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.     

An eight‐node hybrid‐stress solid‐shell element for geometric non‐linear analysis of elastic shells

This paper presents eight‐node solid‐shell elements for geometric non‐linear analysis of elastic shells. To subdue shear, trapezoidal and thickness locking, the assumed natural strain method and an ad hoc modified generalized laminate stiffness matrix are employed. A selectively reduced integrated element is formulated with its membrane and bending shear strain components taken to be constant and equal to the ones evaluated at the element centroid. With the generalized stresses arising from the modified generalized laminate stiffness matrix assumed to be independent from the ones obtained from the displacement, an extended Hellinger–Reissner functional can be derived. By choosing the assumed generalized stresses similar to the assumed stresses of a previous solid element, a hybrid‐stress solid‐shell element is formulated. Commonly employed geometric non‐linear homogeneous and laminated shell problems are attempted and our results are close to those of other state‐of‐the‐art elements. Moreover, the hybrid‐stress element converges more readily than the selectively reduced integrated element in all benchmark problems. Copyright © 2002 John Wiley & Sons, Ltd.     

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.     

New queueing strategies employing service interval-based priority for real-time communications in atm networks

In this paper, we propose queueing strategies employing the service interval-based priority (sip) which can provide delay-bounded, and loss-free services, while maximizing bandwidth utilization in the atm network. We also describe a variation of the sip, the residual service interval-based priority (rsip) which can achieve almost full utilization by assigning priorities dynamically on the basis of the residual service interval. We store the realtime cells belonging to different connections in logically separated queues, and for each queue, we set a parameter called service interval, during which only one cell is allowed to be transmitted. The sip server takes and transmits the head-of-line (hol) cell of the queue which has the smallest service interval, while the rsip server selects the queue with the smallest residual service interval. When there is no eligible real-time cell, it transmits non-real-time cell, thus enabling a maximized bandwidth utilization. Employing the above queueing strategies, we analyze the delay characteristics deterministically with the leaky bucket bounded input traffic and then dimension the optimal service interval. In dimensioning the service interval and buffer space of each real-time service queue, we consider burstiness of traffic in conjunction with delay constraints, so that bandwidth utilization can get maximized. In addition, we consider the issues of protection from malicious users, average bandwidth utilization, and coupling between the delay bound and the bandwidth allocation granularity.     

Recent advances in theory and applications of scrambling techniquesfor lightwave transmission

This paper discusses recent advances in the theory and applications of scrambling techniques for digital lightwave transmission. It introduces the theories of sequence space and shift register generator (SRG) space which enable systematic analysis and mathematical manipulation of the behavior of sequences in general and the related SRG's. It discusses the behavior and realization of frame synchronous scrambling (FSS) and distributed sample scrambling (DSS) with emphasis on parallel sequences and the related parallel SRG's (PSRG). In addition, it describes self synchronous scrambling (SSS). Then the paper applies the theories to today's lightwave transmission systems by demonstrating practical parallel designs of FSS for SDH/SONET transmission, DSS for cell-based ATM transmission, and SSS for SDH-based ATM transmission. It finally considers how DSS can be used for scrambling of mixed isochronous and nonisochronous data in future high-speed data networks. The paper employs various new concepts and terminology, such as PSRG engine, generating vector discrimination matrix, (M,N) PSRG, sampling vector, correction vector, correction matrix, predictable scrambling concurrent sampling, and immediate correction     

Vertex-based inter-frame boundary encoding scheme

The boundary is approximated by a polygon which can be encoded with the smallest number of bits for maximum distortion. The temporal redundancy between two successive frames is efficiently removed with the proposed scheme, resulting in a lower bit rate than the conventional algorithms     

The inverse mapping and distortion measures for 8-node hexahedral isoparametric elements

The inverse relations of the isoparametric mapping for the 8-node hexahedra are derived by using the theory of geodesics in differential geometry. Such inverse relations assume the form of infinite power series in the element geodesic coordinates, which are shown to be the skew Cartesian coordinates determined by the Jacobian of the mapping evaluated at the origin. By expressing the geodesic coordinates in turn in terms of the isoparametric coordinates, the coefficients in the resulted polynomials are suggested to be the distortion parameters of the element. These distortion parameters can be used to sompletely describe the inverse relations and the determinant of the Jacobian of the mapping. The meanings of them can also be explained geometrically and mathematically. These methods of defining the distortion measures and deriving the inverse relations of the mapping are completely general, and can be applied to any other two-or three-dimensional isoparametric elements.