Self-Organising Maps: A new way to screen the level of satisfaction of dialysis patients

Evaluation of patient satisfaction has become an important indicator for assessing health care quality. Fresenius Medical Care (FME) as a global provider of dialysis services through its NephroCare network has a strong interest in monitoring patient satisfaction.The aim of the paper is to test and validate a methodology for detecting a residual area of low satisfaction in dialysis patients.The FME Patient Satisfaction Programme questionnaire was distributed to haemodialysis (HD) patients treated in 335 centers of its network. It contained 79 questions covering various satisfaction aspects regarding Dialysis Unit, Dialysis Arrangement, Nurses, Doctors, etc.To analyse the data provided by the questionnaire, the Self-Organising Map (SOM) method was used. SOM is a neural network model for clustering and projecting high-dimensional data into a low-dimensional space, preserving topological relationships of original high-dimensional data spaces.10,632 HD patients completed the questionnaire. Mean age was 63.05 ± 14.93 years with 56.69% males. Response rate was 66%. Overall level of satisfaction was 1.99 (range from ?3 to +3). On average patients were very satisfied with all issues. Nevertheless, a group of patients, around 60 years old, balanced gender ratio, whose level of satisfaction was lower than 1, were highlighted.In the NephroCare clinics patient satisfaction with service is rather high. While traditional analysis usually stops here, the SOM method allows identification of areas of potential improvement for specific patient groups.     

Infants prefer the musical meter of their own culture: A cross-cultural comparison.

Infants prefer native structures such as familiar faces and languages. Music is a universal human activity containing structures that vary cross-culturally. For example, Western music has temporally regular metric structures, whereas music of the Balkans (e.g., Bulgaria, Macedonia, Turkey) can have both regular and irregular structures. We presented 4- to 8-month-old American and Turkish infants with contrasting melodies to determine whether cultural background would influence their preferences for musical meter. In Experiment 1, American infants preferred Western over Balkan meter, whereas Turkish infants, who were familiar with both Western and Balkan meters, exhibited no preference. Experiments 2 and 3 presented infants with either a Western or Balkan meter paired with an arbitrary rhythm with complex ratios not common to any musical culture. Both Turkish and American infants preferred Western and Balkan meter to an arbitrary meter. Infants’ musical preferences appear to be driven by culture-specific experience and a culture-general preference for simplicity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

对象技术在分布式系统中的作用

对象管理集团公司（ＯｂｊｅｃｔＭａｎａｇｍｅｎｔＧｒｏｕｐ－ＯＭＧ）是一个致力于解决分布式环境中互操作问题的非盈利性协作组织，它遵循一个新的技术途径，即对象技术，产生了公认的基于可商用对象技术的事实标准。它的一套面向对象的标准化语言、接口和协议的基础是一种称作通用对象请求代理结构（ＣｏｍｍｏｎＯｂｊｅｃｔＲｅｑｕｅｓｔＢｒｏｋｅｒＡｒｃｈｉ－ｔｅｃｔｕｒｅ—ＣＯＲＢＡ）的通信约定。ＣＯＲＢＡ在具有不同的操作系统、语言、网络协议和硬件结构的系统间提供了应用层的互操作性。ＯＭＧ未来的计划是运用这些有力的服务和功能支持应用程序员的设计开发。     

Postoperative analgesia in herniated disk surgery. Comparative study of diclofenac , lysine acetylsalicylate, and ketorolac

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating musculoskeletal pain and are theoretically ideal for treating postoperative pain of the lumbar column. OBJECTIVES: To compare the analgesic efficacy and side effects of treatment with 3 NSAIDs (lysine acetylsalicylate, ketorolac and diclofenac) in the treatment of pain after surgery for lumbar disc hernia. PATIENTS AND METHODS: We enrolled 75 ASA I-II patients undergoing discectomy because of lumbar disc hernia; balanced general anesthesia was used in all cases. The patients were randomly distributed in 3 groups based on type of analgesia given in the immediate postoperative period. Group A received lysine acetylsalicylate (1800 mg), group B received ketorolac (30 mg) and group C received diclofenac (75 mg). The analgesics were diluted in 100 mg of saline solution and administered through a peripheral vein over 10 min. We evaluated the analgesia attained on a visual analog scale (VAS) and the physiological response to pain was assessed by monitoring changes in arterial pressure, heart rate and breathing frequency. If analgesia was insufficient 30 min after administration of the drug, 200 mg of lysine cloximate was given as a top-up. The side effects of each drug were also recorded. RESULTS: VAS evaluation showed significant reductions in pain 60 min after administration in groups A and B and after 120 min in group C. Nine patients in each group required lysine cloximate. There were no significant differences in physiological response among the 3 groups. No patient suffered major side effects. Mild side effects were reported most often in group B. CONCLUSIONS: The NSAIDs studied were inadequately for treating pain after surgery for lumbar disc hernia. Ketorolac was no better than the other analgesics studied but was associated with a higher number of mild side effects.     

EGNOS test bed ionospheric corrections under the October and November 2003 storms

Two severe geomagnetic storms were experienced on October 29-31 and November 20, 2003, degrading significantly the European Geostationary Navigation Overlay Service (EGNOS) Test Bed (ESTB) performance in Europe. Such storms reached extreme values of Kp=9 during the most severe periods. The analysis of the ESTB ionospheric corrections and their effect on the ESTB integrity and accuracy is presented in this work. The ESTB performance during those storms was monitored from a network of global positioning system (GPS) receivers widely distributed over Europe, including the ESTB reference stations, and the geographical degradation of the accuracy is analyzed in this paper. The correlation between the Kp index and the misleading information (MI) events is also shown. During the most severe stormy periods, the errors in the ESTB ionospheric corrections and its integrity bounds are analyzed to explain the peaks in the navigation system error, which produces MIs. This analysis has been carried out by comparing with direct dual-frequency GPS measurements and global ionospheric maps.     

Interaction between adrenaline and epidermal growth factor in the control of liver glycogenolysis in mouse

Epidermal growth factor (EGF) stimulates glycogenolysis in mouse liver, but the effect requires concentrations that are only achieved in plasma upon adrenergic stimulation of EGF release from submandibular salivary glands. Thus, we studied the interaction between adrenaline and EGF in liver glycogen metabolism, both in whole animals and in isolated hepatocytes. Adrenaline administered to anesthetized mice stimulated both the endocrine secretion of EGF from submandibular salivary glands and the degradation of glycogen in the liver. In sialoadenalectomized mice, adrenaline administration did not increase plasma EGF concentration. In these animals, the glycogenolytic response to adrenaline was enhanced. The sensitivity of hepatocytes to adrenaline was similar in cells from sialoadenalectomized and sham-operated mice. EGF, added to isolated hepatocytes, reduced the glycogenolytic effect of adrenaline (the maximal effect but not the ED50). Adrenaline stimulated glycogen degradation through both an alpha1-adrenergic mediated Ca2+ increase and a beta-adrenergic-mediated cAMP increase. EGF did not interfere with the rise of cytosolic Ca2+ but decreased the cAMP signal. EGF did not decrease the glycogenolytic effect of phenylephrine or VP (which increased cytosolic Ca2+ but not cAMP), but EGF decreased both the glycogenolytic effect and the cAMP signal generated by glucagon or forskolin. EGF did not interfere with the glycogenolytic effect of CPT-cAMP or bt2-cAMP. The effect of EGF on cAMP was blocked by 3-isobutyl-1-methylxanthine. These results demonstrate that the effect of EGF on the glycogenolytic action of adrenaline involves interference with the generation of the cAMP signal. We suggest that EGF induces such an effect through the activation of a phosphodiesterase.     

A feasibility study of alum recovery in wastewater treatment plants

In this paper the recovery of alum used as a coagulant in water treatment has been examined. This chemical has a very large influence on the operating costs of treatment plants. A factorial design has been used in the experimental work. The factors tested have been pH of coagulation, pH of redissolution and temperature. Optimal recovery conditions have been found regarding these variables and the recovered alum has proved to have coagulation characteristics as good as the fresh one. A detailed engineering cost analysis has also been made for the optimal conditions achieved. The feasibility study has shown the high profit level of the process.     

Relationship between epidermal growth factor in mouse submandibular glands, plasma, and bile: effects of catecholamines and fasting

The epidermal growth factor (EGF) concentration in bile is high (approximately 150 fold higher than that in plasma), but little is known about its physiological control. Acute administration of the alpha 1-adrenergic agonist phenylephrine (1.7 mg/kg, iv) to male mice produced a rapid increase in the EGF concentration in bile. We suggest that this EGF originates in submandibular glands and not in the liver. The bases for this are: 1) this increase was parallel to the increase in plasma, and the EGF content of the submandibular glands decreased after phenylephrine injection; and 2) the EGF concentrations in plasma and bile did not increase after phenylephrine administration to sialoadenalectomized mice. The concentration of EGF in bile is not only under pharmacological control, but is also regulated physiologically. Thus, the EGF concentrations in plasma, bile, and submandibular glands increased in fasted mice. All of these changes were reversed by refeeding. As 1) [125I]EGF binding to liver membranes decreased only after 2 days of fasting, but the level of circulating EGF was already increased in 1-day fasted mice, and 2) EGF secretion by submandibular glands from 1-day fasted mice incubated in vitro increased, we suggest that the increase in EGF concentrations in plasma and bile is the consequence of increased endocrine secretion by submandibular glands. Taken together, our results suggest that there is a flux of EGF from submandibular glands to bile in mice, which is under physiological control.