratified population, relating the RR to the impact of vaccination in each subpopulation on the epidemic's initial effective reproductive number R_e(0). We found that children aged 5-17 had the highest estimates of RR during the five largest influenza A outbreaks, though the relative magnitude of RR in this age group compared to other age groups varied, being highest for the 2009 A/H1N1 pandemic. For the 2010-2011 and 2012-2013 influenza B epidemics, adults aged 18-49, and 0-4 year-olds had the highest estimates of RR respectively. For 83% of simulated epidemics, the group with the highest RR was also the group for which initial distribution of a given quantity of vaccine would result in the largest reduction of R_e(0). In the largest 40% of simulated outbreaks, the group with the highest RR and the largest vaccination impact was children 5-17. While the relative importance of different age groups in propagating influenza outbreaks varies, children aged 5-17 play the leading role during the largest influenza A epidemics. Extra vaccination efforts for this group may contribute

  13. The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

    Directory of Open Access Journals (Sweden)

    Wilke MH

    2011-12-01

    Full Text Available Abstract Introduction The management of bloodstream infections especially sepsis is a difficult task. An optimal antibiotic therapy (ABX is paramount for success. Procalcitonin (PCT is a well investigated biomarker that allows close monitoring of the infection and management of ABX. It has proven to be a cost-efficient diagnostic tool. In Diagnoses Related Groups (DRG based reimbursement systems, hospitals get only a fixed amount of money for certain treatments. Thus it's very important to obtain an optimal balance of clinical treatment and resource consumption namely the length of stay in hospital and especially in the Intensive Care Unit (ICU. We investigated which economic effects an optimized PCT-based algorithm for antibiotic management could have. Materials and methods We collected inpatient episode data from 16 hospitals. These data contain administrative and clinical information such as length of stay, days in the ICU or diagnoses and procedures. From various RCTs and reviews there are different algorithms for the use of PCT to manage ABX published. Moreover RCTs and meta-analyses have proven possible savings in days of ABX (ABD and length of stay in ICU (ICUD. As the meta-analyses use studies on different patient populations (pneumonia, sepsis, other bacterial infections, we undertook a short meta-analyses of 6 relevant studies investigating in sepsis or ventilator associated pneumonia (VAP. From this analyses we obtained savings in ABD and ICUD by calculating the weighted mean differences. Then we designed a new PCT-based algorithm using results from two very recent reviews. The algorithm contains evidence from several studies. From the patient data we calculated cost estimates using German National standard costing information for the German G-DRG system. We developed a simulation model where the possible savings and the extra costs for (in average 8 PCT tests due to our algorithm were brought into equation. Results We calculated ABD

  14. Assessing stakeholder opinion on relations between cancer patient groups and pharmaceutical companies in Europe.

    Science.gov (United States)

    Leto di Priolo, Susanna; Fehervary, Andras; Riggins, Phil; Redmond, Kathy

    2012-01-01

    The relationship between the pharmaceutical industry and cancer patient groups has been the subject of much scrutiny and skepticism, and some high-profile negative media coverage has focused attention on some of the problematic aspects of the relationship. Both the pharmaceutical industry and cancer patient groups have made an effort in recent years to improve the transparency and openness of their relations, specifically with regard to the financial support offered by pharmaceutical companies to patient groups. The objectives of this survey were to benchmark perceptions held by different stakeholder groups about current relationships between cancer patient groups and pharmaceutical companies in Europe, and to explore opinions about ways in which partnerships between patient groups and pharmaceutical companies could evolve to the benefit of cancer patients. The survey was conducted using a structured questionnaire that contained a combination of matrix, scaled, and open-ended questions. The questionnaire was developed based on a literature search and the findings from ten in-depth interviews conducted with policy makers and advocates working at an EU level. Telephone interviews were carried out using a structured questionnaire with a convenience sample of 161 policy makers, cancer healthcare group representatives, and cancer patient group leaders from France, Germany, Hungary, Italy, Latvia, the Netherlands, Poland, Portugal, Romania, Spain, Sweden, and the UK. The interviews took place in the relevant language of the country. The current relationship between the pharmaceutical industry and cancer patient groups in Europe is generally viewed as positive, but it is also viewed as being unequal, not transparent enough, and not sufficiently patient-centric. There is broad agreement that cancer patient groups can help companies identify unmet needs and contribute to the development of innovative medicines; however, there is some concern about cancer patients

  15. Two ways related to performance in elite sport: the path of self-confidence and competitive anxiety and the path of group cohesion and group goal-clarity.

    Science.gov (United States)

    Kjørmo, Odd; Halvari, Hallgeir

    2002-06-01

    A model tested among 136 Norwegian Olympic-level athletes yielded two paths related to performance. The first path indicated that self-confidence, modeled as an antecedent of competitive anxiety, is negatively correlated with anxiety. Competitive anxiety in turn is negatively correlated with performance. The second path indicated that group cohesion is positively correlated with group goal-clarity, which in turn is positively correlated with performance. Competitive anxiety mediates the relation between self-confidence and performance, whereas group goal-clarity mediates the relation between group cohesion and performance. Results from multiple regression analyses supported the model in the total sample and among individual sport athletes organized in training groups (n = 100). Among team sport athletes (n = 36), personality and group measures are more strongly intercorrelated than among individual sport athletes, and the relation with performance is more complex for the former group. The interaction of self-confidence and competitive anxiety is related to performance among team sport athletes.

  16. Factors Related to Women's Childbirth Satisfaction in Physiologic and Routine Childbirth Groups.

    Science.gov (United States)

    Jafari, Elham; Mohebbi, Parvin; Mazloomzadeh, Saeideh

    2017-01-01

    Women's satisfaction with childbirth is an important measure of the quality of maternity care services. This study aims to address factors related to women's childbirth satisfaction in physiological and routine childbirth groups. This descriptive-analytical study was conducted among 340 women in physiological and routine childbirth groups in 2012. Women were selected through convenience sampling method in the routine group and by census in the physiological group. Data were collected using a 5-part questionnaire composed of demographic and obstetrics details, Mackey's Childbirth Satisfaction Rating Scale (CSRS), satisfied with birth setting, Labor Agentry Scale (LAS), and Visual Analogue Scale (VAS), which was completed by interview 24 hours after childbirth. Data were analyzed using the Statistical Package for the Social Sciences version 18 software using Pearson correlation test, independent t -test, analysis of variance, and linear, multivariate regression model at the significant level of P toward the recent pregnancy ( P = 0.007), and perceived severity of pain ( P = 0.016). However, in the routine group, satisfaction was related only to intentional pregnancy ( P = 0.002). In neither group, satisfaction was related to demographic characteristics, maternal parity, and participation in pregnancy and childbirth classes or maternal feelings toward the onset of childbirth ( P > 0.05). Improved physical structure and setting of birth room, nonmedical pain relief, mothers' involvement in the process of labor, and sense of being in control are associated with mothers' satisfaction.

  17. The impacts of racial group membership on people's distributive justice: an event-related potential study.

    Science.gov (United States)

    Wang, Yan; Tang, Yi-Yuan; Deng, Yuqin

    2014-04-16

    How individuals and societies distribute benefits has long been studied by psychologists and sociologists. Previous work has highlighted the importance of social identity on people's justice concerns. However, it is not entirely clear how racial in-group/out-group relationship affects the brain activity in distributive justice. In this study, event-related potentials were recorded while participants made their decisions about donation allocation. Behavioral results showed that racial in-group factor affected participants' decisions on justice consideration. Participants were more likely to make relatively equity decisions when racial in-group factor was congruent with equity compared with the corresponding incongruent condition. Moreover, this incongruent condition took longer response times than congruent condition. Meanwhile, less equity decisions were made when efficiency was larger in the opposite side to equity than it was equal between the two options. Scalp event-related potential analyses revealed that greater P300 and late positive potential amplitudes were elicited by the incongruent condition compared with the congruent condition. These findings suggest that the decision-making of distributive justice could be modulated by racial group membership, and greater attentional resources or cognitive efforts are required when racial in-group factor and equity conflict with each other.

  18. Cosmological term in general relativity theory and localization of de Sitter and Einstein groups

    International Nuclear Information System (INIS)

    Tunyak, V.N.

    1984-01-01

    The theory of gauge gravitational field with the de Sitter group localization is formulated. proceeding from the de Sitter Universe tetrad components the relationship between Riemann metrics and de Sitter gauge field is established. It is shown that General relativity theory (GRT) with a cosmological term is the simplest variant of the de Sitter gauge gravitation theory passing in the limit of infinite curvature radius of the de Sitter Universe into the Poincare - invariant GRT without cosmological term. Similarly the theory of gauge gravitational field at localization of the dynamical group of the Einstein homogeneous static Universe (Einstein group RxSO(4)) is formulated

  19. The prevalence of dementia in a Portuguese community sample: a 10/66 Dementia Research Group study.

    Science.gov (United States)

    Gonçalves-Pereira, Manuel; Cardoso, Ana; Verdelho, Ana; Alves da Silva, Joaquim; Caldas de Almeida, Manuel; Fernandes, Alexandra; Raminhos, Cátia; Ferri, Cleusa P; Prina, A Matthew; Prince, Martin; Xavier, Miguel

    2017-11-07

    Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site). Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80-10.90) using the 10/66 DRG algorithm and 3.65% (95% CI 2.97-4.97) using DSM-IV criteria. Pure Alzheimer's disease was the most prevalent dementia subtype (41.9%). The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two approaches remains to be confirmed in the European context. We

  20. The prevalence of dementia in a Portuguese community sample: a 10/66 Dementia Research Group study

    Directory of Open Access Journals (Sweden)

    Manuel Gonçalves-Pereira

    2017-11-01

    Full Text Available Abstract Background Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. Methods A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site. Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. Results We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women after 313 (18.2% refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80–10.90 using the 10/66 DRG algorithm and 3.65% (95% CI 2.97–4.97 using DSM-IV criteria. Pure Alzheimer’s disease was the most prevalent dementia subtype (41.9%. The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Conclusions Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two

  1. Combat-related, chronic posttraumatic stress disorder: implications for group-therapy intervention.

    Science.gov (United States)

    Makler, S; Sigal, M; Gelkopf, M; Kochba, B B; Horeb, E

    1990-07-01

    The patient with combat-related chronic Posttraumatic Stress Disorder suffers from a wide spectrum of maladaptive behaviors. This paper delineates the work that has been done with such a population in group therapy. The plan that is proposed takes into account three interrelated sets of factors: factors important for creating an effective working relation; curative factors; and particular themes. Each of these factors is analyzed in the light of the particularities of group work with such a population. Each of the points discussed is based upon the relevant literature, upon the experience of the therapist, and illustrated with examples.

  2. Relation of ABO blood groups to the severity of coronary atherosclerosis: an Gensini score assessment.

    Science.gov (United States)

    Gong, Ping; Luo, Song-Hui; Li, Xiao-Lin; Guo, Yuan-Lin; Zhu, Cheng-Gang; Xu, Rui-Xia; Li, Sha; Dong, Qian; Liu, Geng; Chen, Juan; Zeng, Rui-Xiang; Li, Jian-Jun

    2014-12-01

    Although the study on the relationship between ABO blood groups and coronary atherosclerosis has a long history, few data is available regarding ABO to severity of coronary atherosclerosis in a large cohort study. Therefore, the present study aimed to investigate the relation of the ABO blood groups to the severity of coronary atherosclerosis assessed by Gensini score (GS) in a large Chinese cohort undergoing coronary angiography. A total of 2919 consecutive patients undergoing coronary angiography were enrolled, and their baseline characteristics and ABO blood groups were collected. The GS was calculated as 1st tertile (0-10), 2nd tertile (11-36), 3rd tertile (>36) according to angiographic results. The relation of the ABO blood groups to GS was investigated. The frequency of blood group A was significantly higher in the upper GS tertiles (24.4% vs. 28.2% vs. 29.5%, p = 0.032). Multivariable linear regression analysis revealed that blood group A was independently associated with GS (β = 0.043, p = 0.017). Likewise, multivariable logistic regression analysis showed that group A remained significantly associated with mid-high GS (OR = 1.44, 95% CI 1.16-1.80, p = 0.001), and the group O was showed as a protective factor (OR = 0.77, 95% CI = 0.65-0.92, p = 0.004). In this large Chinese cohort study, the data indicated that there was an association between ABO blood groups and the severity of coronary atherosclerosis. Moreover, the blood group A was an independent risk factor for serious coronary atherosclerosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Dissociating the effects of semantic grouping and rehearsal strategies on event-related brain potentials.

    Science.gov (United States)

    Schleepen, T M J; Markus, C R; Jonkman, L M

    2014-12-01

    The application of elaborative encoding strategies during learning, such as grouping items on similar semantic categories, increases the likelihood of later recall. Previous studies have suggested that stimuli that encourage semantic grouping strategies had modulating effects on specific ERP components. However, these studies did not differentiate between ERP activation patterns evoked by elaborative working memory strategies like semantic grouping and more simple strategies like rote rehearsal. Identification of neurocognitive correlates underlying successful use of elaborative strategies is important to understand better why certain populations, like children or elderly people, have problems applying such strategies. To compare ERP activation during the application of elaborative versus more simple strategies subjects had to encode either four semantically related or unrelated pictures by respectively applying a semantic category grouping or a simple rehearsal strategy. Another goal was to investigate if maintenance of semantically grouped vs. ungrouped pictures modulated ERP-slow waves differently. At the behavioral level there was only a semantic grouping benefit in terms of faster responding on correct rejections (i.e. when the memory probe stimulus was not part of the memory set). At the neural level, during encoding semantic grouping only had a modest specific modulatory effect on a fronto-central Late Positive Component (LPC), emerging around 650 ms. Other ERP components (i.e. P200, N400 and a second Late Positive Component) that had been earlier related to semantic grouping encoding processes now showed stronger modulation by rehearsal than by semantic grouping. During maintenance semantic grouping had specific modulatory effects on left and right frontal slow wave activity. These results stress the importance of careful control of strategy use when investigating the neural correlates of elaborative encoding. Copyright © 2014 Elsevier B.V. All rights

  4. [Monitoring of nursing service context factors: first descriptive results of a cross-sectional Swiss study prior the introduction of SwissDRG].

    Science.gov (United States)

    Kleinknecht-Dolf, Michael; Spichiger, Elisabeth; Frei, Irena Anna; Müller, Marianne; Martin, Jacqueline S; Spirig, Rebecca

    2015-04-01

    The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.

  5. Progress on study of nuclear data theory and related fields at the Theory Group of CNDC

    Energy Technology Data Exchange (ETDEWEB)

    Zhigang, Ge [China Nuclear Data Center, CIAE (China)

    1996-06-01

    The Theory Group of CNDC (China Nuclear Data Center) has made a lot of progress in nuclear reaction theory and its application as well as many other related fields in 1995. The recent progress in nuclear reaction theory study and its applications, the recent progress in the nuclear data calculation and related code development are introduced. The production rate of radioactive nuclear beam induced by 70 MeV protons on {sup 72}Ge target were calculated. The calculated results are presented.

  6. A Semiparametric Bayesian Approach for Analyzing Longitudinal Data from Multiple Related Groups.

    Science.gov (United States)

    Das, Kiranmoy; Afriyie, Prince; Spirko, Lauren

    2015-11-01

    Often the biological and/or clinical experiments result in longitudinal data from multiple related groups. The analysis of such data is quite challenging due to the fact that groups might have shared information on the mean and/or covariance functions. In this article, we consider a Bayesian semiparametric approach of modeling the mean trajectories for longitudinal response coming from multiple related groups. We consider matrix stick-breaking process priors on the group mean parameters which allows information sharing on the mean trajectories across the groups. Simulation studies are performed to demonstrate the effectiveness of the proposed approach compared to the more traditional approaches. We analyze data from a one-year follow-up of nutrition education for hypercholesterolemic children with three different treatments where the children are from different age-groups. Our analysis provides more clinically useful information than the previous analysis of the same dataset. The proposed approach will be a very powerful tool for analyzing data from clinical trials and other medical experiments.

  7. The relationship between relational models and individualism and collectivism: evidence from culturally diverse work groups.

    Science.gov (United States)

    Vodosek, Markus

    2009-04-01

    Relational models theory (Fiske, 1991 ) proposes that all thinking about social relationships is based on four elementary mental models: communal sharing, authority ranking, equality matching, and market pricing. Triandis and his colleagues (e.g., Triandis, Kurowski, & Gelfand, 1994 ) have suggested a relationship between the constructs of horizontal and vertical individualism and collectivism and Fiske's relational models. However, no previous research has examined this proposed relationship empirically. The objective of the current study was to test the association between the two frameworks in order to further our understanding of why members of culturally diverse groups may prefer different relational models in interactions with other group members. Findings from this study support a relationship between Triandis' constructs and Fiske's four relational models and uphold Fiske's ( 1991 ) claim that the use of the relational models is culturally dependent. As hypothesized, horizontal collectivism was associated with a preference for equality matching and communal sharing, vertical individualism was related to a preference for authority ranking, and vertical collectivism was related to a preference for authority ranking and communal sharing. However, contrary to expectations, horizontal individualism was not related to a preference for equality matching and market pricing, and vertical individualism was not associated with market pricing. By showing that there is a relationship between Triandis' and Fiske's frameworks, this study closes a gap in relational models theory, namely how culture relates to people's preferences for relational models. Thus, the findings from this study will enable future researchers to explain and predict what relational models are likely to be used in a certain cultural context.

  8. Assessment of Groups Influence on Management Style as Related to University Governance

    Science.gov (United States)

    Irtwange, S. V.; Orsaah, S.

    2010-01-01

    The study was undertaken with the objective of assessing groups influence on management style as related to University governance with University of Agriculture, Makurdi as a case study from academic staff perspective. The management style of the Vice Chancellor of the University of Agriculture, Makurdi between the period September 3, 1996 to…

  9. Weak Lensing Calibrated M-T Scaling Relation of Galaxy Groups in the COSMOS Field

    NARCIS (Netherlands)

    Kettula, K.; Finoguenov, A.; Massey, R.; Rhodes, J.; Hoekstra, H.; Taylor, J.; Spinelli, P.; Tanaka, M.; Ilbert, O.; Capak, P.; McCracken, H.; Koekemoer, A.

    2013-01-01

    The scaling between X-ray observables and mass for galaxy clusters and groups is instrumental for cluster-based cosmology and an important probe for the thermodynamics of the intracluster gas. We calibrate a scaling relation between the weak lensing mass and X-ray spectroscopic temperature for 10

  10. Smoking and Adolescence: Exploring Tobacco Consumption and Related Attitudes in Three Different Adolescent Groups in Switzerland

    Science.gov (United States)

    Bosson, Marlene; Maggiori, Christian; Gygax, Pascal Mark; Gay, Christelle

    2012-01-01

    The present study constitutes an investigation of tobacco consumption, related attitudes and individual differences in smoking or non-smoking behaviors in a sample of adolescents of different ages in the French-speaking part of Switzerland. We investigated three school-age groups (7th-grade, 9th-grade, and the second-year of high school) for…

  11. Adolescents' Motivation for Reading: Group Differences and Relation to Standardized Achievement

    Science.gov (United States)

    Wolters, Christopher A.; Denton, Carolyn A.; York, Mary J.; Francis, David J.

    2014-01-01

    The purpose of this study was to extend the research on adolescents' motivation for reading by examining important group differences and the relation of motivation to standardized achievement. Adolescents (N = 406) ranging from grade 7 to grade 12 completed a self-report survey that assessed 13 different aspects of their reading motivation…

  12. 8-group relative delayed neutron yields for monoenergetic neutron induced fission of 239Pu

    International Nuclear Information System (INIS)

    Piksaikin, V.M.; Kazakov, L.E.; Isaev, S.G.; Korolev, G.G.; Roshchenko, V.A.; Tertychnyj, R.G

    2002-01-01

    The energy dependence of the relative yield of delayed neutrons in an 8-group model representation was obtained for monoenergetic neutron induced fission of 239 Pu. A comparison of this data with the available experimental data by other authors was made in terms of the mean half-life of the delayed neutron precursors. (author)

  13. soil groups relative susceptibility to erosion in parts of south-eastern

    African Journals Online (AJOL)

    Dr Obe

    erosion by water determined based on the amount of soil lost during the various runs. Based on ... knowledge of the many factors of soil erosion .... Table 4: Relative erodibility levels of soil groups in lmo and Abia States under 'wet' conditions. Moderately Erodible. Highly Erodible. Very Highly Erodible. 1. Type Dystropepts.

  14. The Effect of Group Differences among Church-Related Youth in Indonesia, Malaysia, and Singapore.

    Science.gov (United States)

    Pedersen, Paul

    1983-01-01

    Examines the influence of nationality, ethnicity, language, and beliefs on priority concerns among church related college students in Indonesia (N=122), Malaysia and Singapore (N=341). Results confirm the importance of traditional values with less agreement between groups about peers and adults. Implications for counselors are discussed. (JAC)

  15. Control Algorithms Along Relative Equilibria of Underactuated Lagrangian Systems on Lie Groups

    DEFF Research Database (Denmark)

    Nordkvist, Nikolaj; Bullo, F.

    2008-01-01

    We present novel algorithms to control underactuated mechanical systems. For a class of invariant systems on Lie groups, we design iterative small-amplitude control forces to accelerate along, decelerate along, and stabilize relative equilibria. The technical approach is based upon a perturbation...

  16. Control algorithms along relative equilibria of underactuated Lagrangian systems on Lie groups

    DEFF Research Database (Denmark)

    Nordkvist, Nikolaj; Bullo, Francesco

    2007-01-01

    We present novel algorithms to control underactuated mechanical systems. For a class of invariant systems on Lie groups, we design iterative small-amplitude control forces to accelerate along, decelerate along, and stabilize relative equilibria. The technical approach is based upon a perturbation...

  17. Constructing a Measurement Method of Differences in Group Preferences Based on Relative Entropy

    Directory of Open Access Journals (Sweden)

    Shiyu Zhang

    2017-01-01

    Full Text Available In the research and data analysis of the differences involved in group preferences, conventional statistical methods cannot reflect the integrity and preferences of human minds; in particular, it is difficult to exclude humans’ irrational factors. This paper introduces a preference amount model based on relative entropy theory. A related expansion is made based on the characteristics of the questionnaire data, and we also construct the parameters to measure differences in the data distribution of different groups on the whole. In this paper, this parameter is called the center distance, and it effectively reflects the preferences of human minds. Using the survey data of securities market participants as an example, this paper analyzes differences in market participants’ attitudes toward the effectiveness of securities regulation. Based on this method, differences between groups that were overlooked by analysis of variance are found, and certain aspects obscured by general data characteristics are also found.

  18. Relations between high and low power groups: the importance of legitimacy.

    Science.gov (United States)

    Hornsey, Matthew J; Spears, Russell; Cremers, Iris; Hogg, Michael A

    2003-02-01

    Using a social identity perspective, two experiments examined the effects of power and the legitimacy of power differentials on intergroup bias. In Experiment 1, 125 math-science students were led to believe that they had high or low representation in a university decision-making body relative to social-science students and that this power position was either legitimate or illegitimate. Power did not have an independent effect on bias; rather, members of both high and low power groups showed more bias when the power hierarchy was illegitimate than when it was legitimate. This effect was replicated in Experiment 2 (N = 105). In addition, Experiment 2 showed that groups located within an unfair power hierarchy expected the superordinate power body to be more discriminatory than did those who had legitimately high or low power. The results are discussed in terms of their implications for group relations. Copyright 2003 Society for Personality and Social Psychology, Inc.

  19. How does social essentialism affect the development of inter-group relations?

    Science.gov (United States)

    Rhodes, Marjorie; Leslie, Sarah-Jane; Saunders, Katya; Dunham, Yarrow; Cimpian, Andrei

    2018-01-01

    Psychological essentialism is a pervasive conceptual bias to view categories as reflecting something deep, stable, and informative about their members. Scholars from diverse disciplines have long theorized that psychological essentialism has negative ramifications for inter-group relations, yet little previous empirical work has experimentally tested the social implications of essentialist beliefs. Three studies (N = 127, ages 4.5-6) found that experimentally inducing essentialist beliefs about a novel social category led children to share fewer resources with category members, but did not lead to the out-group dislike that defines social prejudice. These findings indicate that essentialism negatively influences some key components of inter-group relations, but does not lead directly to the development of prejudice. © 2017 John Wiley & Sons Ltd.

  20. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature.

    Science.gov (United States)

    Butani, Yogita; Weintraub, Jane A; Barker, Judith C

    2008-09-15

    The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations. The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied. Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base. The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

  1. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature

    Directory of Open Access Journals (Sweden)

    Barker Judith C

    2008-09-01

    Full Text Available Abstract Background The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino were chosen as exemplar populations. Methods The dental literature published in English for the period 1980–2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied. Results Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base. Conclusion The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.

  2. Content-related interactions and methods of reasoning within self-initiated organic chemistry study groups

    Science.gov (United States)

    Christian, Karen Jeanne

    2011-12-01

    Students often use study groups to prepare for class or exams; yet to date, we know very little about how these groups actually function. This study looked at the ways in which undergraduate organic chemistry students prepared for exams through self-initiated study groups. We sought to characterize the methods of social regulation, levels of content processing, and types of reasoning processes used by students within their groups. Our analysis showed that groups engaged in predominantly three types of interactions when discussing chemistry content: co-construction, teaching, and tutoring. Although each group engaged in each of these types of interactions at some point, their prevalence varied between groups and group members. Our analysis suggests that the types of interactions that were most common depended on the relative content knowledge of the group members as well as on the difficulty of the tasks in which they were engaged. Additionally, we were interested in characterizing the reasoning methods used by students within their study groups. We found that students used a combination of three content-relevant methods of reasoning: model-based reasoning, case-based reasoning, or rule-based reasoning, in conjunction with one chemically-irrelevant method of reasoning: symbol-based reasoning. The most common way for groups to reason was to use rules, whereas the least common way was for students to work from a model. In general, student reasoning correlated strongly to the subject matter to which students were paying attention, and was only weakly related to student interactions. Overall, results from this study may help instructors to construct appropriate tasks to guide what and how students study outside of the classroom. We found that students had a decidedly strategic approach in their study groups, relying heavily on material provided by their instructors, and using the reasoning strategies that resulted in the lowest levels of content processing. We suggest

  3. Ethnic group variations in alcohol-related hospital admissions in England: does place matter?

    Science.gov (United States)

    Barry, Eleanor; Laverty, Anthony A; Majeed, Azeem; Millett, Christopher

    2015-01-01

    The health burden of alcohol use is socially and geographically patterned in many countries. Less is known about variations in this burden between ethnic groups and whether this differs across place of residence. National cross-sectional study using hospital admission data in England. Alcohol-related admission rates, where an alcohol-related condition was either the primary diagnosis (considered as the reason for admission) or a comorbidity, were calculated using ethnic group specific rates for English regions. In 2010/11 there were a total of 264,870 alcohol-related admissions in England. Admission rates were higher in the North of England than elsewhere (e.g. for primary diagnosis 161 per 100,000 population in the North vs. 62 per 100,000 in the South). These patterns were not uniform across ethnic groups however. For example, admission rates for alcohol-related comorbidity were four times higher among White Irish in London compared with those in the South of England (306 to 76 per 100,000) and four times higher in Indians living in the Midlands compared with those in the South of England (128 to 29 per 100,000). These patterns were similar for admissions with a comorbid alcohol-related condition. Geographical location may be an important determinant of within and between ethnic group variations in alcohol-related hospital admissions in England. While a number of factors were not examined here, this descriptive analysis suggests that this heterogeneity should be taken into account when planning interventions and services for the prevention and management of alcohol misuse.

  4. How Does Biological Belief in Race Relate to Our Feelings towards In-Group and Out-Groups?: A Cognitive Dissonance Framework

    Science.gov (United States)

    Tawa, John; Kim, Grace S.

    2011-01-01

    This study considered the effect of belief in race as a biological construct (RACEBIO) and inter-group anxiety (IGA) on in-group racial salience (IGRS) and out-group discomfort (OGD). Participants included 66 racially and ethnically diverse high school boarding students. As hypothesized, RACEBIO was positively related to both IGRS and OGD. In…

  5. Work and diet-related risk factors of cardiovascular diseases: comparison of two occupational groups.

    Science.gov (United States)

    Hartung, Danielle; Stadeler, Martina; Grieshaber, Romano; Keller, Sylvia; Jahreis, Gerhard

    2010-03-22

    Although work related risk factors associated with Cardiovascular Diseases (CD) have been well researched, there is no detailed knowledge regarding disparate occupational groups each with a different risk exposition. Therefore, two occupational groups (chefs and office workers) were compared with a focus on nutritional and psychosocial factors. Two groups of subjects were tested for work and diet-related risks of CD (45 chefs and 48 office workers). The groups matched both for gender (male) and age (30 to 45 years). The study included a medical check-up, bioelectrical impedance analysis as well as an evaluation of questionnaires on health, nutritional behaviour and coping capacity. In addition, volunteers were required to compile a 7-day-dietary-record and collect their urine 24 h prior to their check-up. Blood samples drawn were analysed for glucose and lipid metabolism, homocysteine, vitamin B12, folic acid; C-reactive protein, uric acid, red blood cell fatty acids, plant sterols, antioxidative capacity and oxidative stress. On average, the chefs showed one risk factor more compared to the office workers. The most frequent risk factors in both groups included overweight/obesity (chef group [CG]: 62.2%; office group [OG]: 58.3%) and elevated TC (CG: 62.2%; OG: 43.8%]. Moreover, although the chefs often had higher CRP-concentrations (40.0%), more office workers suffered from hypertension (37.5%).Chefs showed significant higher concentrations of saturated fatty acids and oleic acid, whereas docosahexaenoic acid, Omega-6- and trans fatty acids were found more frequently in the red blood cell membranes of office workers. While there were no significant differences in analysed plant sterols between the two occupational groups, 7,8-dihydro-8-oxo-2'-deoxyguanosine was significantly increased in office workers.Concerning the work-related psychosocial factors, the chefs were characterised by a stronger subjective importance of work, a greater degree of professional

  6. The role of national identity representation in the relation between in-group identification and out-group derogation: Ethnic versus civic representation

    OpenAIRE

    Meeus, Joke; Duriez, Bart; Vanbeselaere, Norbert; Boen, Filip

    2010-01-01

    Two studies investigated whether the content of in-group identity affects the relation between in-group identification and ethnic prejudice. The first study among university students, tested whether national identity representations (i.e. ethnic vs. civic) moderate or mediate the relation between Flemish in-group identification and ethnic prejudice. A moderation hypothesis is supported when those higher in identification who subscribe to a more ethnic representation display higher ethnic prej...

  7. Palliative sedation: a focus group study on the experiences of relatives.

    Science.gov (United States)

    Bruinsma, Sophie; Rietjens, Judith; van der Heide, Agnes

    2013-04-01

    Most studies that have investigated the practice of palliative sedation have focused on physicians' practices and attitudes. The aim of this study was to explore relatives' experiences with palliative sedation and to gain more insight in positive and negative elements in their evaluation of palliative sedation. Focus groups and individual interviews. Various care settings in the Netherlands. A total of 14 relatives of patients who received palliative sedation until death participated. Most relatives evaluated the provision of palliative sedation of their dying family member positively. Positive experiences were related to: the beneficial impact of palliative sedation on the patient's suffering, the opportunity that was offered to prepare for the patient's death, their involvement in the decision-making and care for the patient, and the pleasant care environment. However, the majority of the relatives were unsatisfied with one or more aspects of how information was being provided for. Some relatives were frustrated about the fact that nurses were not authorized to make decisions about the care for the patient and about the absence of physicians during weekends. None of the relatives mentioned the loss of the ability to communicate with the patient during the sedation and the possibility of "hastening death" as disadvantages of palliative sedation. Relatives tend to evaluate the provision of palliative sedation to their severely suffering family member positively because it contributes to a peaceful dying process. However, relatives indicated discontent with how information was being provided and with the communication in general.

  8. DRG axon elongation and growth cone collapse rate induced by Sema3A are differently dependent on NGF concentration.

    Science.gov (United States)

    Kaselis, Andrius; Treinys, Rimantas; Vosyliūtė, Rūta; Šatkauskas, Saulius

    2014-03-01

    Regeneration of embryonic and adult dorsal root ganglion (DRG) sensory axons is highly impeded when they encounter neuronal growth cone-collapsing factor semaphorin3A (Sema3A). On the other hand, increasing evidence shows that DRG axon's regeneration can be stimulated by nerve growth factor (NGF). In this study, we aimed to evaluate whether increased NGF concentrations can counterweight Sema3A-induced inhibitory responses in 15-day-old mouse embryo (E15) DRG axons. The DRG explants were grown in Neurobasal-based medium with different NGF concentrations ranging from 0 to 100 ng/mL and then treated with Sema3A at constant 10 ng/mL concentration. To evaluate interplay between NGF and Sema3A number of DRG axons, axon outgrowth distance and collapse rate were measured. We found that the increased NGF concentrations abolish Sema3A-induced inhibitory effect on axon outgrowth, while they have no effect on Sema3A-induced collapse rate.

  9. Human Nav1.8: enhanced persistent and ramp currents contribute to distinct firing properties of human DRG neurons

    Science.gov (United States)

    Han, Chongyang; Estacion, Mark; Huang, Jianying; Vasylyev, Dymtro; Zhao, Peng; Dib-Hajj, Sulayman D.

    2015-01-01

    Although species-specific differences in ion channel properties are well-documented, little has been known about the properties of the human Nav1.8 channel, an important contributor to pain signaling. Here we show, using techniques that include voltage clamp, current clamp, and dynamic clamp in dorsal root ganglion (DRG) neurons, that human Nav1.8 channels display slower inactivation kinetics and produce larger persistent current and ramp current than previously reported in other species. DRG neurons expressing human Nav1.8 channels unexpectedly produce significantly longer-lasting action potentials, including action potentials with half-widths in some cells >10 ms, and increased firing frequency compared with the narrower and usually single action potentials generated by DRG neurons expressing rat Nav1.8 channels. We also show that native human DRG neurons recapitulate these properties of Nav1.8 current and the long-lasting action potentials. Together, our results demonstrate strikingly distinct properties of human Nav1.8, which contribute to the firing properties of human DRG neurons. PMID:25787950

  10. Ectodomain shedding of Limbic System-Associated Membrane Protein (LSAMP) by ADAM Metallopeptidases promotes neurite outgrowth in DRG neurons.

    Science.gov (United States)

    Sanz, Ricardo L; Ferraro, Gino B; Girouard, Marie-Pier; Fournier, Alyson E

    2017-08-11

    IgLONs are members of the immunoglobulin superfamily of cell adhesion proteins implicated in the process of neuronal outgrowth, cell adhesion and subdomain target recognition. IgLONs form homophilic and heterophilic complexes on the cell surface that repress or promote growth depending on the neuronal population, the developmental stage and surface repertoire of IgLON family members. In the present study, we identified a metalloproteinase-dependent mechanism necessary to promote growth in embryonic dorsal root ganglion cells (DRGs). Treatment of embryonic DRG neurons with pan-metalloproteinase inhibitors, tissue inhibitor of metalloproteinase-3, or an inhibitor of ADAM Metallopeptidase Domain 10 (ADAM10) reduces outgrowth from DRG neurons indicating that metalloproteinase activity is important for outgrowth. The IgLON family members Neurotrimin (NTM) and Limbic System-Associated Membrane Protein (LSAMP) were identified as ADAM10 substrates that are shed from the cell surface of DRG neurons. Overexpression of LSAMP and NTM suppresses outgrowth from DRG neurons. Furthermore, LSAMP loss of function decreases the outgrowth sensitivity to an ADAM10 inhibitor. Together our findings support a role for ADAM-dependent shedding of cell surface LSAMP in promoting outgrowth from DRG neurons.

  11. CX3CL1-mediated macrophage activation contributed to paclitaxel-induced DRG neuronal apoptosis and painful peripheral neuropathy.

    Science.gov (United States)

    Huang, Zhen-Zhen; Li, Dai; Liu, Cui-Cui; Cui, Yu; Zhu, He-Quan; Zhang, Wen-Wen; Li, Yong-Yong; Xin, Wen-Jun

    2014-08-01

    Painful peripheral neuropathy is a dose-limiting side effect of paclitaxel therapy, which hampers the optimal clinical management of chemotherapy in cancer patients. Currently the underlying mechanisms remain largely unknown. Here we showed that the clinically relevant dose of paclitaxel (3×8mg/kg, cumulative dose 24mg/kg) induced significant upregulation of the chemokine CX3CL1 in the A-fiber primary sensory neurons in vivo and in vitro and infiltration of macrophages into the dorsal root ganglion (DRG) in rats. Paclitaxel treatment also increased cleaved caspase-3 expression, induced the loss of primary afferent terminal fibers and decreased sciatic-evoked A-fiber responses in the spinal dorsal horn, indicating DRG neuronal apoptosis induced by paclitaxel. In addition, the paclitaxel-induced DRG neuronal apoptosis occurred exclusively in the presence of macrophage in vitro study. Intrathecal or systemic injection of CX3CL1 neutralizing antibody blocked paclitaxel-induced macrophage recruitment and neuronal apoptosis in the DRG, and also attenuated paclitaxel-induced allodynia. Furthermore, depletion of macrophage by systemic administration of clodronate inhibited paclitaxel-induced allodynia. Blocking CX3CL1 decreased activation of p38 MAPK in the macrophage, and inhibition of p38 MAPK activity blocked the neuronal apoptosis and development of mechanical allodynia induced by paclitaxel. These findings provide novel evidence that CX3CL1-recruited macrophage contributed to paclitaxel-induced DRG neuronal apoptosis and painful peripheral neuropathy. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Understanding Mathematic Concept in Relation and Function Method through Active Learning Type Group to Group Distributed LKS

    Science.gov (United States)

    Kudri, F.; Rahmi, R.; Haryono, Y.

    2018-04-01

    This research is motivated by the lack of understanding of mathematical concepts students and teachers have not familiarize students discussed in groups. This researchaims to determine whether an understanding of mathematical concepts junior class VIII SMPN 2 in Ranah Batahan Kabupaten Pasaman Barat by applying active learning strategy group to group types with LKS better than conventional learning. The type of research is experimental the design of randomized trials on the subject. The population in the study were all students VIII SMPN 2 Ranah Batahan Kabupaten Pasaman Barat in year 2012/2013 which consists of our class room experiment to determine the grade and control class with do nerandomly, so that classes VIII1 elected as a experiment class and class VIII4 as a control class. The instruments used in the test empirically understanding mathematical concepts are shaped by the essay with rt=0,82 greater than rt=0,468 means reliable tests used. The data analysis technique used is the test with the help of MINITAB. Based on the results of the data analisis known that both of the sample are normal and homogenity in real rate α = 0,05, so the hypothesis of this research is received. So, it can be concluded students’ understanding mathematical concept applied the active Group to Group learning strategy with LKS is better than the students’ understanding mathematical concept with Conventional Learning.

  13. Health-related quality of life of infants from ethnic minority groups: the Generation R Study.

    Science.gov (United States)

    Flink, Ilse J E; Beirens, Tinneke M J; Looman, Caspar; Landgraf, Jeanne M; Tiemeier, Henning; Mol, Henriette A; Jaddoe, Vincent W V; Hofman, Albert; Mackenbach, Johan P; Raat, Hein

    2013-04-01

    To assess whether the health-related quality of life of infants from ethnic minority groups differs from the health-related quality of life of native Dutch infants and to evaluate whether infant health and family characteristics explain the potential differences. We included 4,506 infants participating in the Generation R Study, a longitudinal birth cohort. When the child was 12 months, parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL); ITQOL scale scores in each ethnic subgroup were compared with scores in the Dutch reference population. Influence of infant health and family characteristics on ITQOL scale scores were evaluated using multivariate regression models. Infants from ethnic minority groups presented significantly lower ITQOL scale scores compared to the Dutch subgroup (e.g., Temperament and Moods scale: median score of Turkish subgroup, 70.8 (IQR, 15.3); median score of Dutch subgroup, 80.6 (IQR, 13.9; P ethnic minority status and infant health-related quality of life. However, these factors could not fully explain all the differences in the ITQOL scale scores. Parent-reported health-related quality of life is lower in infants from ethnic minority groups compared to native Dutch infants, which could partly be explained by infant health and by family characteristics.

  14. Group singing and health-related quality of life in Parkinson's disease.

    Science.gov (United States)

    Abell, Romane V; Baird, Amee D; Chalmers, Kerry A

    2017-01-01

    Parkinson's disease (PD) has a negative impact on health-related quality of life (HRQoL). Previous studies have shown that participating in group singing activities can improve quality of life in some patient populations (e.g., people with chronic mental health or neurological conditions). The aim of this study was to investigate the effects of group singing on HRQoL for people diagnosed with PD. Eleven participants (mean age 70.6 years) with a formal diagnosis of PD between Hoehn and Yahr Stages I-III were recruited from a community singing group for people with PD, their family and their carers. Participants' perceptions of the effect of group singing on their quality of life were captured in a semistructured interview. Interpretive Phenomenological Analysis (IPA), a qualitative methodology, informed data collection and analysis. The IPA analysis revealed 6 categories that characterized the effects of group singing: physical, mood, cognitive functioning, social connectedness, "flow-on" effects, and sense-of-self. All participants reported positive effects across at least 4 of these categories. Three participants reported a negative effect in 1 category (physical, mood, or sense-of-self). The results suggest that group singing improved HRQoL with all participants reporting positive effects regardless of PD stage or symptom severity. Weekly engagement in group singing resulted in multiple benefits for the participants and counteracted some of the negative effects of PD. These findings suggest that group singing "gives back" some of what PD "takes away." (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Calcineurin Dysregulation Underlies Spinal Cord Injury-Induced K+ Channel Dysfunction in DRG Neurons.

    Science.gov (United States)

    Zemel, Benjamin M; Muqeem, Tanziyah; Brown, Eric V; Goulão, Miguel; Urban, Mark W; Tymanskyj, Stephen R; Lepore, Angelo C; Covarrubias, Manuel

    2017-08-23

    Dysfunction of the fast-inactivating Kv3.4 potassium current in dorsal root ganglion (DRG) neurons contributes to the hyperexcitability associated with persistent pain induced by spinal cord injury (SCI). However, the underlying mechanism is not known. In light of our previous work demonstrating modulation of the Kv3.4 channel by phosphorylation, we investigated the role of the phosphatase calcineurin (CaN) using electrophysiological, molecular, and imaging approaches in adult female Sprague Dawley rats. Pharmacological inhibition of CaN in small-diameter DRG neurons slowed repolarization of the somatic action potential (AP) and attenuated the Kv3.4 current. Attenuated Kv3.4 currents also exhibited slowed inactivation. We observed similar effects on the recombinant Kv3.4 channel heterologously expressed in Chinese hamster ovary cells, supporting our findings in DRG neurons. Elucidating the molecular basis of these effects, mutation of four previously characterized serines within the Kv3.4 N-terminal inactivation domain eliminated the effects of CaN inhibition on the Kv3.4 current. SCI similarly induced concurrent Kv3.4 current attenuation and slowing of inactivation. Although there was little change in CaN expression and localization after injury, SCI induced upregulation of the native regulator of CaN 1 (RCAN1) in the DRG at the transcript and protein levels. Consistent with CaN inhibition resulting from RCAN1 upregulation, overexpression of RCAN1 in naive DRG neurons recapitulated the effects of pharmacological CaN inhibition on the Kv3.4 current and the AP. Overall, these results demonstrate a novel regulatory pathway that links CaN, RCAN1, and Kv3.4 in DRG neurons. Dysregulation of this pathway might underlie a peripheral mechanism of pain sensitization induced by SCI. SIGNIFICANCE STATEMENT Pain sensitization associated with spinal cord injury (SCI) involves poorly understood maladaptive modulation of neuronal excitability. Although central mechanisms have

  16. TOPSIS-based consensus model for group decision-making with incomplete interval fuzzy preference relations.

    Science.gov (United States)

    Liu, Fang; Zhang, Wei-Guo

    2014-08-01

    Due to the vagueness of real-world environments and the subjective nature of human judgments, it is natural for experts to estimate their judgements by using incomplete interval fuzzy preference relations. In this paper, based on the technique for order preference by similarity to ideal solution method, we present a consensus model for group decision-making (GDM) with incomplete interval fuzzy preference relations. To do this, we first define a new consistency measure for incomplete interval fuzzy preference relations. Second, a goal programming model is proposed to estimate the missing interval preference values and it is guided by the consistency property. Third, an ideal interval fuzzy preference relation is constructed by using the induced ordered weighted averaging operator, where the associated weights of characterizing the operator are based on the defined consistency measure. Fourth, a similarity degree between complete interval fuzzy preference relations and the ideal one is defined. The similarity degree is related to the associated weights, and used to aggregate the experts' preference relations in such a way that more importance is given to ones with the higher similarity degree. Finally, a new algorithm is given to solve the GDM problem with incomplete interval fuzzy preference relations, which is further applied to partnership selection in formation of virtual enterprises.

  17. Group contribution modelling for the prediction of safety-related and environmental properties

    DEFF Research Database (Denmark)

    Frutiger, Jerome; Abildskov, Jens; Sin, Gürkan

    warming potential and ozone depletion potential. Process safety studies and environmental assessments rely on accurate property data. Safety data such as flammability limits, heat of combustion or auto ignition temperature play an important role in quantifying the risk of fire and explosions among others......We present a new set of property prediction models based on group contributions to predict major safety-related and environmental properties for organic compounds. The predicted list of properties includes lower and upper flammability limits, heat of combustion, auto ignition temperature, global...... models like group contribution (GC) models can estimate data. However, the estimation needs to be accurate, reliable and as little time-consuming as possible so that the models can be used on the fly. In this study the Marrero and Gani group contribution (MR GC) method has been used to develop the models...

  18. Using Synchronous Online Peer Response Groups in EFL Writing: Revision-Related Discourse

    Directory of Open Access Journals (Sweden)

    Mei-Ya Liang

    2010-02-01

    Full Text Available In recent years, synchronous online peer response groups have been increasingly used in English as a foreign language (EFL writing. This article describes a study of synchronous online interaction among three small peer groups in a Taiwanese undergraduate EFL writing class. An environmental analysis of students’ online discourse in two writing tasks showed that meaning negotiation, error correction, and technical actions seldom occurred and that social talk, task management, and content discussion predominated the chat. Further analysis indicates that relationships among different types of online interaction and their connections with subsequent writing and revision are complex and depend on group makeup and dynamics. Findings suggest that such complex activity may not guarantee revision. Writing instructors may need to proactively model, scaffold and support revision-related online discourse if it is to be of benefit.

  19. Relation Analysis of Knowledge Management, Research, and Innovation in University Research Groups

    Directory of Open Access Journals (Sweden)

    Heyder Paez-Logreira

    2016-12-01

    Full Text Available Knowledge is a competitive advantage for companies. Knowledge Management helps to keep this competitiveness. Universities face with challenges in research, innovation and international competitiveness. The purpose of this paper includes studying Knowledge Management Models, and Innovation Models apply to Research Groups of Universities, through an analysis of relation in inter-organizational level. Some researchers and leaders of research groups participated in a survey about knowledge management and innovation. Here we show the relationship between knowledge management, innovation and research, including processes and operations performed by universities around these. We organize the results in three dimensions: Knowledge Management perception, the relationship between Knowledge Management and Innovation, and Strategic Knowledge organization. Too, we identify a generality of good practices, challenges, and limitations on Research Groups for Knowledge Management.

  20. Decomposing one-relator products of cyclic groups into free products with amalgamation

    International Nuclear Information System (INIS)

    Benyash-Krivets, V V

    1998-01-01

    The problem of the decomposition of one-relator products of cyclics into non-trivial free products with amalgamation is considered. Two theorems are proved, one of which is as follows. Let G= 2n =R m (a,b)=1>, where n≥0, m≥2, and R(a,b) is a cyclically reduced word containing b in the free group on a and b. Then G is a non-trivial free product with amalgamation. One consequence of this theorem is a proof of the conjecture of Fine, Levin, and Rosenberger that each two-generator one-relator group with torsion is a non-trivial free product with amalgamation

  1. Neurofilament protein synthesis in DRG neurons decreases more after peripheral axotomy than after central axotomy

    International Nuclear Information System (INIS)

    Greenberg, S.G.; Lasek, R.J.

    1988-01-01

    Cytoskeletal protein synthesis was studied in DRG neurons after transecting either their peripheral or their central branch axons. Specifically, the axons were transected 5-10 mm from the lumbar-5 ganglion on one side of the animal; the DRGs from the transected side and contralateral control side were labeled with radiolabeled amino acids in vitro; radiolabeled proteins were separated by 2-dimensional (2D) PAGE; and the amounts of radiolabel in certain proteins of the experimental and control ganglia were quantified and compared. We focused on the neurofilament proteins because they are neuron-specific. If either the peripheral or central axons were cut, the amounts of radiolabeled neurofilament protein synthesized by the DRG neurons decreased between 1 and 10 d after transection. Neurofilament protein labeling decreased more after transection of the peripheral axons than after transection of the central axons. In contrast to axonal transections, sham operations or heat shock did not decrease the radiolabeling of the neurofilament proteins, and these procedures also affected the labeling of actin, tubulin, and the heat-shock proteins differently from transection. These results and others indicate that axonal transection leads to specific changes in the synthesis of cytoskeletal proteins of DRG neurons, and that these changes differ from those produced by stress to the animal or ganglia. Studies of the changes in neurofilament protein synthesis from 1 to 40 d after axonal transection indicate that the amounts of radiolabeled neurofilament protein synthesis were decreased during axonal elongation, but that they returned toward control levels when the axons reached cells that stopped elongation

  2. Funding intensive care - approaches in systems using diagnosis-related groups.

    OpenAIRE

    Ettelt, S; Nolte, E

    2010-01-01

    This report reviews approaches to funding intensive care in health systems that use activitybased payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care. The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Funding mechanisms reviewed here include those in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to org...

  3. A conserved inter-domain communication mechanism regulates the ATPase activity of the AAA-protein Drg1.

    Science.gov (United States)

    Prattes, Michael; Loibl, Mathias; Zisser, Gertrude; Luschnig, Daniel; Kappel, Lisa; Rössler, Ingrid; Grassegger, Manuela; Hromic, Altijana; Krieger, Elmar; Gruber, Karl; Pertschy, Brigitte; Bergler, Helmut

    2017-03-17

    AAA-ATPases fulfil essential roles in different cellular pathways and often act in form of hexameric complexes. Interaction with pathway-specific substrate and adaptor proteins recruits them to their targets and modulates their catalytic activity. This substrate dependent regulation of ATP hydrolysis in the AAA-domains is mediated by a non-catalytic N-terminal domain. The exact mechanisms that transmit the signal from the N-domain and coordinate the individual AAA-domains in the hexameric complex are still the topic of intensive research. Here, we present the characterization of a novel mutant variant of the eukaryotic AAA-ATPase Drg1 that shows dysregulation of ATPase activity and altered interaction with Rlp24, its substrate in ribosome biogenesis. This defective regulation is the consequence of amino acid exchanges at the interface between the regulatory N-domain and the adjacent D1 AAA-domain. The effects caused by these mutations strongly resemble those of pathological mutations of the AAA-ATPase p97 which cause the hereditary proteinopathy IBMPFD (inclusion body myopathy associated with Paget's disease of the bone and frontotemporal dementia). Our results therefore suggest well conserved mechanisms of regulation between structurally, but not functionally related members of the AAA-family.

  4. ESPEN expert group recommendations for action against cancer-related malnutrition.

    Science.gov (United States)

    Arends, J; Baracos, V; Bertz, H; Bozzetti, F; Calder, P C; Deutz, N E P; Erickson, N; Laviano, A; Lisanti, M P; Lobo, D N; McMillan, D C; Muscaritoli, M; Ockenga, J; Pirlich, M; Strasser, F; de van der Schueren, M; Van Gossum, A; Vaupel, P; Weimann, A

    2017-10-01

    Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  5. Therapeutic Change in Group Therapy For Interpersonal Trauma: A Relational Framework for Research and Clinical Practice.

    Science.gov (United States)

    Chouliara, Zoë; Karatzias, Thanos; Gullone, Angela; Ferguson, Sandra; Cosgrove, Katie; Burke Draucker, Claire

    2017-04-01

    Our understanding of therapeutic change processes in group therapy for complex interpersonal trauma has been limited. The present study aimed at addressing this gap by developing a framework of therapeutic change in this field from a survivor and therapist perspective. This is a qualitative study, which utilized semistructured individual interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA) to identify recurrent themes. A final sample of n = 16 patients and n = 5 facilitators completed the interview. Main change processes identified by survivors were as follows: self versus others, trust versus threat, confrontation versus avoidance, and "patching up" versus true healing. Therapeutic processes identified by therapist facilitators included managing group dynamics, unpredictability and uncertainty, and process versus content. The proposed framework explains therapeutic change in group therapy in relational terms, that is, therapeutic dissonance, the dynamic interaction of self and experience as well as building empathic trusting relations. The importance of managing dissonance to aid personally meaningful recovery was highlighted. These findings have implications for the usefulness of relational and person-centered approaches to clinical practice in the area of interpersonal and complex trauma, especially in the early identification, prevention, and management of dropouts.

  6. Relative Risk of Various Head and Neck Cancers among Different Blood Groups: An Analytical Study.

    Science.gov (United States)

    Singh, Khushboo; Kote, Sunder; Patthi, Basavaraj; Singla, Ashish; Singh, Shilpi; Kundu, Hansa; Jain, Swati

    2014-04-01

    Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study. To assess the relative risk of various Head & Neck cancers among different blood groups. Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected. Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odd ratios were calculated. The level of significance was fixed at 5%. The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Oral cancer patients showed maximum number in blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.000 p=0.112 respectively. The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers.

  7. Relative Risk of Various Head and Neck Cancers among Different Blood Groups: An Analytical Study

    Science.gov (United States)

    Kote, Sunder; Patthi, Basavaraj; Singla, Ashish; Singh, Shilpi; Kundu, Hansa; Jain, Swati

    2014-01-01

    Background: Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study. Aim and Objective: To assess the relative risk of various Head & Neck cancers among different blood groups. Materials and Method: Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected. Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odd ratios were calculated. The level of significance was fixed at 5%. Results: The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Oral cancer patients showed maximum number in blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.000 p=0.112 respectively. Conclusion: The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers. PMID:24959511

  8. Viral Richness is Positively Related to Group Size, but Not Mating System, in Bats.

    Science.gov (United States)

    Webber, Quinn M R; Fletcher, Quinn E; Willis, Craig K R

    2017-12-01

    Characterizing host traits that influence viral richness and diversification is important for understanding wildlife pathogens affecting conservation and/or human health. Behaviors that affect contact rates among hosts could be important for viral diversification because more frequent intra- and inter-specific contacts among hosts should increase the potential for viral diversification within host populations. We used published data on bats to test the contact-rate hypothesis. We predicted that species forming large conspecific groups, that share their range with more heterospecifics (i.e., sympatry), and with mating systems characterized by high contact rates (polygynandry: multi-male/multi-female), would host higher viral richness than species with small group sizes, lower sympatry, or low contact-rate mating systems (polygyny: single male/multi-female). Consistent with our hypothesis and previous research, viral richness was positively correlated with conspecific group size although the relationship plateaued at group sizes of approximately several hundred thousand bats. This pattern supports epidemiological theory that, up to a point, larger groups have higher contact rates, greater likelihood of acquiring and transmitting viruses, and ultimately greater potential for viral diversification. However, contrary to our hypothesis, there was no effect of sympatry on viral richness and no difference in viral richness between mating systems. We also found no residual effect of host phylogeny on viral richness, suggesting that closely related species do not necessarily host similar numbers of viruses. Our results support the contact-rate hypothesis that intra-specific viral transmission can enhance viral diversification within species and highlight the influence of host group size on the potential of viruses to propagate within host populations.

  9. Abnormal expression of blood group-related antigens in uterine endometrial cancers.

    Science.gov (United States)

    Tsukazaki, K; Sakayori, M; Arai, H; Yamaoka, K; Kurihara, S; Nozawa, S

    1991-08-01

    The expression of A, B, and H group antigens, Lewis group antigens (Lewis(a), Lewis(b), Lewis(x), and Lewis(y)), and Lc4 and nLc4 antigens, the precursor antigens of both groups, was examined immunohistochemically with monoclonal antibodies in 9 normal endometria, 6 endometrial hyperplasias, and 31 endometrial cancers. 1) A, B and/or H antigens were detected in endometrial cancers at an incidence of 51.6%, while no distinct localization of these antigens was observed in normal endometria. H antigen, the precursor of A and B antigens, was particularly frequently detected in endometrial cancers. 2) An increased rate of expression of Lewis group antigens, particularly Lewis(b) antigen, was observed in endometrial cancers compared with its expression in normal endometria. 3) Lc4 and nLc4 antigens were detected in endometrial cancers at rates of 41.9% and 38.7%, respectively, these expressions being increased compared with those in normal endometria. 4) These results suggest that a highly abnormal expression of blood group-related antigens in endometrial cancers occurs not only at the level of A, B, and H antigens and Lewis group antigens, but also at the level of their precursor Lc4 and nLc4 antigens. 5) Lewis(a), Lewis(b), and Lc4 antigens, built on the type-1 chain, are more specific to endometrial cancers than their respective positional isomers, Lewis(x), Lewis(y), and nLc4 antigens, built on the type-2 chain.

  10. Dolphin underwater bait-balling behaviors in relation to group and prey ball sizes.

    Science.gov (United States)

    Vaughn-Hirshorn, Robin L; Muzi, Elisa; Richardson, Jessica L; Fox, Gabriella J; Hansen, Lauren N; Salley, Alyce M; Dudzinski, Kathleen M; Würsig, Bernd

    2013-09-01

    We characterized dusky dolphin (Lagenorhynchus obscurus) feeding behaviors recorded on underwater video, and related behaviors to variation in prey ball sizes, dolphin group sizes, and study site (Argentina versus New Zealand, NZ). Herding behaviors most often involved dolphins swimming around the side or under prey balls, but dolphins in Argentina more often swam under prey balls (48% of passes) than did dolphins in NZ (34% of passes). This result may have been due to differences in group sizes between sites, since groups are larger in Argentina. Additionally, in NZ, group size was positively correlated with proportion of passes that occurred under prey balls (pdolphins in Argentina more often swam through prey balls (8% of attempts) than did dolphins in NZ (4% of attempts). This result may have been due to differences in prey ball sizes between sites, since dolphins fed on larger prey balls in Argentina (>74m(2)) than in NZ (maximum 33m(2)). Additionally, in NZ, dolphins were more likely to swim through prey balls to capture fish when they fed on larger prey balls (p=0.025). Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Relative stability of core groups in pollination networks in a biodiversity hotspot over four years.

    Science.gov (United States)

    Fang, Qiang; Huang, Shuang-Quan

    2012-01-01

    Plants and their pollinators form pollination networks integral to the evolution and persistence of species in communities. Previous studies suggest that pollination network structure remains nested while network composition is highly dynamic. However, little is known about temporal variation in the structure and function of plant-pollinator networks, especially in species-rich communities where the strength of pollinator competition is predicted to be high. Here we quantify temporal variation of pollination networks over four consecutive years in an alpine meadow in the Hengduan Mountains biodiversity hotspot in China. We found that ranked positions and idiosyncratic temperatures of both plants and pollinators were more conservative between consecutive years than in non-consecutive years. Although network compositions exhibited high turnover, generalized core groups--decomposed by a k-core algorithm--were much more stable than peripheral groups. Given the high rate of turnover observed, we suggest that identical plants and pollinators that persist for at least two successive years sustain pollination services at the community level. Our data do not support theoretical predictions of a high proportion of specialized links within species-rich communities. Plants were relatively specialized, exhibiting less variability in pollinator composition at pollinator functional group level than at the species level. Both specialized and generalized plants experienced narrow variation in functional pollinator groups. The dynamic nature of pollination networks in the alpine meadow demonstrates the potential for networks to mitigate the effects of fluctuations in species composition in a high biodiversity area.

  12. Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups.

    Science.gov (United States)

    Caetano, Raul; Vaeth, Patrice A C; Chartier, Karen G; Mills, Britain A

    2014-01-01

    This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels. © 2014 Elsevier B.V. All rights reserved.

  13. Factors related to women's childbirth satisfaction in physiologic and routine childbirth groups

    Directory of Open Access Journals (Sweden)

    Elham Jafari

    2017-01-01

    Full Text Available Background: Women's satisfaction with childbirth is an important measure of the quality of maternity care services. This study aims to address factors related to women's childbirth satisfaction in physiological and routine childbirth groups. Materials and Methods: This descriptive-analytical study was conducted among 340 women in physiological and routine childbirth groups in 2012. Women were selected through convenience sampling method in the routine group and by census in the physiological group. Data were collected using a 5-part questionnaire composed of demographic and obstetrics details, Mackey's Childbirth Satisfaction Rating Scale (CSRS, satisfied with birth setting, Labor Agentry Scale (LAS, and Visual Analogue Scale (VAS, which was completed by interview 24 hours after childbirth. Data were analyzed using the Statistical Package for the Social Sciences version 18 software using Pearson correlation test, independent t-test, analysis of variance, and linear, multivariate regression model at the significant level of P 0.05. Conclusions: Improved physical structure and setting of birth room, nonmedical pain relief, mothers' involvement in the process of labor, and sense of being in control are associated with mothers' satisfaction.

  14. Outpatient psychodynamic group psychotherapy - outcomes related to personality disorder, severity, age and gender.

    Science.gov (United States)

    Kvarstein, Elfrida Hartveit; Nordviste, Ola; Dragland, Lone; Wilberg, Theresa

    2017-02-01

    Outpatient group psychotherapy is frequent within specialist services, recruits a mixed population, but effects are poorly documented. This study investigates long-term outcomes for patients with personality disorder (PD) treated in outpatient, psychodynamic groups within secondary mental health service. A naturalistic study (N = 103) with repeated assessments of process and clinical outcomes. Longitudinal statistics are linear mixed models. The main PDs were avoidant, borderline and NOS PD, mean number of PDs 1.4(SD0.7), 60% females and mean initial age 38(SD10) years. Mean treatment duration was 1.5(SD 0.9) years. Therapist alliance and experienced group climate was satisfactory and stable. Improvements were significant (symptom distress, interpersonal problems, occupational functioning and additional mental health services), irrespective of general PD-severity, but not of PD-type, age or gender. The study demonstrates PD NOS benefits across all outcomes, occupational improvements for avoidant PD, despite prevailing symptoms, but generally poorer outcomes for males and age >38 years. For borderline PD, experienced conflict was stronger, treatment duration shorter and outcomes poor for early drop-outs (28%). Psychodynamic group psychotherapy is a recommendable treatment for moderate PDs, which may address avoidant strategies, but may not meet clinical challenges of borderline PD. The outcome differences related to gender and age are noteworthy. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Development of a relational database for nuclear material (NM) accounting in RC and I Group

    International Nuclear Information System (INIS)

    Yadav, M.B.; Ramakumar, K.L.; Venugopal, V.

    2011-01-01

    A relational database for the nuclear material accounting in RC and I Group has been developed with MYSQL for Back-End and JAVA for Front-End development. Back-End has been developed to avoid any data redundancy, to provide random access of the data and to retrieve the required information from database easily. JAVA Applet and Java Swing components of JAVA programming have been used in the Front-End development. Front-End has been developed to provide data security, data integrity, to generate inventory status report at the end of accounting period, and also to have a quick look of some required information on computer screen. The database has been tested for the data of three quarters of the year 2009. It has been implemented from 1st January, 2010 for the accounting of nuclear material in RC and I Group. (author)

  16. Development of a relational database for nuclear material (NM) accounting in RC and I Group

    Energy Technology Data Exchange (ETDEWEB)

    Yadav, M B; Ramakumar, K L; Venugopal, V [Radioanalytical Chemistry Division, Radiochemistry and Isotope Group, Bhabha Atomic Research Centre, Mumbai (India)

    2011-07-01

    A relational database for the nuclear material accounting in RC and I Group has been developed with MYSQL for Back-End and JAVA for Front-End development. Back-End has been developed to avoid any data redundancy, to provide random access of the data and to retrieve the required information from database easily. JAVA Applet and Java Swing components of JAVA programming have been used in the Front-End development. Front-End has been developed to provide data security, data integrity, to generate inventory status report at the end of accounting period, and also to have a quick look of some required information on computer screen. The database has been tested for the data of three quarters of the year 2009. It has been implemented from 1st January, 2010 for the accounting of nuclear material in RC and I Group. (author)

  17. Barriers related to physical activity practice in adolescents. A focus-group study

    Directory of Open Access Journals (Sweden)

    Ciro Romélio Rodriguez Añez

    2010-04-01

    Full Text Available The aim of study was to identify barriers to physical activity in adolescents. Focus group interviews were conducted with subjects aged 15 to 18 years (n=59, 50.8% girls and divided according to gender. Content analysis was used to classify the reports into specific dimensions. Descriptive statistics employing relative and absolute frequencies of similar reports was performed using the SPSS 11.0 software. The most frequent barriers among adolescents were those associated with “psychological, cognitive and emotional” and “cultural and social” dimensions. For boys, the most frequently reported barriers were “feeling lazy”, “lack of company” and “lack of time”. For girls, “feeling lazy”, “lack of com-pany” and “occupation” were the most common barriers. In conclusion, the perception of barriers by adolescents varies according to gender, a fact requiring specific actions for the promotion of physical activity in this group.

  18. Great Expectations: How Role Expectations and Role Experiences Relate to Perceptions of Group Cohesion.

    Science.gov (United States)

    Benson, Alex J; Eys, Mark A; Irving, P Gregory

    2016-04-01

    Many athletes experience a discrepancy between the roles they expect to fulfill and the roles they eventually occupy. Drawing from met expectations theory, we applied response surface methodology to examine how role expectations, in relation to role experiences, influence perceptions of group cohesion among Canadian Interuniversity Sport athletes (N = 153). On the basis of data from two time points, as athletes approached and exceeded their role contribution expectations, they reported higher perceptions of task cohesion. Furthermore, as athletes approached and exceeded their social involvement expectations, they reported higher perceptions of social cohesion. These response surface patterns-pertaining to task and social cohesion-were driven by the positive influence of role experiences. On the basis of the interplay between athletes' role experiences and their perception of the group environment, efforts to improve team dynamics may benefit from focusing on improving the quality of role experiences, in conjunction with developing realistic role expectations.

  19. Assemblage patterns of fish functional groups relative to habitat connectivity and conditions in floodplain lakes

    Science.gov (United States)

    Miyazono, S.; Aycock, J.N.; Miranda, L.E.; Tietjen, T.E.

    2010-01-01

    We evaluated the influences of habitat connectivity and local environmental factors on the distribution and abundance patterns of fish functional groups in 17 floodplain lakes in the Yazoo River Basin, USA. The results of univariate and multivariate analyses showed that species-environmental relationships varied with the functional groups. Species richness and assemblage structure of periodic strategists showed strong and positive correlations with habitat connectivity. Densities of most equilibrium and opportunistic strategists decreased with habitat connectivity. Densities of certain equilibrium and opportunistic strategists increased with turbidity. Forested wetlands around the lakes were positively related to the densities of periodic and equilibrium strategists. These results suggest that decreases in habitat connectivity, forested wetland buffers and water quality resulting from environmental manipulations may cause local extinction of certain fish taxa and accelerate the dominance of tolerant fishes in floodplain lakes. ?? 2010 John Wiley & Sons A/S.

  20. Finding Combination of Features from Promoter Regions for Ovarian Cancer-related Gene Group Classification

    KAUST Repository

    Olayan, Rawan S.

    2012-12-01

    In classification problems, it is always important to use the suitable combination of features that will be employed by classifiers. Generating the right combination of features usually results in good classifiers. In the situation when the problem is not well understood, data items are usually described by many features in the hope that some of these may be the relevant or most relevant ones. In this study, we focus on one such problem related to genes implicated in ovarian cancer (OC). We try to recognize two important OC-related gene groups: oncogenes, which support the development and progression of OC, and oncosuppressors, which oppose such tendencies. For this, we use the properties of promoters of these genes. We identified potential “regulatory features” that characterize OC-related oncogenes and oncosuppressors promoters. In our study, we used 211 oncogenes and 39 oncosuppressors. For these, we identified 538 characteristic sequence motifs from their promoters. Promoters are annotated by these motifs and derived feature vectors used to develop classification models. We made a comparison of a number of classification models in their ability to distinguish oncogenes from oncosuppressors. Based on 10-fold cross-validation, the resultant model was able to separate the two classes with sensitivity of 96% and specificity of 100% with the complete set of features. Moreover, we developed another recognition model where we attempted to distinguish oncogenes and oncosuppressors as one group from other OC-related genes. That model achieved accuracy of 82%. We believe that the results of this study will help in discovering other OC-related oncogenes and oncosuppressors not identified as yet.

  1. Finding Combination of Features from Promoter Regions for Ovarian Cancer-related Gene Group Classification

    KAUST Repository

    Olayan, Rawan S.

    2012-01-01

    In classification problems, it is always important to use the suitable combination of features that will be employed by classifiers. Generating the right combination of features usually results in good classifiers. In the situation when the problem is not well understood, data items are usually described by many features in the hope that some of these may be the relevant or most relevant ones. In this study, we focus on one such problem related to genes implicated in ovarian cancer (OC). We try to recognize two important OC-related gene groups: oncogenes, which support the development and progression of OC, and oncosuppressors, which oppose such tendencies. For this, we use the properties of promoters of these genes. We identified potential “regulatory features” that characterize OC-related oncogenes and oncosuppressors promoters. In our study, we used 211 oncogenes and 39 oncosuppressors. For these, we identified 538 characteristic sequence motifs from their promoters. Promoters are annotated by these motifs and derived feature vectors used to develop classification models. We made a comparison of a number of classification models in their ability to distinguish oncogenes from oncosuppressors. Based on 10-fold cross-validation, the resultant model was able to separate the two classes with sensitivity of 96% and specificity of 100% with the complete set of features. Moreover, we developed another recognition model where we attempted to distinguish oncogenes and oncosuppressors as one group from other OC-related genes. That model achieved accuracy of 82%. We believe that the results of this study will help in discovering other OC-related oncogenes and oncosuppressors not identified as yet.

  2. Neuropathic pain in experimental autoimmune neuritis is associated with altered electrophysiological properties of nociceptive DRG neurons.

    Science.gov (United States)

    Taha, Omneya; Opitz, Thoralf; Mueller, Marcus; Pitsch, Julika; Becker, Albert; Evert, Bernd Oliver; Beck, Heinz; Jeub, Monika

    2017-11-01

    Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy characterized by rapidly progressive paresis and sensory disturbances. Moderate to severe and often intractable neuropathic pain is a common symptom of GBS, but its underlying mechanisms are unknown. Pathology of GBS is classically attributed to demyelination of large, myelinated peripheral fibers. However, there is increasing evidence that neuropathic pain in GBS is associated with impaired function of small, unmyelinated, nociceptive fibers. We therefore examined the functional properties of small DRG neurons, the somata of nociceptive fibers, in a rat model of GBS (experimental autoimmune neuritis=EAN). EAN rats developed behavioral signs of neuropathic pain. This was accompanied by a significant shortening of action potentials due to a more rapid repolarization and an increase in repetitive firing in a subgroup of capsaicin-responsive DRG neurons. Na + current measurements revealed a significant increase of the fast TTX-sensitive current and a reduction of the persistent TTX-sensitive current component. These changes of Na + currents may account for the significant decrease in AP duration leading to an overall increase in excitability and are therefore possibly directly linked to pathological pain behavior. Thus, like in other animal models of neuropathic and inflammatory pain, Na + channels seem to be crucially involved in the pathology of GBS and may constitute promising targets for pain modulating pharmaceuticals. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    Science.gov (United States)

    Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

    2013-01-01

    Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

  4. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    Directory of Open Access Journals (Sweden)

    Jürgen Heinz

    2013-01-01

    Full Text Available Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs. Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually.

  5. Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

    Science.gov (United States)

    Feyrer, R; Rösch, J; Weyand, M; Kunzmann, U

    2005-10-01

    Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.

  6. Muscle Torque and its Relation to Technique, Tactics, Sports Level and Age Group in Judo Contestants

    Science.gov (United States)

    Lech, Grzegorz; Chwała, Wiesław; Ambroży, Tadeusz; Sterkowicz, Stanisław

    2015-01-01

    The aim of this study was to perform a comparative analysis of maximal muscle torques at individual stages of development of athletes and to determine the relationship between muscle torques, fighting methods and the level of sports performance. The activity of 25 judo contestants during judo combats and the effectiveness of actions were evaluated. Maximum muscle torques in flexors/extensors of the body trunk, shoulder, elbow, hip and knee joints were measured. The level of significance was set at p≤0.05; for multiple comparisons the Mann-Whitney U test, p≤0.016, was used. Intergroup differences in relative torques in five muscle groups studied (elbow extensors, shoulder flexors, knee flexors, knee extensors, hip flexors) were not significant. In cadets, relative maximum muscle torques in hip extensors correlated with the activity index (Spearman’s r=0.756). In juniors, maximum relative torques in elbow flexors and knee flexors correlated with the activity index (r=0.73 and r=0.76, respectively). The effectiveness of actions correlated with relative maximum torque in elbow extensors (r=0.67). In seniors, the relative maximum muscle torque in shoulder flexors correlated with the activity index during the second part of the combat (r=0.821). PMID:25964820

  7. Muscle torque and its relation to technique, tactics, sports level and age group in judo contestants.

    Science.gov (United States)

    Lech, Grzegorz; Chwała, Wiesław; Ambroży, Tadeusz; Sterkowicz, Stanisław

    2015-03-29

    The aim of this study was to perform a comparative analysis of maximal muscle torques at individual stages of development of athletes and to determine the relationship between muscle torques, fighting methods and the level of sports performance. The activity of 25 judo contestants during judo combats and the effectiveness of actions were evaluated. Maximum muscle torques in flexors/extensors of the body trunk, shoulder, elbow, hip and knee joints were measured. The level of significance was set at p≤0.05; for multiple comparisons the Mann-Whitney U test, p≤0.016, was used. Intergroup differences in relative torques in five muscle groups studied (elbow extensors, shoulder flexors, knee flexors, knee extensors, hip flexors) were not significant. In cadets, relative maximum muscle torques in hip extensors correlated with the activity index (Spearman's r=0.756). In juniors, maximum relative torques in elbow flexors and knee flexors correlated with the activity index (r=0.73 and r=0.76, respectively). The effectiveness of actions correlated with relative maximum torque in elbow extensors (r=0.67). In seniors, the relative maximum muscle torque in shoulder flexors correlated with the activity index during the second part of the combat (r=0.821).

  8. MiR-210 disturbs mitotic progression through regulating a group of mitosis-related genes

    OpenAIRE

    He, Jie; Wu, Jiangbin; Xu, Naihan; Xie, Weidong; Li, Mengnan; Li, Jianna; Jiang, Yuyang; Yang, Burton B.; Zhang, Yaou

    2012-01-01

    MiR-210 is up-regulated in multiple cancer types but its function is disputable and further investigation is necessary. Using a bioinformatics approach, we identified the putative target genes of miR-210 in hypoxia-induced CNE cells from genome-wide scale. Two functional gene groups related to cell cycle and RNA processing were recognized as the major targets of miR-210. Here, we investigated the molecular mechanism and biological consequence of miR-210 in cell cycle regulation, particularly ...

  9. 76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

    Science.gov (United States)

    2011-07-26

    ... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

  10. Transient Relative Age Effects across annual age groups in National level Australian Swimming.

    Science.gov (United States)

    Cobley, Stephen; Abbott, Shaun; Dogramaci, Sera; Kable, Adam; Salter, James; Hintermann, Mirjam; Romann, Michael

    2017-12-29

    To determine the prevalence, magnitude and transient patterning of Relative Age Effects (RAEs) according to sex and stroke event across all age-groups at the Australian National age swimming Championships. Repeated years of cross-sectional participation data were examined. Participants were 6014 unique male (3185) and female (2829) swimmers (aged 12-18 years) who participated in Freestyle (50, 400m) and/or Breaststroke (100, 200m) at the National age swimming Championships between 2000-2014 (inclusive). RAE prevalence, magnitude and transience were determined using Chi-square tests and Cramer's V estimates for effect size. Odds Ratios (OR) and 95% Confidence Intervals (CI) examined relative age quartile discrepancies. These steps were applied across age-groups and according to sex and each stroke event. Consistent RAEs with large-medium effect sizes were evident for males at 12-15 years of age respectively, and with large-medium effects for females at 12-14 respectively across all four swimming strokes. RAE magnitude then consistently reduced with age across strokes (e.g., Q1 vs. Q4 OR range 16year old males=0.94-1.20; females=0.68-1.41). With few exceptions, by 15-16 years RAEs had typically dissipated; and by 17-18 years, descriptive and significant inverse RAEs emerged, reflecting overrepresentation of relatively younger swimmers. Performance advantages associated with relative age (and thereby likely growth and maturation) are transient. Greater consideration of transient performance and participation in athlete development systems is necessary. This may include revising the emphasis of sport programmes according to developmental stages and delaying forms of athlete selection to improve validity. Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  11. Multivariate analysis of chromatographic retention data as a supplementary means for grouping structurally related compounds.

    Science.gov (United States)

    Fasoula, S; Zisi, Ch; Sampsonidis, I; Virgiliou, Ch; Theodoridis, G; Gika, H; Nikitas, P; Pappa-Louisi, A

    2015-03-27

    In the present study a series of 45 metabolite standards belonging to four chemically similar metabolite classes (sugars, amino acids, nucleosides and nucleobases, and amines) was subjected to LC analysis on three HILIC columns under 21 different gradient conditions with the aim to explore whether the retention properties of these analytes are determined from the chemical group they belong. Two multivariate techniques, principal component analysis (PCA) and discriminant analysis (DA), were used for statistical evaluation of the chromatographic data and extraction similarities between chemically related compounds. The total variance explained by the first two principal components of PCA was found to be about 98%, whereas both statistical analyses indicated that all analytes are successfully grouped in four clusters of chemical structure based on the retention obtained in four or at least three chromatographic runs, which, however should be performed on two different HILIC columns. Moreover, leave-one-out cross-validation of the above retention data set showed that the chemical group in which an analyte belongs can be 95.6% correctly predicted when the analyte is subjected to LC analysis under the same four or three experimental conditions as the all set of analytes was run beforehand. That, in turn, may assist with disambiguation of analyte identification in complex biological extracts. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Migratory bird habitat in relation to tile drainage and poorly drained hydrologic soil groups

    Science.gov (United States)

    Kastner, Brandi; Christensen, Victoria G.; Williamson, Tanja N.; Sanocki, Chris A.

    2016-01-01

    The Prairie Pothole Region (PPR) is home to more than 50% of the migratory waterfowl in North America. Although the PPR provides an abundance of temporary and permanent wetlands for nesting and feeding, increases in commodity prices and agricultural drainage practices have led to a trend of wetland drainage. The Northern Shoveler is a migratory dabbling duck species that uses wetland habitats and cultivated croplands in the PPR. Richland County in North Dakota and Roberts County in South Dakota have an abundance of wetlands and croplands and were chosen as the study areas for this research to assess the wetland size and cultivated cropland in relation to hydrologic soil groups for the Northern Shoveler habitat. This study used geographic information system data to analyze Northern Shoveler habitats in association with Natural Resource Conservation Service soil data. Habitats, which are spatially associated with certain hydrologic soil groups, may be at risk of artificial drainage installations because of their proximity to cultivated croplands and soil lacking in natural drainage that may become wet or inundated. Findings indicate that most wetlands that are part of Northern Shoveler habitats were within or adjacent to cultivated croplands. The results also revealed soil hydrologic groups with high runoff potential and low water transmission rates account for most of the soil within the Northern Shoveler‘s wetland and cropland habitats. Habitats near agriculture with high runoff potential are likely to be drained and this has the potential of reducing Northern Shoveler habitat.

  13. Becoming the denigrated other: Group relations perspectives on initial reactions to a bipolar disorder diagnosis

    Directory of Open Access Journals (Sweden)

    Susan G. Goldberg

    2012-09-01

    Full Text Available The initial reactions to a bipolar disorder diagnosis of research participants in a small, qualitative study consisted of astonishment, dread of being mad, and extremely negative associations. All had prior mental health diagnoses, including episodes of severe depression (all but one and alcoholism (one. All participants reported mental health histories prediagnosis and most had spent years contending with mental health labels, medications, symptoms, and hospitalizations. In addition, most participants were highly educated health professionals, quite familiar with the behaviors that the medical system considered to comprise bipolar disorder. Their negative associations to the initial bipolar disorder diagnosis, therefore, appeared inconsistent with their mental health histories and professional knowledge. This article contextualizes these initial reactions of shock and distress and proposes interpretations of these findings from societal and psychodynamic group relations perspectives. The participants’ initial negative reactions are conceptualized as involving the terror of being transported from the group of normal people into the group of mad or crazy people, i.e., people with mental illnesses, who may constitute a societal denigrated other.

  14. 76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

    Science.gov (United States)

    2011-06-24

    ... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

  15. 75 FR 27121 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent...

    Science.gov (United States)

    2010-05-13

    ... 45 CFR Parts 144, 146, and 147 Group Health Plans and Health Insurance Issuers Relating to Dependent... 144, 146, and 147 RIN 0991-AB66 Interim Final Rules for Group Health Plans and Health Insurance... requirements for group health plans and health insurance issuers in the group and individual markets under...

  16. MiR-210 disturbs mitotic progression through regulating a group of mitosis-related genes.

    Science.gov (United States)

    He, Jie; Wu, Jiangbin; Xu, Naihan; Xie, Weidong; Li, Mengnan; Li, Jianna; Jiang, Yuyang; Yang, Burton B; Zhang, Yaou

    2013-01-07

    MiR-210 is up-regulated in multiple cancer types but its function is disputable and further investigation is necessary. Using a bioinformatics approach, we identified the putative target genes of miR-210 in hypoxia-induced CNE cells from genome-wide scale. Two functional gene groups related to cell cycle and RNA processing were recognized as the major targets of miR-210. Here, we investigated the molecular mechanism and biological consequence of miR-210 in cell cycle regulation, particularly mitosis. Hypoxia-induced up-regulation of miR-210 was highly correlated with the down-regulation of a group of mitosis-related genes, including Plk1, Cdc25B, Cyclin F, Bub1B and Fam83D. MiR-210 suppressed the expression of these genes by directly targeting their 3'-UTRs. Over-expression of exogenous miR-210 disturbed mitotic progression and caused aberrant mitosis. Furthermore, miR-210 mimic with pharmacological doses reduced tumor formation in a mouse metastatic tumor model. Taken together, these results implicate that miR-210 disturbs mitosis through targeting multi-genes involved in mitotic progression, which may contribute to its inhibitory role on tumor formation.

  17. Relation between ABO blood groups and Helicobacter pylori infection in symptomatic patients

    Directory of Open Access Journals (Sweden)

    Jaff MS

    2011-09-01

    Full Text Available Mohamad Salih Jaff Pathology Department, College of Medicine, Hawler Medical University (formerly Salahuddin University, Erbil, Kurdistan Region, Iraq Abstract: Epidemiological studies have demonstrated higher frequencies of the O blood group and the nonsecretor phenotype of ABH antigens among patients suffering from peptic ulcers. Since Helicobacter pylori has been established as the main etiological factor in this disease, controversies about the associations of the ABO and Lewis blood group phenotypes and secretor and nonsecretor phenotypes in relation to susceptibility towards infection by this bacillus have been presented. The aim of this study was to verify the frequencies of ABO and Rhesus (Rh blood groups in H. pylori seropositive symptomatic patients. The study included (n = 1108 patients with dyspepsia symptoms referred from an outpatient clinic in Erbil city for investigation. Age, sex, and residency were recorded as a routine laboratory framework. Patients underwent SD Bioline (Standard Diagnostics Inc, Kyonggi-do, South Korea and enzyme-linked immunosorbent assay serologic tests for H. pylori. ABO blood group phenotypes were determined by a standard hemagglutination test. Results showed that 64.8% of patients (n = 718/1108 were seropositive for H. pylori infection, and (35.2% (n = 390/1108 were seronegative. Of the seropositive patients, 40.8% (n = 293/718 were male and 59.2% (n = 425/718 were female; while of the seronegative patients, 46.7% (n = 182/390 were male and 53.3% (n = 208/390 were female. The mean age for seropositives and seronegatives was (38.0 ± 14.6 years and (37.6 ± 15.7 years respectively. The frequency of the ABO and Rh-positive (Rh+ blood groups among seropositive patients was (A = 32.0%, B = 19.5%, AB = 6.7%, O = 41.8%, and Rh+ = 92.5% and was (A = 32.3%, B = 28.2%, AB = 8.0%, O = 31.5%, and Rh+ = 92.5% in seronegatives. The results of this study suggest that ABO blood groups, age, and gender influence

  18. Understanding Medical Students' Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore.

    Science.gov (United States)

    Farquhar, Julia; Lie, Desiree; Chan, Angelique; Ow, Mandy; Vidyarthi, Arpana

    2018-02-01

    In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students' experiences, and to distinguish pre-clinical and clinical year students' experiences relating to these four constructs. The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.

  19. Disk and dwarf spheroidal galaxies kinematics from general relativity with infrared renormalization group effects

    International Nuclear Information System (INIS)

    Rodrigues, Davi C.; Oliveira, Paulo L.C. de; Fabris, Julio C.; Shapiro, Ilya L.

    2011-01-01

    Full text: The running of coupling constants is a well known phenomenon within Quantum Field Theory. It is also known that the renormalization group method can be extended to quantum field theory on curved space time. Nonetheless, although we know that the beta function of QED go to zero in the infrared limit fast enough to lead to constant charge at the classical level (in conformity with both the Appelquist-Carazzone theorem and experimental data), no analogous proof exists for General Relativity. Some authors have proposed that the infrared beta function of General Relativity is not trivial, and as such certain small running of the gravitational coupling might take place at astrophysical scales, leading in particular to changes on the role of dark matter in galaxies. We review and extend our contribution to infrared Renormalization Group (RG) effects to General Relativity in the context of galaxies, an approach we call RGGR. We extend our previous results by analyzing a larger sample of galaxies, now also including elliptical and dwarf spheroidal galaxies, besides disk galaxies (both LSB and HSB). We compare our RGGR results to both standard dark matter profiles (NFW, Isothermal, Burkert) and alternative models of gravity (MOND, MSTG), showing that the RGGR results are similar in quality to the best dark matter profiles (the cored ones, e.g., Isothermal and Burkert), while displaying a better fitting to the data than NFW, MOND or MSTG. To the latter, we evaluated both the shape of the rotation curve and the expected stellar mass-to-light ratios. Dwarf spheroidal (dSph) galaxies are small galaxies believed to be dominated by dark matter, with the highest fraction do dark matter per baryonic matter. These galaxies provide a strong test to any theory that mimics either all or part of the dark matter behavior. In particular, this is the only type of galaxy that MOND seems incapable of fitting the data. (author)

  20. Relative position of the mandibular foramen in different age groups of children: A radiographic study

    Directory of Open Access Journals (Sweden)

    Poonacha K

    2010-09-01

    Full Text Available Objectives: To assess the relative position of the mandibular foramen (MF and to evaluate the measurement of gonial angle (GoA and its relationship with distances between different mandibular borders in growing children between 3 and 13years of dental age. Materials and methods: The radiographs were traced to arrive at six linear and two angular measurements from which the relative position of the MF was assessed and compared in different age groups to determine the growth pattern of the mandible and changes in the location of the MF. Results: The distances between the MF and the anterior plane of the ramus were greater than that between MF and posterior plane of the ramus through all stages. There was a maximum increase in the vertical dimensions of the mandible compared with the horizontal dimensions, particularly in the late mixed dentition period. Conclusion: The mandible and its growth did not alter the position of the MF, both vertically and horizontally, in relation to different landmarks, and more obtuse GoA indicated an increased growth potential of the mandible. This has major implications in the inferior alveolar nerve block technique when used in children.

  1. Women's experience of SLE-related fatigue: a focus group interview study.

    Science.gov (United States)

    Pettersson, Susanne; Möller, Sonia; Svenungsson, Elisabet; Gunnarsson, Iva; Welin Henriksson, Elisabet

    2010-10-01

    The aim of this study was to describe women's experience of SLE-related fatigue, how they express the feeling of fatigue, impact on life and strategies developed to manage fatigue in daily living. Seven, semi-structured focus group discussions with 33 women were audio-taped, transcribed verbatim and analysed according to qualitative content analysis. Perceptions of SLE-related fatigue were sorted into four themes. Nature of Fatigue, involved the sensation, occurrence and character. Aspects Affected by Fatigue described emotions that arose together with fatigue as well as aspects of work, family life, social contacts and leisure activities that were affected by fatigue. Striving Towards Power and Control concluded the array of ways used to manage daily life and were categorized into the mental struggle, structure, restrict and provide. Factors Influencing the Perception of Fatigue described understanding from their surroundings and pain as strongly influencing the experience and perception of fatigue. SLE-related fatigue was portrayed as an overwhelming phenomenon with an unpredictable character, resulting in the feeling that fatigue dominates and controls most situations in life. The choice of strategies was described as a balance with implications for how fatigue limited a person's life. Health care professionals are advised to take a more active role to empower people with SLE to find their own balance as a way to achieve a feeling of being in control.

  2. What young people want from health-related online resources: a focus group study.

    Science.gov (United States)

    Fergie, Gillian; Hunt, Kate; Hilton, Shona

    2013-08-01

    The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it.

  3. Group B streptococcus activates transcriptomic pathways related to premature birth in human extraplacental membranes in vitro.

    Science.gov (United States)

    Park, Hae-Ryung; Harris, Sean M; Boldenow, Erica; McEachin, Richard C; Sartor, Maureen; Chames, Mark; Loch-Caruso, Rita

    2018-03-01

    Streptococcus agalactiae (group B streptococcus [GBS]) infection in pregnant women is the leading cause of infectious neonatal morbidity and mortality in the United States. Although inflammation during infection has been associated with preterm birth, the contribution of GBS to preterm birth is less certain. Moreover, the early mechanisms by which GBS interacts with the gestational tissue to affect adverse pregnancy outcomes are poorly understood. We hypothesized that short-term GBS inoculation activates pathways related to inflammation and premature birth in human extraplacental membranes. We tested this hypothesis using GBS-inoculated human extraplacental membranes in vitro. In agreement with our hypothesis, a microarray-based transcriptomics analysis of gene expression changes in GBS-inoculated membranes revealed that GBS activated pathways related to inflammation and preterm birth with significant gene expression changes occurring as early as 4 h postinoculation. In addition, pathways related to DNA replication and repair were downregulated with GBS treatment. Conclusions based on our transcriptomics data were further supported by responses of prostaglandin E2 (PGE2), and matrix metalloproteinases 1 (MMP1) and 3 (MMP3), all of which are known to be involved in parturition and premature rupture of membranes. These results support our initial hypothesis and provide new information on molecular targets of GBS infection in human extraplacental membranes.

  4. Managing more than the mean: Using quantile regression to identify factors related to large elk groups

    Science.gov (United States)

    Brennan, Angela K.; Cross, Paul C.; Creely, Scott

    2015-01-01

    Summary Animal group size distributions are often right-skewed, whereby most groups are small, but most individuals occur in larger groups that may also disproportionately affect ecology and policy. In this case, examining covariates associated with upper quantiles of the group size distribution could facilitate better understanding and management of large animal groups.

  5. Dorsiflexor muscle-group thickness in children with cerebral palsy: Relation to cross-sectional area

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Magnusson, Peter; Jensen, Bente Rona

    2009-01-01

    If the thickness and cross-sectional area of the dorsiflexor muscle group are related in children with cerebral palsy, measurements of muscle thickness may be used to monitor changes in muscle size due to training or immobilisation in these patients. We assessed the validity and reliability.......001), and the reliability of the muscle-thickness measurements was high in the healthy subjects (ICC_{2.1} = 0.94, standard error of measurement = 0.04 cm). The dorsiflexor muscle-thickness was 22% less in the affected compared to the non-affected leg in children with hemiplegic cerebral palsy (P ..., the dorsiflexor cross-sectional area was 32% less in the affected compared to the non-affected leg (P = 0.002). Measurements of dorsiflexor muscle-thickness can be reliably obtained, and they reflect dorsiflexor cross-sectional area in children with cerebral palsy....

  6. Serum pepsin levels Hiroshima adult health study. Relation to radiation, ABO blood groups, and gastrointestinal diseases

    Energy Technology Data Exchange (ETDEWEB)

    Knittle, J L

    1961-07-12

    At the ABCC clinic in Hiroshima 1330 subjects were investigated as to serum pepsin levels over a four month period. The normal mean values compared well with those reported for a United States population using a similar technique. There appeared to be no significant change in serum pepsin level with age, and no difference could be detected among individuals of the ABO blood groups. No relationship was found between serum pepsin level and exposure to ionizing radiation. Patients with gastric and duodenal ulcers had mean levels which were higher than normal mean values, while patients with leukemia had lower than normal mean levels. Patients with gastric polyps and gastric cancer had normal mean values. It is believed that the relation of serum pepsin activity to cancer of the stomach is not settled and deserves further investigation. 23 references, 2 figures, 4 tables.

  7. Shaping the System - The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG).

    Science.gov (United States)

    Fiori, W; Renner, S P; Siam, K; Babapirali, J; Roeder, N; Dausch, E; Hildebrandt, T; Hillemanns, P; Nehmzow, M; Zygmunt, M; Piroth, D; Schem, C; Schwenzer, T; Friese, K; Wallwiener, D; Beckmann, M W

    2013-08-01

    Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system.

  8. The effect of group exercise frequency on health related quality of life in institutionalized elderly.

    Science.gov (United States)

    Rugbeer, Nivash; Ramklass, Serela; Mckune, Andrew; van Heerden, Johan

    2017-01-01

    The study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. One hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. A quasi-experimental design was used to compare the effect of a 12 week group exercise programme on two groups of participants using pre-test and post-test procedures. A significant difference was noted in social function post training 2X/week (MD = -13.85, 95% CI [-24.66, -3.38], p = 0.017, d = 0.674) and 3X/week (MD = -13.30, 95% CI [-21.81, -5.59], p = 0.003, d = 0.712) a week. Training 3X/week a week provided an additional benefit in vitality (MD = -7.55, 95% CI [-13.16, -1.91], p = 0.018, d =0. 379). Improvements in mental component summary scale post training 2X/week (MD = -4.08, 95% CI [-7.67, -0.42], p = 0.033, d = 0.425) and 3X/week (MD = -6.67, 95% CI [-10.92, -2.33], p = 0.005, d = 0.567) a week was further noted. Mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week. The exercise intervention at a frequency 3X/ week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of 2X/week. Additional benefits in vitality were achieved by exercising 3X/week. This may assist the elderly in preserving their independence.

  9. Dutch Cyberbullying Victims’ Experiences, Perceptions, Attitudes and Motivations Related to (Coping with Cyberbullying: Focus Group Interviews

    Directory of Open Access Journals (Sweden)

    Niels C.L. Jacobs

    2015-01-01

    Full Text Available Because of the negative effects of cyberbullying; and because of its unique characteristics; interventions to stop cyberbullying are needed. For this purpose, more insightful information is needed about cyberbullying victims’ (i.e., the target group experiences, perceptions, attitudes and motivations related to (coping with cyberbullying. Five schools with 66 low-educated Dutch adolescents between 12 and 15 (53% female participated in 10 focus group interviews. Results show that victims do not perceive all behaviors as cyberbullying and traditional bullying is generally perceived as worse than cyberbullying. Cyberbullies are perceived as sad, cowards and embarrassing themselves. Victims are perceived as easy targets; they wear strange clothes, act in a provocative manner and have a bad appearance. These perceptions often depend on context, the level of anonymity, being in a fight or not, the person sending the message and his/her behavior. Further, victims reacted to cyberbullying by acting nonchalant, by not actually saying anything and seeking help from others (i.e., parents are not often asked for help because they do not want to bother them; fear of restricted Internet privileges. It can be concluded that asking cyberbullying victims about their experiences in an open manner, and allowing them to discuss these experiences, likely results in new and insightful information compared to using self-reports. In this questioning the perception of adolescents is key to see what is perceived as cyberbullying.

  10. Evaluation of the performance of diagnosis-related groups and similar casemix systems: methodological issues.

    Science.gov (United States)

    Palmer, G; Reid, B

    2001-05-01

    With the increasing recognition and application of casemix for managing and financing healthcare resources, the evaluation of alternative versions of systems such as diagnosis-related groups (DRGs) has been afforded high priority by governments and researchers in many countries. Outside the United States, an important issue has been the perceived need to produce local versions, and to establish whether or not these perform more effectively than the US-based classifications. A discussion of casemix evaluation criteria highlights the large number of measures that may be used, the rationale and assumptions underlying each measure, and the problems in interpreting the results. A review of recent evaluation studies from a number of countries indicates that considerable emphasis has been placed on the predictive validity criterion, as measured by the R2 statistic. However, the interpretation of the findings has been affected greatly by the methods used, especially the treatment and definition of outlier cases. Furthermore, the extent to which other evaluation criteria have been addressed has varied widely. In the absence of minimum evaluation standards, it is not possible to draw clear-cut conclusions about the superiority of one version of a casemix system over another, the need for a local adaptation, or the further development of an existing version. Without the evidence provided by properly designed studies, policy-makers and managers may place undue reliance on subjective judgments and the views of the most influential, but not necessarily best informed, healthcare interest groups.

  11. Distinct subclassification of DRG neurons innervating the distal colon and glans penis/distal urethra based on the electrophysiological current signature.

    Science.gov (United States)

    Rau, Kristofer K; Petruska, Jeffrey C; Cooper, Brian Y; Johnson, Richard D

    2014-09-15

    Spinal sensory neurons innervating visceral and mucocutaneous tissues have unique microanatomic distribution, peripheral modality, and physiological, pharmacological, and biophysical characteristics compared with those neurons that innervate muscle and cutaneous tissues. In previous patch-clamp electrophysiological studies, we have demonstrated that small- and medium-diameter dorsal root ganglion (DRG) neurons can be subclassified on the basis of their patterns of voltage-activated currents (VAC). These VAC-based subclasses were highly consistent in their action potential characteristics, responses to algesic compounds, immunocytochemical expression patterns, and responses to thermal stimuli. For this study, we examined the VAC of neurons retrogradely traced from the distal colon and the glans penis/distal urethra in the adult male rat. The afferent population from the distal colon contained at least two previously characterized cell types observed in somatic tissues (types 5 and 8), as well as four novel cell types (types 15, 16, 17, and 18). In the glans penis/distal urethra, two previously described cell types (types 6 and 8) and three novel cell types (types 7, 14, and 15) were identified. Other characteristics, including action potential profiles, responses to algesic compounds (acetylcholine, capsaicin, ATP, and pH 5.0 solution), and neurochemistry (expression of substance P, CGRP, neurofilament, TRPV1, TRPV2, and isolectin B4 binding) were consistent for each VAC-defined subgroup. With identification of distinct DRG cell types that innervate the distal colon and glans penis/distal urethra, future in vitro studies related to the gastrointestinal and urogenital sensory function in normal as well as abnormal/pathological conditions may be benefitted. Copyright © 2014 the American Physiological Society.

  12. Viral vector mediated continuous expression of interleukin-10 in DRG alleviates pain in type 1 diabetic animals.

    Science.gov (United States)

    Thakur, Vikram; Gonzalez, Mayra; Pennington, Kristen; Chattopadhyay, Munmun

    2016-04-01

    Painful diabetic neuropathy is a common and difficult to treat complication of diabetes. A growing body of evidence implicates the role of inflammatory mediators in the damage to the peripheral axons and in the pathogenesis of neuropathic pain. Increased expression of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α in the peripheral nervous system suggests the possibility of change in pain perception in diabetes. In this study we investigated that continuous delivery of IL10 in the nerve fibers achieved by HSV vector mediated transduction of dorsal root ganglion (DRG) in animals with Type 1 diabetes, blocks the nociceptive and stress responses in the DRG neurons by reducing IL1β expression along with inhibition of phosphorylation of p38 MAPK (mitogen-activated protein kinase) and protein kinase C (PKC). The continuous expression of IL10 also alters Toll like receptor (TLR)-4 expression in the DRG with increased expression of heat shock protein (HSP)-70 in conjunction with the reduction of pain. Taken together, this study suggests that macrophage activation in the peripheral nervous system may be involved in the pathogenesis of pain in Type 1 diabetes and therapeutic benefits of HSV mediated local expression of IL10 in the DRG with the reduction of a number of proinflammatory cytokines, subsequently inhibits the development of painful neuropathy along with a decrease in stress associated markers in the DRG. This basic and preclinical study provides an important evidence for a novel treatment strategy that could lead to a clinical trial for what is currently a treatment resistant complication of diabetes. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Selective Radiofrequency Stimulation of the Dorsal Root Ganglion (DRG) as a Method for Predicting Targets for Neuromodulation in Patients With Post Amputation Pain: A Case Series.

    Science.gov (United States)

    Hunter, Corey W; Yang, Ajax; Davis, Tim

    2017-10-01

    While spinal cord stimulation (SCS) has established itself as an accepted and validated treatment for neuropathic pain, there are a number of conditions where it has experienced less, long-term success: post amputee pain (PAP) being one of them. Dorsal root ganglion (DRG) stimulation has shown great promise, particularly in conditions where traditional SCS has fallen short. One major difference between DRG stimulation and traditional SCS is the ability to provide focal stimulation over targeted areas. While this may be a contributing factor to its superiority, it can also be a limitation insofar stimulating the wrong DRG(s) can lead to failure. This is particularly relevant in conditions like PAP where neuroplastic maladaptation occurs causing the pain to deviate from expected patterns, thus creating uncertainty and variability in predicting targets for stimulation. We propose selective radiofrequency (RF) stimulation of the DRG as a method for preoperatively predicting targets for neuromodulation in patients with PAP. We present four patients with PAP of the lower extremities. RF stimulation was used to selectively stimulate individual DRG's, creating areas of paresthesias to see which most closely correlated/overlapped with the painful area(s). RF stimulation to the DRG's that resulted in the desirable paresthesia coverage in the residual or the missing limb(s) was recorded as "positive." Trial DRG leads were placed based on the positive RF stimulation findings. In each patient, stimulating one or more DRG(s) produced paresthesias patterns that were contradictory to know dermatomal patterns. Upon completion of a one-week trial all four patients reported 60-90% pain relief, with coverage over the painful areas, and opted for permanent implant. Mapping the DRG via RF stimulation appears to provide improved accuracy for determining lead placement in the setting of PAP where pain patterns are known to deviate from conventional dermatomal mapping. © 2017

  14. Event-Related Potential Patterns Associated with Hyperarousal in Gulf War Illness Syndrome Groups

    Science.gov (United States)

    Tillman, Gail D.; Calley, Clifford S.; Green, Timothy A.; Buhl, Virginia I.; Biggs, Melanie M.; Spence, Jeffrey S.; Briggs, Richard W.; Haley, Robert W.; Hart, John; Kraut, Michael A.

    2012-01-01

    An exaggerated response to emotional stimuli is one of several symptoms widely reported by veterans of the 1991 Persian Gulf War. Many have attributed these symptoms to post-war stress; others have attributed the symptoms to deployment-related exposures and associated damage to cholinergic, dopaminergic, and white matter systems. We collected event-related potential (ERP) data from 20 veterans meeting Haley criteria for Gulf War Syndromes 1–3 and from 8 matched Gulf War veteran controls, who were deployed but not symptomatic, while they performed an auditory three-condition oddball task with gunshot and lion roar sounds as the distractor stimuli. Reports of hyperarousal from the ill veterans were significantly greater than those from the control veterans; different ERP profiles emerged to account for their hyperarousability. Syndromes 2 and 3, who have previously shown brainstem abnormalities, show significantly stronger auditory P1 amplitudes, purported to indicate compromised cholinergic inhibitory gating in the reticular activating system. Syndromes 1 and 2, who have previously shown basal ganglia dysfunction, show significantly weaker P3a response to distractor stimuli, purported to indicate dysfunction of the dopaminergic contribution to their ability to inhibit distraction by irrelevant stimuli. All three syndrome groups showed an attenuated P3b to target stimuli, which could be secondary to both cholinergic and dopaminergic contributions or disruption of white matter integrity. PMID:22691951

  15. The influence of individual, group, and relative self-esteem on outcome for patients undergoing group cognitive-behavioural therapy treatment.

    Science.gov (United States)

    Parker, Thomas J; Page, Andrew C; Hooke, Geoff R

    2013-11-01

    Despite a strong association between individual self-esteem and treatment outcome in group cognitive-behavioural therapy (GCBT), no study has investigated how patient outcomes might be influenced by an individual's self-esteem relative to other group members. The study comprised a retrospective examination of patients' data and used a multiple regression analysis to identify predictors of treatment outcome. Patients' pre-treatment self-esteem scores were assessed on a continuum and assigned to be low, medium, or high. Therapy groups were assigned to be either low, balanced or high self-esteem groups based on averaged self-esteem scores of participants. In this study, 3,878 patients who had completed a 10-day intensive cognitive behavioural group therapy programme at a private psychiatric facility were included in the study. The Rosenberg Self-Esteem measure was chosen to assess self-esteem. The three subscales of the Depression Anxiety Stress Scales were used as the outcome measures. Patient outcomes were influenced by pre-treatment self-esteem scores, such that higher initial self-esteem was associated with better treatment outcomes. Low group self-esteem was predictive of significantly better outcomes for depression, relative to higher self-esteem groups. Additionally, the combined influence of high individual self-esteem and low group self-esteem was associated with significantly enhanced depression improvement. High self-esteem patients perform better on outcome measures following completion of GCBT. Low self-esteem groups show greater improvement in depression symptoms. Similar results for depression are achieved when patients with high self-esteem complete treatment in low self-esteem groups. © 2013 The British Psychological Society.

  16. Oxytocin conditions intergroup relations through upregulated in-group empathy, cooperation, conformity, and defense

    NARCIS (Netherlands)

    de Dreu, C.K.W.; Kret, M.E.

    2016-01-01

    Humans live in, rely on, and contribute to groups. Evolution may have biologically prepared them to quickly identify others as belonging to the in-group (vs. not), to decode emotional states, and to empathize with in-group members; to learn and conform to group norms and cultural practices; to

  17. 75 FR 79348 - TRICARE; Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Science.gov (United States)

    2010-12-20

    ... affect the TRICARE DRG-based payment system. A. DRG Classifications Under both the Medicare PPS and the... Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2011 Diagnosis-Related Group (DRG) Updates AGENCY: Office of the Secretary, DoD. ACTION: Notice of DRG revised rates. SUMMARY: This notice...

  18. Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system.

    Science.gov (United States)

    Polyzos, Nikolaos; Karanikas, Haralampos; Thireos, Eleftherios; Kastanioti, Catherine; Kontodimopoulos, Nick

    2013-01-01

    Until recently, in-patient NHS hospital care in Greece was reimbursed via an anachronistic and under-priced retrospective per diem system, which has been held primarily responsible for continuous budget deficits. The purpose of this paper is to present the efforts of the Ministry of Health (MoH) to implement a new DRG-based payment system. As in many countries, the decision was to adopt a patient classification from abroad and to refine it for use in Greece with national data. Pricing was achieved with a combination of activity-based costing with data from selected Greek hospitals, and "imported" cost weights. Data collection, IT support and monitoring are provided via ESY.net, a web-based facility developed and implemented by the MoH. After an initial pilot testing of the classification in 20 hospitals, complete DRG reimbursement data was reported by 113 hospitals (85% of total) for the fourth quarter of 2011. The recorded monthly increase in patient discharges billed with the new system and in revenue implies increasing adaptability by the hospitals. However, the unfavorable inlier vs. outlier distribution of discharges and revenue observed in some health regions signifies the need for corrective actions. The importance of this reimbursement reform is discussed in light of the current crisis faced by the Greek economy. There is yet much to be done and many projects are currently in progress to support this effort; however the first cost containment results are encouraging. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Centralizers of maximal regular subgroups in simple Lie groups and relative congruence classes of representations

    Energy Technology Data Exchange (ETDEWEB)

    Larouche, M [Departement de Mathematiques et Statistique, Universite de Montreal, 2920 chemin de la Tour, Montreal, Quebec H3T 1J4 (Canada); Lemire, F W [Department of Mathematics, University of Windsor, Windsor, Ontario (Canada); Patera, J, E-mail: larouche@dms.umontreal.ca, E-mail: lemire@uwindsor.ca, E-mail: patera@crm.umontreal.ca [Centre de Recherches Mathematiques, Universite de Montreal, CP 6128-Centre ville, Montreal, Quebec H3C 3J7 (Canada)

    2011-10-14

    In this paper, we present a new, uniform and comprehensive description of centralizers of the maximal regular subgroups in compact simple Lie groups of all types and ranks. The centralizer is either a direct product of finite cyclic groups, a continuous group of rank 1, or a product, not necessarily direct, of a continuous group of rank 1 with a finite cyclic group. Explicit formulas for the action of such centralizers on irreducible representations of the simple Lie algebras are given. (paper)

  20. Self-categorization, commitment to the group and social self-esteem as related but distinct aspects of social identity.

    NARCIS (Netherlands)

    Ellemers, N.; Kortekaas, P.; Ouwerkerk, J.W.

    1999-01-01

    The aim of this study is to show that, when examining social identification, it is both possible and important to distinguish between self-categorisation, commitment to the group, and group self-esteem, as related but separate aspects of group members' social identity. This was demonstrated in an

  1. 75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

    Science.gov (United States)

    2010-11-17

    ... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

  2. 75 FR 43329 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal...

    Science.gov (United States)

    2010-07-23

    ... 45 CFR Part 147 Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to... Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and... of Labor; Office of Consumer Information and Insurance Oversight, Department of Health and Human...

  3. 75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

    Science.gov (United States)

    2010-06-17

    ... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... and Insurance Oversight, Department of Health and Human Services. ACTION: Interim final rules with...

  4. Two experimental tests of relational models of procedural justice: non-instrumental voice and authority group membership.

    Science.gov (United States)

    Platow, Michael J; Eggins, Rachael A; Chattopadhyay, Rachana; Brewer, Greg; Hardwick, Lisa; Milsom, Laurin; Brocklebank, Jacinta; Lalor, Thérèse; Martin, Rowena; Quee, Michelle; Vassallo, Sara; Welsh, Jenny

    2013-06-01

    In both a laboratory experiment (in Australia) using university as the basis of group membership, and a scenario experiment (in India) using religion as the basis of group membership, we observe more favourable respect and fairness ratings in response to an in-group authority than an out-group authority who administers non-instrumental voice. Moreover, we observe in our second experiment that reported likelihood of protest (herein called "social-change voice") was relatively high following non-instrumental voice from an out-group authority, but relatively low following non-instrumental voice from an in-group authority. Our findings are consistent with relational models of procedural justice, and extend the work by examining likely use of alternative forms of voice as well as highlighting the relative importance of instrumentality. ©2012 The British Psychological Society.

  5. Midwives' perceptions of women's preferences related to midwifery care in Germany: A focus group study.

    Science.gov (United States)

    Lohmann, Susanne; Mattern, Elke; Ayerle, Gertrud M

    2018-06-01

    To explore how midwives perceive patient preferences related to midwifery care in Germany. This qualitative study, which was part of a larger study, used a hermeneutic-interpretive approach and involved focus group interviews with midwives. Data collection and analysis were done in a conjoined fashion between April 2015 and September 2016. Four focus group interviews were conducted in four different federal states of Germany. The sample of 20 qualified midwives was heterogeneous with regards to age, educational level, professional experience, type of midwifery care provided, and setting (employed, caseload, education) in which they provided services. Three main themes were identified: Strengths and limitations of midwives' present professional profile (midwives' area of responsibility, range of services, and competency); lack of midwives and midwifery services; women's experiences of conflict in interprofessional care. Each main theme is broken down into several aspects of content. Many women are not aware of the scope of professional knowledge and expertise of midwives. Moreover, the poor delineation of midwives' and obstetricians' areas of competency in Germany's hospitals seems to be disadvantageous for the women. Midwives feel that due to context implications they cannot live up to the quality of midwifery care they aspire to. Lack of midwives results in midwives being overwhelmed, women underserved, and both disappointed. On the one hand, new models of midwifery/maternity care need to be developed to solve some of the existing problems; on the other hand, new forms of interprofessional cooperation and management of transition of care points are required. Overall it is important that changes are implemented in such a way that women are enabled, and welcome, to clearly state their preferences for midwifery and maternity care. Particularly in Germany, tertiary education of midwives is needed to broaden their expertise and place them on an equal footing with

  6. Plasma-related matrix effects in inductively coupled plasma--atomic emission spectrometry by group I and group II matrix-elements

    International Nuclear Information System (INIS)

    Chan, George C.-Y.; Chan, W.-T.

    2003-01-01

    The effects of Na, K, Ca and Ba matrices on the plasma excitation conditions in inductively coupled plasma-atomic emission spectrometry (ICP-AES) were studied. Normalized relative intensity was used to indicate the extent of the plasma-related matrix effects. The group I matrices have no effects on the plasma excitation conditions. In contrast, the group II matrices depress the normalized relative intensities of some spectral lines. Specifically, the Group II matrices have no effects on the normalized relative intensity of atomic lines of low upper energy level (soft lines), but reduce the normalized relative intensity of some ionic lines and atomic lines of high energy level (hard lines). The Group II matrices seem to shift the Saha balance of the analytes only; no shift in the Boltzmann balance was observed experimentally. Moreover, for some ionic lines with sum of ionization and excitation potentials close to the ionization potential of argon (15.75 eV), the matrix effect is smaller than other ionic lines of the same element. The reduced matrix effects may be attributed qualitatively to charge transfer excitation mechanism of these ionic lines. Charge transfer reaction renders ionic emission lines from the quasi-resonant levels similar in characteristics of atomic lines. The contribution of charge transfer relative to excitation by other non-specific excitation mechanisms (via Saha balance and Boltzmann balance) determines the degree of atomic behavior of a quasi-resonant level. A significant conclusion of this study is that plasma-related matrix effect depends strongly on the excitation mechanism of a spectral line. Since, in general, more than one excitation mechanism may contribute to the overall excitation of an emission line, the observed matrix effects reflect the sum of the effects due to individual excitation mechanisms. Excitation mechanisms, in addition to the often-used total excitation energy, should be considered in matrix effect studies

  7. Allergies, atopy, immune-related factors and childhood rhabdomyosarcoma: a report from the Children's Oncology Group.

    Science.gov (United States)

    Lupo, Philip J; Zhou, Renke; Skapek, Stephen X; Hawkins, Douglas S; Spector, Logan G; Scheurer, Michael E; Fatih Okcu, M; Melin, Beatrice; Papworth, Karin; Erhardt, Erik B; Grufferman, Seymour

    2014-01-15

    Rhabdomyosarcoma (RMS) is a highly malignant tumor of developing muscle that can occur anywhere in the body. Due to its rarity, relatively little is known about the epidemiology of RMS. Atopic disease is hypothesized to be protective against several malignancies; however, to our knowledge, there have been no assessments of atopy and childhood RMS. Therefore, we explored this association in a case-control study of 322 childhood RMS cases and 322 pair-matched controls. Cases were enrolled in a trial run by the Intergroup Rhabdomyosarcoma Study Group. Controls were matched to cases on race, sex and age. The following atopic conditions were assessed: allergies, asthma, eczema and hives; in addition, we examined other immune-related factors: birth order, day-care attendance and breastfeeding. Conditional logistic-regression models were used to calculate an odds ratio (OR) and 95% confidence interval (CI) for each exposure, adjusted for age, race, sex, household income and parental education. As the two most common histologic types of RMS are embryonal (n=215) and alveolar (n=66), we evaluated effect heterogeneity of these exposures. Allergies (OR=0.60, 95% CI: 0.41-0.87), hives (OR = 0.61, 95% CI: 0.38-0.97), day-care attendance (OR=0.48, 95% CI: 0.32-0.71) and breastfeeding for ≥ 12 months (OR=0.36, 95% CI: 0.18-0.70) were inversely associated with childhood RMS. These exposures did not display significant effect heterogeneity between histologic types (p>0.52 for all exposures). This is the first study indicating that atopic exposures may be protective against childhood RMS, suggesting additional studies are needed to evaluate the immune system's role in the development of this tumor. © 2013 UICC.

  8. Public attitudes towards pricing policies to change health-related behaviours: a UK focus group study.

    Science.gov (United States)

    Somerville, Claire; Marteau, Theresa M; Kinmonth, Ann Louise; Cohn, Simon

    2015-12-01

    Evidence supports the use of pricing interventions in achieving healthier behaviour at population level. The public acceptability of this strategy continues to be debated throughout Europe, Australasia and USA. We examined public attitudes towards, and beliefs about the acceptability of pricing policies to change health-related behaviours in the UK. The study explores what underlies ideas of acceptability, and in particular those values and beliefs that potentially compete with the evidence presented by policy-makers. Twelve focus group discussions were held in the London area using a common protocol with visual and textual stimuli. Over 300,000 words of verbatim transcript were inductively coded and analyzed, and themes extracted using a constant comparative method. Attitudes towards pricing policies to change three behaviours (smoking, and excessive consumption of alcohol and food) to improve health outcomes, were unfavourable and acceptability was low. Three sets of beliefs appeared to underpin these attitudes: (i) pricing makes no difference to behaviour; (ii) government raises prices to generate income, not to achieve healthier behaviour and (iii) government is not trustworthy. These beliefs were evident in discussions of all types of health-related behaviour. The low acceptability of pricing interventions to achieve healthier behaviours in populations was linked among these responders to a set of beliefs indicating low trust in government. Acceptability might be increased if evidence regarding effectiveness came from trusted sources seen as independent of government and was supported by public involvement and hypothecated taxation. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.

  9. Self-help groups for former patients: relations with mental health professionals.

    Science.gov (United States)

    Emerick, R E

    1990-04-01

    Data from a national survey of 104 self-help groups for former mental patients were examined to assess actual and potential partnerships between these groups and mental health professionals. The groups' level of interaction with and attitudes toward professionals varied with the structure, affiliation, and service model of the groups. The majority were moderate "supportive" groups in which partnerships with professionals could occur but were problematic. Less common were radical "separatist" groups, with which professional partnerships were almost guaranteed to fail, and conservative "partnership" groups, with which partnerships were likely to succeed. Strong antipsychiatric attitudes throughout the mental patient movement suggest that mental health professionals who approach former-patient groups with narrow clinical conceptions of mental illness are likely to fail in establishing partnerships.

  10. Will-Nordtvedt PPN formalism applied to renormalization group extensions of general relativity

    Science.gov (United States)

    Toniato, Júnior D.; Rodrigues, Davi C.; de Almeida, Álefe O. F.; Bertini, Nicolas

    2017-09-01

    We apply the full Will-Nordtvedt version of the parametrized post-Newtonian (PPN) formalism to a class of general relativity extensions that are based on nontrivial renormalization group (RG) effects at large scales. We focus on a class of models in which the gravitational coupling constant G is correlated with the Newtonian potential. A previous PPN analysis considered a specific realization of the RG effects, and only within the Eddington-Robertson-Schiff version of the PPN formalism, which is a less complete and robust PPN formulation. Here we find stronger, more precise bounds, and with less assumptions. We also consider the external potential effect (EPE), which is an effect that is intrinsic to this framework and depends on the system environment (it has some qualitative similarities to the screening mechanisms of modified gravity theories). We find a single particular RG realization that is not affected by the EPE. Some physical systems have been pointed out as candidates for measuring the possible RG effects in gravity at large scales; for any of them the Solar System bounds need to be considered.

  11. A renormalization group invariant line and an infrared attractive top-Higgs mass relation

    International Nuclear Information System (INIS)

    Schrempp, B.; Schrempp, F.

    1992-10-01

    The renormalization group equations (RGE's) of the Standard Model at one loop in terms of the gauge couplings g 1,2,3, the top Yukawa coupling g t and the scalar self coupling λ are reexamined. For g 1,2 = 0, the general solution of the RGE's is obtained analytically in terms of an interesting special solution for the ratio λ/g 2 t as function of the ratio g 2 t /g 2 3 which i) represents an RG invariant line which is strongly infrared attractive ii) interpolates all known quasi-fixed points and iii) is finite for large g 2 t /g 2 3 (ultraviolet limit). All essential features survive for g 1,2 ≠ 0. The invariant line translates into an infrared attractive top-Higgs mass relation, which e.g. associates to the top masses m t = 130/145/200 GeV the Higgs masses m H ≅ 68-90/103-115/207 GeV, respectively. (orig.)

  12. Safety evaluation report related to Babcock and Wilcox Owners Group Plant Reassessment Program: [Final report

    International Nuclear Information System (INIS)

    1987-11-01

    After the accident of Three Mile Island, Unit 2, nuclear power plant owners made a number of improvements to their nuclear facilities. Despite these improvements, the US Nuclear Regulatory Commission (NRC) staff is concerned that the number and complexity of events at Babcock and Wilcox (B and W) nuclear plants have not decreased as expected. This concern was reinforced by the June 9, 1985 total-loss-of-feedwater event at Davis-Besse Nuclear Power Station and the December 26, 1985 overcooling transient at Rancho Seco Nuclear Generating Station. By letter dated January 24, 1986, the Executive Director for Operations (EDO) informed the Chairman of the B and W Owners Group (BWOG) that a number of recent events at B and W-designed reactors have led the NRC staff to conclude that the basic requirements for B and W reactors need to be reexamined. In its February 13, 1986 response to the EDO's letter, the BWOG committed to lead an effort to define concerns relative to reducing the frequency of reactor trips and the complexity of post-trip response in B and W plants. The BWOG submitted a description of the B and W program entitled ''Safety and Performance Improvement Program'' (BAW-1919) on May 15, 1986. Five revisions to BAW-1919 have also been submitted. The NRC staff has reviewed BAW-1919 and its revisions and presents its evaluation in this report. 2 figs., 34 tabs

  13. Perceptions of Playing-Related Musculoskeletal Disorders (PRMDs) in Irish traditional musicians: a focus group study.

    Science.gov (United States)

    Wilson, Iseult M; Doherty, Liz; McKeown, Laura

    2014-01-01

    Playing-related musculoskeletal disorders (PRMDs) are common in musicians and interfere with the ability to play an instrument at the accustomed level. There is limited research into injuries affecting folk musicians. To explore the Irish traditional musicians' experience of PRMDs. Focus group interviews were conducted in 2011 and 2012, in two venues in Ireland. Data were recorded and transcribed verbatim. Data collection ended when no new findings emerged from the analysis of interviews. The inclusion criteria were: males or females aged 18 and above, and who taught or played Irish traditional music on any instrument. The data were analysed using the interpretative phenomenological method. All participants (n=22) believed there was a link between playing music and musculoskeletal problems. The main body areas affected were the back, shoulders, arms and hands. The main theme that emerged was: 'PRMDs are an integral part of being a traditional musician', and that the musical experience was generally prioritised over the health of the musician. There were sub-themes of 'fear' and 'stresses that contributed to PRMDs'. PRMDs are an occupational hazard for Irish musicians. There is an awareness of PRMDs, but changes (technique, environment) may threaten identity.

  14. Health Professionals Information for Diagnostics Related Groups (DRGs) with the Use of a Website.

    Science.gov (United States)

    Mpizopoulou, Katerina; Mpizopoulou, Zoe; Magita, Andrianna; Mechili, Aggelos E; Diomidous, Marianna; Mantas, John

    2015-01-01

    In recent years the costs of hospital care in developed countries absorbed a high proportion of total health resources. In Greece, after the establishment of the National Health System (NHS), funding for hospitals comes mainly from the state budget, and social insurance, therefore auditing of hospital cost is imperative to ensure their viability, especially at this time when the country is tested by economic crisis. Overtime many factors for the increase of hospital cost have been mentioned, such as the rapid development of medical technology, the low level of organization of the hospital system and the low productivity of human resources. The problem of rising health expenditure over the past decades is a worldwide phenomenon and it has brought about many changes in traditional retrospective methods for financing in the hospital sector, with prospective financial forms that combine patient composition and needs, and the productive activity of hospital need to the rationalization and contain expenditures. The system of Diagnosis Related Groups was a revolutionary success over the past decades and has now achieved worldwide recognition.

  15. The Emergence of Embedded Relations and Group Formation in Networks of Competition

    Science.gov (United States)

    Thye, Shane R.; Lawler, Edward J.; Yoon, Jeongkoo

    2011-01-01

    This study examines how and when small networks of self-interested agents generate a group tie or affiliation at the network level. A group affiliation is formed when actors (a) perceive themselves as members of a group and (b) share resources with each other despite an underlying competitive structure. We apply a concept of structural cohesion to…

  16. Measuring Group Work Dynamics and Its Relation with L2 Learners' Task Motivation and Language Production

    Science.gov (United States)

    Poupore, Glen

    2016-01-01

    While learners of a second language (L2) are increasingly interacting in small groups as part of a communicative methodological paradigm, very few studies have investigated the social dynamics that occur in such groups. The aim of this study is to introduce a group work dynamic measuring instrument and to investigate the relationship between group…

  17. [Continuity of hospital identifiers in hospital discharge data - Analysis of the nationwide German DRG Statistics from 2005 to 2013].

    Science.gov (United States)

    Nimptsch, Ulrike; Wengler, Annelene; Mansky, Thomas

    2016-11-01

    In Germany, nationwide hospital discharge data (DRG statistics provided by the research data centers of the Federal Statistical Office and the Statistical Offices of the 'Länder') are increasingly used as data source for health services research. Within this data hospitals can be separated via their hospital identifier ([Institutionskennzeichen] IK). However, this hospital identifier primarily designates the invoicing unit and is not necessarily equivalent to one hospital location. Aiming to investigate direction and extent of possible bias in hospital-level analyses this study examines the continuity of the hospital identifier within a cross-sectional and longitudinal approach and compares the results to official hospital census statistics. Within the DRG statistics from 2005 to 2013 the annual number of hospitals as classified by hospital identifiers was counted for each year of observation. The annual number of hospitals derived from DRG statistics was compared to the number of hospitals in the official census statistics 'Grunddaten der Krankenhäuser'. Subsequently, the temporal continuity of hospital identifiers in the DRG statistics was analyzed within cohorts of hospitals. Until 2013, the annual number of hospital identifiers in the DRG statistics fell by 175 (from 1,725 to 1,550). This decline affected only providers with small or medium case volume. The number of hospitals identified in the DRG statistics was lower than the number given in the census statistics (e.g., in 2013 1,550 IK vs. 1,668 hospitals in the census statistics). The longitudinal analyses revealed that the majority of hospital identifiers persisted in the years of observation, while one fifth of hospital identifiers changed. In cross-sectional studies of German hospital discharge data the separation of hospitals via the hospital identifier might lead to underestimating the number of hospitals and consequential overestimation of caseload per hospital. Discontinuities of hospital

  18. Relative Susceptibilities of ABO Blood Groups to Plasmodium falciparum Malaria in Ghana.

    Science.gov (United States)

    Afoakwah, Richmond; Aubyn, Edmond; Prah, James; Nwaefuna, Ekene Kwabena; Boampong, Johnson N

    2016-01-01

    The clinical outcome of falciparum malaria in endemic areas is influenced by erythrocyte polymorphisms including the ABO blood groups. Studies have reported association of ABO blood group to resistance, susceptibility, and severity of P. falciparum malaria infection. Individuals with blood group "A" have been found to be highly susceptible to falciparum malaria whereas blood group "O" is said to confer protection against complicated cases. We analyzed samples from 293 young children less than six years old with malaria in the Korle-Bu Teaching Hospital in Accra, Ghana. It was observed that group O was present in about 16.1% of complicated cases weighed against 40.9% of uncomplicated controls. Individuals with complicated malaria were about twice likely to be of blood groups A and B compared to group O (A versus O, OR = 1.90, 95% CI = 1.59-2.26, P Blood group O participants with complicated diseases had low parasitaemia compared to the other blood groups (P blood group O individuals a survival advantage over the other groups in complicated malaria as suggested. Participants with complicated falciparum malaria were generally anaemic and younger than those with uncomplicated disease.

  19. Relative Susceptibilities of ABO Blood Groups to Plasmodium falciparum Malaria in Ghana

    Directory of Open Access Journals (Sweden)

    Richmond Afoakwah

    2016-01-01

    Full Text Available The clinical outcome of falciparum malaria in endemic areas is influenced by erythrocyte polymorphisms including the ABO blood groups. Studies have reported association of ABO blood group to resistance, susceptibility, and severity of P. falciparum malaria infection. Individuals with blood group “A” have been found to be highly susceptible to falciparum malaria whereas blood group “O” is said to confer protection against complicated cases. We analyzed samples from 293 young children less than six years old with malaria in the Korle-Bu Teaching Hospital in Accra, Ghana. It was observed that group O was present in about 16.1% of complicated cases weighed against 40.9% of uncomplicated controls. Individuals with complicated malaria were about twice likely to be of blood groups A and B compared to group O (A versus O, OR = 1.90, 95% CI = 1.59–2.26, P<0.0001; B versus O, OR = 1.82. 95% CI = 1.57–2.23, P<0.0001. Blood group O participants with complicated diseases had low parasitaemia compared to the other blood groups (P<0.0001. This may give blood group O individuals a survival advantage over the other groups in complicated malaria as suggested. Participants with complicated falciparum malaria were generally anaemic and younger than those with uncomplicated disease.

  20. Some reciprocity-like relations in multi-group neutron diffusion and transport theory over bare homogeneous regions

    International Nuclear Information System (INIS)

    Modak, R.S.; Sahni, D.C.

    1996-01-01

    Some simple reciprocity-like relations that exist in multi-group neutron diffusion and transport theory over bare homogeneous regions are presented. These relations do not involve the adjoint solutions and are directly related to numerical schemes based on an explicit evaluation of the fission matrix. (author)

  1. Voltage-gated sodium channel expression in mouse DRG after SNI leads to re-evaluation of projections of injured fibers.

    Science.gov (United States)

    Laedermann, Cédric J; Pertin, Marie; Suter, Marc R; Decosterd, Isabelle

    2014-03-11

    Dysregulation of voltage-gated sodium channels (Na(v)s) is believed to play a major role in nerve fiber hyperexcitability associated with neuropathic pain. A complete transcriptional characterization of the different isoforms of Na(v)s under normal and pathological conditions had never been performed on mice, despite their widespread use in pain research. Na(v)s mRNA levels in mouse dorsal root ganglia (DRG) were studied in the spared nerve injury (SNI) and spinal nerve ligation (SNL) models of neuropathic pain. In the SNI model, injured and non-injured neurons were intermingled in lumbar DRG, which were pooled to increase the tissue available for experiments. A strong downregulation was observed for every Na(v)s isoform expressed except for Na(v)1.2; even Na(v)1.3, known to be upregulated in rat neuropathic pain models, was lower in the SNI mouse model. This suggests differences between these two species. In the SNL model, where the cell bodies of injured and non-injured fibers are anatomically separated between different DRG, most Na(v)s were observed to be downregulated in the L5 DRG receiving axotomized fibers. Transcription was then investigated independently in the L3, L4 and L5 DRG in the SNI model, and an important downregulation of many Na(v)s isoforms was observed in the L3 DRG, suggesting the presence of numerous injured neurons there after SNI. Consequently, the proportion of axotomized neurons in the L3, L4 and L5 DRG after SNI was characterized by studying the expression of activating transcription factor 3 (ATF3). Using this marker of nerve injury confirmed that most injured fibers find their cell bodies in the L3 and L4 DRG after SNI in C57BL/6 J mice; this contrasts with their L4 and L5 DRG localization in rats. The spared sural nerve, through which pain hypersensitivity is measured in behavioral studies, mostly projects into the L4 and L5 DRG. The complex regulation of Na(v)s, together with the anatomical rostral shift of the DRG harboring injured

  2. Regulation of pathogenicity in hop stunt viroid-related group II citrus viroids.

    Science.gov (United States)

    Reanwarakorn, K; Semancik, J S

    1998-12-01

    Nucleotide sequences were determined for two hop stunt viroid-related Group II citrus viroids characterized as either a cachexia disease non-pathogenic variant (CVd-IIa) or a pathogenic variant (CVd-IIb). Sequence identity between the two variants of 95.6% indicated a conserved genome with the principal region of nucleotide difference clustered in the variable (V) domain. Full-length viroid RT-PCR cDNA products were cloned into plasmid SP72. Viroid cDNA clones as well as derived RNA transcripts were transmissible to citron (Citrus medica L.) and Luffa aegyptiaca Mill. To determine the locus of cachexia pathogenicity as well as symptom expression in Luffa, chimeric viroid cDNA clones were constructed from segments of either the left terminal, pathogenic and conserved (T1-P-C) domains or the conserved, variable and right terminal (C-V-T2) domains of CVd-IIa or CVd-IIb in reciprocal exchanges. Symptoms induced by the various chimeric constructs on the two bioassay hosts reflected the differential response observed with CVd-IIa and -IIb. Constructs with the C-V-T2 domains region from clone-IIa induced severe symptoms on Luffa typical of CVd-IIa, but were non-symptomatic on mandarin as a bioassay host for the cachexia disease. Constructs