A case-mix classification system for medical rehabilitation

Dissatisfaction with Medicare's current system of paying for rehabilitation care has led to proposals for a rehabilitation prospective payment system, but first a classification system for rehabilitation patients must be created. Data for 36,980 patients admitted to and discharged from 125 rehabilitation facilities between January 1, 1990, and April 19, 1991, were provided by the Uniform Data System for Medical Rehabilitation. Classification rules were formed using clinical judgment and a recursive partitioning algorithm. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) uses four predictor variables: diagnosis leading to disability, admission scores for motor and cognitive functional status subscales as measured by the Functional Independence Measure, and patient age. The system contains 53 FRGs and explains 31.3% of the variance in the natural logarithm length of stay for patients in a validation sample. The FIM-FRG classification system is conceptually simple and stable when tested on a validation sample. The classification system contains a manageable number of groups, and may represent a solution to the problem of classifying medical rehabilitation patients for payment, facility planning, and research on the outcomes, quality, and cost of rehabilitation.     

Vitek system antimicrobial susceptibility testing of O1, O139, and non-O1 Vibrio cholerae

Vibrio cholerae causes epidemic diarrhea throughout the world. Fluid replacement is the primary therapy for cholera; however, high mortality rates often necessitate the use of antibiotics. V. cholerae, like most bacteria, has developed resistance to some antibiotics. In the early 1990s a new serotype strain, Bengal 0139, began a new wave of cholera epidemics. Bengal isolates showed unique trends in antimicrobial resistance. Many clinical laboratories use automated antibiotic susceptibility testing for V. cholerae. It is important to know if automated susceptibility test results for V. cholerae coincide with reported trends in antibiotic susceptibility. In the present study, we used the Vitek automated susceptibility system to determine the susceptibilities of 79 V. cholerae O1 isolates, 100 O139 isolates, and 112 non-O1 isolates. Vitek susceptibilities for V. cholerae showed a good correlation with preestablished epidemiological data. Although the new O139 serogroup showed a trend of increased resistance to trimethoprim-sulfamethoxazole and nitrofurantoin, it was more susceptible to ampicillin than previous serogroup O1 and non-O1 strains. Regardless of serogroup, > or = 98% of the V. cholerae isolates tested were susceptible to most antibiotics tested by us. It is important to continue susceptibility testing of all new isolates of V. cholerae because of emerging resistant strains. However, V. cholerae remains susceptible to most of the available antibiotics.     

Pharmacokinetics of hyperimmune anti-human immunodeficiency virus immunoglobulin in persons with AIDS

Hyperimmune anti-human immunodeficiency virus immunoglobulin (HIVIG) is an intravenous immunoglobulin prepared from HIV-infected asymptomatic donors with a CD4 cell count greater than 400 cells/microl and a high titer of antibody to HIV-1 p24 protein. Twelve persons with AIDS received four doses of HMG (two at 50 mg/kg of body weight and then two at 200 mg/kg) every 28 days. Pharmacokinetics were evaluated by measurement of anti-p24 antibody. HIVIG was well tolerated, and all participants completed the study. Three subjects who were not receiving Pneumocystis carinii pneumonia (PCP) prophylaxis developed PCP. The mean value for HIVIG clearance was 3.02 ml/kg/day at 50 mg/kg and 3.65 ml/kg/day at 200 mg/kg (P = 0.027); the mean trough antibody titers (reciprocal units) were 1,442 and 4,428, respectively. This study indicates that high titers of anti-p24 antibody can be maintained with a monthly administration schedule of HIVIG and that short-term safety is acceptable. Comparisons to evaluate the therapeutic potential of HIVIG are justified.     

Constraint programming and graph algorithms

Aconstraint system includes a set of variables and a set of relations among these variables, calledconstraints. The solution of a constraint system is an assignment of values to variables so that all, or many, of the relations are made true. A simple and efficient method for constraint resolution has been proposed in the work of B.N. Freeman-Benson, J. Maloney, and A. Borning. We show how their method is related to the classical problem of graph matching, and from this connection we derive new resolution algorithms.     

Effects of plant community composition and exposure to wave action on invertebrate habitat use of Lake Huron coastal wetlands

Invertebrate communities from different coastal marsh‐plant communities were compared along wave‐exposure gradients using data from 1994, 1998 and 1999. Data were subjected to correspondence analyses to search for patterns in invertebrate communities in relation to plant‐community structure and wave exposure. In 1994, quantitative plant‐ and sediment‐invertebrate samples were taken from nine habitats: four from inland, subsurface‐connected marshes and five from littoral, emergent marshes. In 1998, sweep‐net samples were taken from 13 plant communities: six on the exposed and seven on the protected side of an island. In 1999, 2–3 plant communities/sites were sampled with sweep nets from four sites around the Bay so that intersite differences between inner, less‐exposed and outer, more‐exposed habitats could be examined. In all three studies, correspondence analyses separated inland, protected or inner sites from littoral, exposed or outer sites, suggesting differences in invertebrate‐community structure. For example, Hydracarina and Asellidae occurred in large numbers in inland sites, but were less common or absent from exposed, littoral sites. Littoral marshes also separated along an exposure gradient with Tanytarsini and Orthocladiinae collectors of organic particles occurring in very high numbers in outer, exposed areas where organic particles from the pelagic zone entered the marsh. Certain plant‐community types clustered together (e.g. wet meadow and Scirpus) while others, such as Typha, stands clustered according to exposure to waves suggesting the importance of both plant‐community structure and wave exposure in determining invertebrate‐community structure. We present a conceptual model that suggests that invertebrates in Great Lakes' marshes are distributed along gradients of decreased mixing of pelagic water and increases in sediment organic matter from outer to inner marsh and between littoral and adjacent inland marshes. Some invertebrates do best on one end of these gradients, while the majority are generalists found across habitat types.     

Normative data for the Wechsler Memory Scale—Revised: 25- to 34-year olds.

The normative data provided in the Wechsler Memory Scale—Revised (WMS—R) manual for individuals aged 25–34 yrs were estimated statistically by interpolation. As an empirical check of this procedure, a representative stratified sample in this age range was selected to match the 1980 US Census data on relevant demographic characteristics. Prorated Full Scale IQs for the group were normally distributed, having a mean of 101.3 (SD?=?14.58, range?=?72–231). Differences between the empirically derived and published index scores appeared to be clinically significant. Substantial intra-individual differences were common when Visual–Verbal or General–Attention/Concentration indexes were compared. Normative data for the WMS—R subtests, indexes, and distribution of differences between indexes is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)