Longitudinal analysis of utilization of inpatient treatment based on insurance data of mandatory health insurance

AIM: To investigate which of the routinely collected claims data from the German "Legal sickness funds" on hospital utilisation may be used, in addition to that prescribed by the legislator. DESIGN: We used claims data to study a cohort of sickness fund beneficiaries who were insured during the complete year 1992 (n = 81,309). Six utilisation parameters, using the number of cases and in hospital days overall as well as diseases specific (i.e. readmission rates, in-hospital days per person with [at least] one hospital stay) were calculated. RESULTS: There are 88 persons with (at least) one hospital stay, 116 hospital cases and a total of 1306 in-hospital days per 1000 insured persons in the study cohort. The average hospital days per person (14.8 days) are ca. 30% higher than the average length of stay (11.2 days). Hospital utilisation increases with age. Hospital stays associated with ICD-239 (neoplasms of unknown origin) resulted in a higher than average number of hospital days in total although the mean length of stay is not above the average. This is due to a high readmission rate. Hospital stays associated with elective surgical procedures have a high prevalence rate but a low readmission ratio and short length of stay. CONCLUSION: The parameters related to insured persons, cases and specifically personal parameters of hospital utilisation allow a detailed analysis of hospital care; different utilisation and user patterns can be investigated and possible determinants of utilisation can be identified. After technical transformation, routine data of the sickness funds can be used to obtain information relevant for health care planners as well as for quality management.     

Design Optimization of Composite Prosthetic Tubes Using GA-ANN Algorithm Considering Tsai-Wu Failure Criteria

The investigation of possible failures in composite materials is a matter of very great importance, and the Tsai-Wu criterion is an effective criterion for analyzing those flaws in anisotropic materials and defining whether the material at a given load will or will not suffer structural failure. In this study, an optimization procedure is proposed to minimize the maximum value of Tsai-Wu of laminated composite tubes subject to axial loading. Artificial neural networks and genetic algorithms are chosen as optimization tools. The results of this study show that the developed algorithm converges faster. Then, the maximum Tsai-Wu value is used as the objective function and the fiber orientations are the constraints in the optimization process. The results yielded by them are compared and discussed. Optimal results are compared with respect to the usual initial design. The design approach is recommended for structures where composites are the key load-carrying members such as orthopedic prosthesis.     

Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance

BACKGROUND: Optimal criteria for valve replacement are unclear in asymptomatic/minimally symptomatic patients with aortic regurgitation (AR) and normal left ventricular (LV) performance at rest. Moreover, previous studies have not assessed the prognostic capacity of load-adjusted LV performance ("contractility") variables, which may be fundamentally related to clinical state. Therefore, 18 years ago, we set out to test prospectively the hypothesis that objective noninvasive measures of LV size and performance and, specifically, of load-adjusted variables, assessed at rest and during exercise (ex), could predict the development of currently accepted indications for operation for AR. METHODS AND RESULTS: Clinical variables and measures of LV size, performance, and end-systolic wall stress (ESS) were assessed annually in 104 patients by radionuclide cineangiography at rest and maximal ex and by echocardiography at rest; ESS was derived during ex. During an average 7.3-year follow-up among patients who had not been operated on, 39 of 104 patients either died suddenly (n = 4) or developed operable symptoms only (n = 22) or subnormal LV performance with or without symptoms (n = 13) (progression rate=6.2%/y). By multivariate Cox model analysis, change (delta) in LV ejection fraction (EF) from rest to ex, normalized for deltaESS from rest to ex (deltaLVEF-deltaESS index), was the strongest predictor of progression to any end point or to sudden cardiac death alone. Unadjusted deltaLVEF was almost as efficient. Symptom status modified prediction on the basis of the deltaLVEF-deltaESS index. The population tercile at highest risk by deltaLVEF-deltaESS progressed to end points at a rate of 13.3%/y, and the lowest-risk tercile progressed at 1.8%/y. CONCLUSIONS: Currently accepted symptom and LV performance indications for valve replacement, as well as sudden cardiac death, can be predicted in asymptomatic/minimally symptomatic patients with AR by load-adjusted deltaLVEF-deltaESS index, which includes data obtained during exercise.     

Comparison of molecular changes in lung cancers in HIV-positive and HIV-indeterminate subjects

CONTEXT: Human immunodeficiency virus (HIV) infection has been associated with an increasing incidence of malignancy, and HIV-infected persons have an increased incidence of primary lung carcinoma compared with the general population. OBJECTIVE: To investigate the molecular changes present in HIV-associated lung tumors and compare them with those present in lung carcinomas arising in HIV-indeterminate subjects ("sporadic tumors"). DESIGN: Convenience sample. SUBJECTS: Archival tissues from 11 HIV-positive persons and from 35 persons of indeterminate HIV status. SETTING: University-based medical centers and affiliated hospitals. MAIN OUTCOME MEASURES: Analysis of frequency of loss of heterozygosity (LOH) and microsatellite alteration (MA) using polymerase chain reaction and 16 polymorphic microsatellite markers at 8 chromosomal regions frequently deleted in lung cancer. Presence of HIV and human papillomavirus (HPV) sequences. RESULTS: The overall frequency of LOH at all chromosomal regions tested and the frequencies at most of the individual regions were similar in the 2 groups. Frequency of MA present in the HIV-associated tumors (0.18) was 6-fold higher than in sporadic tumors (0.03) (P<.001). At least 1 MA was present in 10 (91%) of 11 HIV-associated tumors vs 17 (48%) of 35 sporadic tumors (P=.02). Molecular changes were independent of tumor stage and gender. HIV and HPV sequences were not detected in the HIV-associated lung carcinomas. CONCLUSIONS: Microsatellite alterations, which reflect widespread genomic instability, occur at greatly increased frequency in HIV-associated lung carcinomas. Although the mechanism underlying the development of increased MAs is unknown, it may play a crucial role in the development of many HIV-associated tumors.     

Primate vocalizations during social separation and aggression: effects of alcohol and benzodiazepines

The most common group of squirrel monkey vocalizations, peeps, are emitted during different social situations including social separation, affiliative interactions, feeding and aggressive confrontations. The present experiments investigated whether peeps and other vocalizations emitted during different social contexts are pharmacologically altered in a similar manner. First, vocalizations were characterized during (1) social separation in juveniles, and (2) "resident-intruder" aggressive confrontations between dominant monkeys from different social groups. Then, the effects of alcohol (EtOH) and the benzodiazepine chlordiazepoxide (CDP) on vocalizations during social separation and during aggression were examined. Isolated juveniles emitted only one type of call, the isolation peep. Resident monkeys primarily emitted peeps, but also emitted cackles, chucks, noisy calls and pulsed calls. Aggressive peeps were similar in structure and frequency (kHz) to isolation peeps, but were shorter in duration. At the same doses, both CDP (0.3-3 mg/kg) and EtOH (0.1-1.0 g/kg) reduced explosive motor behaviors and isolation peeps in juvenile monkeys during social separation and increased threat displays and aggression peeps in resident monkeys during confrontations with an intruder monkey from a different social group. Thus, similarly structured vocalizations that were emitted during social separation and aggression were very sensitive to EtOH and CDP, but the social context determined the direction and magnitude of effects.     

BOO: Behavior-oriented ontology to describe participant dynamics in collocated design meetings

Facilitating meetings is not an easy task. To assist the facilitator, we have been designing intelligent support systems, which can help contextual sensemaking, decision making and action. However, these systems are constructed based on behavioral models that provide guidelines to understand participant behaviors. This paper presents an ontology to describe participants’ behaviors in collaborative design meetings and rules that correlate them with the group’s acceptance of the final product. This ontology describes the group dynamics at collocated meetings, using verbal and non-verbal cues of attention shifts and attention maintenance as its basic constructs. The objective of creating this ontology was to better understand face-to-face meetings to eventually help meeting facilitators identify issues that may lead to dissatisfaction with the final product through behavioral cues. The ontology was derived through extensive analysis of a series of engineering design session videos. The design group was composed of experts with similar backgrounds, but working in different divisions of the same company. Different points of view were argued and decisions were made at the end of each meeting. After each meeting, participants were asked to asynchronously commit to the decisions made in the group. Our ontology can be used to identify the factors that lead to an undesired outcome, and now serves as a basis for a new project, which uses rules to support design meetings, improve final artifact acceptance and reduce rework. Our conclusions point out correlations between designers’ behaviors and future artifact acceptance and actions that interrupt or bring back group attention. The ontology was validated through application to other meeting situations. These findings may guide software developers in the creation of tools to support group design, and may be applied by an intelligent system.     

Applying machine learning techniques for scaling out data quality algorithms in cloud computing environments

Deduplication is the task of identifying the entities in a data set which refer to the same real world object. Over the last decades, this problem has been largely investigated and many techniques have been proposed to improve the efficiency and effectiveness of the deduplication algorithms. As data sets become larger, such algorithms may generate critical bottlenecks regarding memory usage and execution time. In this context, cloud computing environments have been used for scaling out data quality algorithms. In this paper, we investigate the efficacy of different machine learning techniques for scaling out virtual clusters for the execution of deduplication algorithms under predefined time restrictions. We also propose specific heuristics (Best Performing Allocation, Probabilistic Best Performing Allocation, Tunable Allocation, Adaptive Allocation and Sliced Training Data) which, together with the machine learning techniques, are able to tune the virtual cluster estimations as demands fluctuate over time. The experiments we have carried out using multiple scale data sets have provided many insights regarding the adequacy of the considered machine learning algorithms and proposed heuristics for tackling cloud computing provisioning.     

Supporting Unified Distributed Management and Autonomic Decisions: Design,Implementation and Deployment

Nowadays, the prevailing use of networks based on traditional centralized management systems reflects on a fast increase of the management costs. The growth in the number of network equipments and services reinforces the need to distribute the management responsibilities throughout the network devices. In this approach, each device executes common network management functionalities, being part of the overall network management platform. In this paper, we present a Unified Distributed Network Management (UDNM) framework that provides a unified (wired and wireless) management network solution, where further different network services can take part of this infrastructure, e.g., flow monitoring, accurate routing decisions, distributed policies dissemination, etc. This framework is divided in two main components: (A) Situation awareness, which sets up initial information through bootstrapping, discovery, fault-management process and exchange of management information; (B) Autonomic Decision System (ADS) that performs distributed decisions in the network with incomplete information. We deploy the UDNM framework in a testbed which involves two cities (\(\approx\)250 km between), different standards (IEEE 802.3, IEEE 802.11 and IEEE 802.16e) and network technologies, such as, wired virtual grid, wireless ad-hoc gateways, ad-hoc mobile access devices. The UDNM framework integrates management functionalities into the managed devices, proving to be a lightweight and easy-respond framework. The performance analysis shows that the UDNM framework is feasible to unify devices management functionalities and to take accurate decisions on top of a real network.     

Robotic control in knee joint replacement surgery

A brief history of robotic systems in knee arthroplasty is provided. The place of autonomous robots is then discussed and compared to more recent 'hands-on' robotic systems that can be more cost effective. The case is made for robotic systems to have a clear justification, with improved benefits compared to those from cheaper navigation systems. A number of more recent, smaller, robot systems for knee arthroplasty are also described. A specific example is given of an active constraint medical robot, the ACROBOT system, used in a prospective randomized controlled trial of unicondylar robotic knee arthroplasty in which the robot was compared to conventional surgery. The results of the trial are presented together with a discussion of the need for measures of accuracy to be introduced so that the efficacy of the robotic surgery can be immediately identified, rather than have to wait for a number of years before long-term clinical improvements can be demonstrated.     

Development of a scoring system to assess disability in an Italian elderly population. Evaluation of a disability questionnaire

Patients with idiopathic and symptomatic restless legs syndrome (RLS) suffer from "dyskinesia while awake" or "daytime myoclonus" when at rest preceded by sensory symptoms. In order to characterise the RLS either as reflex movement or as voluntary movement we measured movement-related cortical potentials in 5 idiopathic and 8 uraemic RLS patients. Movements from both legs were polygraphically recorded concomitantly with cortical activity 2000 msec before to 500 msec after onset of EMG activity. These data were compared with a voluntary simulation of each patient's movement pattern and with 5 age-matched controls performing dorsiflexion of the right, left and both feet. Cortical activity preceding daytime myoclonus was absent in RLS patients whereas self-initiated leg movements in patients elicited onset times (1180-1380 msec) and amplitudes of Bereitschaftspotential (readiness potential) not significantly different from readiness potentials in control subjects (P > 0.05). Lack of movement-related potentials in myoclonus and/or dyskinesias during daytime in RLS patients is compatible with an involuntary mechanism of induction and points towards a subcortical or spinal origin of RLS.