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PubMed2005

National Provider Identifier (NPI) planning and implementation fundamentals for providers and payers.

Federal HIPAA legislation mandates that the National Provider Identifier (NPI) be fully implemented across all healthcare entities between May 2005 and May 2007, or 2008 for small payers. Starting May 2005, healthcare providers will be eligible to obtain an NPI and use these numbers to submit claims or conduct other transactions specified by HIPAA. By 2007, the NPI must be used in connection with the electronic transactions identified in HIPAA. Today, individual payers assign unique identification numbers to healthcare providers, and, in most cases, payers assign multiple identification numbers to healthcare providers and their "subparts." As a result, providers have multiple payer-specific identification numbers. The NPI is a unique, 10-digit federal healthcare provider identification number that will be used by all healthcare providers and payers and other healthcare entities involved in administrative and financial transactions associated with health service events and related activities. This article will use software and data experts' knowledge as well as the authors' NPI implementation readiness assessment work to review the impact to both payers and providers, including hospitals, clinics, and other service entities. The authors will suggest planning, budgeting, architecting, and data management solutions for payers and providers to achieve the optimal administrative simplification goals intended by the NPI, without compromising data integrity and interoperability objectives across the service spectrum of the healthcare enterprise.

Guideline Adherence↗

PubMed2005

Three-dimensional representation of complex muscle architectures and geometries.

Almost all computer models of the musculoskeletal system represent muscle geometry using a series of line segments. This simplification (i) limits the ability of models to accurately represent the paths of muscles with complex geometry and (ii) assumes that moment arms are equivalent for all fibers within a muscle (or muscle compartment). The goal of this work was to develop and evaluate a new method for creating three-dimensional (3D) finite-element models that represent complex muscle geometry and the variation in moment arms across fibers within a muscle. We created 3D models of the psoas, iliacus, gluteus maximus, and gluteus medius muscles from magnetic resonance (MR) images. Peak fiber moment arms varied substantially among fibers within each muscle (e.g., for the psoas the peak fiber hip flexion moment arms varied from 2 to 3 cm, and for the gluteus maximus the peak fiber hip extension moment arms varied from 1 to 7 cm). Moment arms from the literature were generally within the range of fiber moment arms predicted by the 3D models. The models accurately predicted changes in muscle surface geometry over a 55 degrees range of hip flexion, as compared to changes in shape predicted from MR images (average errors between the model and measured surfaces were between 1.7 and 5.2 mm). This new framework for representing muscle will enhance the accuracy of computer models of the musculoskeletal system.

Adult↗

PubMedDate not supplied

Federal guidelines update.

This article reviews laws and regulations that were introduced recently and that will see special application for the allergist/immunologist in 2005. The current work plan of the Office of Inspector General of the Department of Health and Human Services is analyzed New implications of the Medicare Modernization Act of 2003, Health Insurance Portability and Accountability Act (HIPAA) security standards, the Administrative Simplification Compliance Act provider identifier number, and Stark II regulations deserve attention.

Allergy and Immunology↗

PubMed2006

Automatic object extraction over multiscale edge field for multimedia retrieval.

In this work, we focus on automatic extraction of object boundaries from Canny edge field for the purpose of content-based indexing and retrieval over image and video databases. A multiscale approach is adopted where each successive scale provides further simplification of the image by removing more details, such as texture and noise, while keeping major edges. At each stage of the simplification, edges are extracted from the image and gathered in a scale-map, over which a perceptual subsegment analysis is performed in order to extract true object boundaries. The analysis is mainly motivated by Gestalt laws and our experimental results suggest a promising performance for main objects extraction, even for images with crowded textural edges and objects with color, texture, and illumination variations. Finally, integrating the whole process as feature extraction module into MUVIS framework allows us to test the mutual performance of the proposed object extraction method and subsequent shape description in the context of multimedia indexing and retrieval. A promising retrieval performance is achieved, and especially in some particular examples, the experimental results show that the proposed method presents such a retrieval performance that cannot be achieved by using other features such as color or texture.

Algorithms↗

PubMedDate not supplied

Topology-controlled volume rendering.

Topology provides a foundation for the development of mathematically sound tools for processing and exploration of scalar fields. Existing topology-based methods can be used to identify interesting features in volumetric data sets, to find seed sets for accelerated isosurface extraction, or to treat individual connected components as distinct entities for isosurfacing or interval volume rendering. We describe a framework for direct volume rendering based on segmenting a volume into regions of equivalent contour topology and applying separate transfer functions to each region. Each region corresponds to a branch of a hierarchical contour tree decomposition, and a separate transfer function can be defined for it. The novel contributions of our work are 1) a volume rendering framework and interface where a unique transfer function can be assigned to each subvolume corresponding to a branch of the contour tree, 2) a runtime method for adjusting data values to reflect contour tree simplifications, 3) an efficient way of mapping a spatial location into the contour tree to determine the applicable transfer function, and 4) an algorithm for hardware-accelerated direct volume rendering that visualizes the contour tree-based segmentation at interactive frame rates using graphics processing units (GPUs) that support loops and conditional branches in fragment programs.

Algorithms↗

PubMed1976

Simplifications of the derivations and forms of steady-state equations for non-equilibrium random substrate-modifier and allosteric enzyme mechanisms.

The steady-state equations for "random" enzymic mechanisms (ones with alternative routes for substrate and enzyme to form enzyme-substrate complexes) are non-Michaelian and very complicated when a quasi-equilibrium approximation cannot be used. General methods for simplifying their forms and derivations are given and applied to several single-substrate mechanisms of general or topical interest. The special simplifications resulting from partial ordering of reaction mechanism, from gross inequalities of rate constants, and from special relationships between catalytic and dissociation rate constants, are considered with reference to allosteric mechanisms. Some equations mentioned, but not given here, and more detailed working out of some of those given, have been deposited as Supplementary Publication SUP 50069 (18 pages) at the British Library Lending Division, Boston Spa, Wetherby, West Yorkshire LS23 7BQ, U.K., from whom copies can be obtained on the terms given in Biochem. J. (1976) 153, 5.

Allosteric Regulation↗

PubMed2004

Rule fitness and pathology in learning classifier systems.

It has long been known that in some relatively simple reinforcement learning tasks traditional strength-based classifier systems will adapt poorly and show poor generalisation. In contrast, the more recent accuracy-based XCS, appears both to adapt and generalise well. In this work, we attribute the difference to what we call strong over general and fit over general rules. We begin by developing a taxonomy of rule types and considering the conditions under which they may occur. In order to do so an extreme simplification of the classifier system is made, which forces us toward qualitative rather than quantitative analysis. We begin with the basics, considering definitions for correct and incorrect actions, and then correct, incorrect, and overgeneral rules for both strength and accuracy-based fitness. The concept of strong overgeneral rules, which we claim are the Achilles' heel of strength-based classifier systems, are then analysed. It is shown that strong overgenerals depend on what we call biases in the reward function (or, in sequential tasks, the value function). We distinguish between strong and fit overgeneral rules, and show that although strong overgenerals are fit in a strength-based system called SB-XCS, they are not in XCS. Next we show how to design fit overgeneral rules for XCS (but not SB-XCS), by introducing biases in the variance of the reward function, and thus that each system has its own weakness. Finally, we give some consideration to the prevalence of reward and variance function bias, and note that non-trivial sequential tasks have highly biased value functions.

Algorithms↗

PubMed2005

Site interdependence attributed to tertiary structure in amino acid sequence evolution.

Standard likelihood-based frameworks in phylogenetics consider the process of evolution of a sequence site by site. Assuming that sites evolve independently greatly simplifies the required calculations. However, this simplification is known to be incorrect in many cases. Here, a computational method that allows for general dependence between sites of a sequence is investigated. Using this method, measures acting as sequence fitness proxies can be considered over a phylogenetic tree. In this work, a set of statistically derived amino acid pairwise potentials, developed in the context of protein threading, is used to account for what we call the structural fitness of a sequence. We describe a model combining statistical potentials with an empirical amino acid substitution matrix. We propose such a combination as a useful way of capturing the complexity of protein evolution. Finally, we outline features of the model using three datasets and show the approach's sensitivity to different tree topologies.

Amino Acid Sequence↗

PubMed2000

Distributions and size scalings for strength in a one-dimensional random lattice with load redistribution to nearest and next-nearest neighbors

Lattice and network models with elements that have random strength are useful tools in explaining various statistical features of failure in heterogeneous materials, including the evolution of failure clusters and overall strength distributions and size effects. Models have included random fuse and spring networks where Monte Carlo simulation coupled to scaling analysis from percolation theory has been a common approach. Unfortunately, severe computational demands have limited the network sizes that can be treated. To gain insight at large size scales, interest has returned to idealized fiber bundle models in one dimension. Many models can be solved exactly or asymptotically in increasing size n, but at the expense of major simplification of the local stress redistribution mechanism. Models have typically assumed either equal load-sharing among nonfailed elements, or nearest-neighbor, local load-sharing (LLS) where a failed element redistributes its load onto its two nearest flanking survivors. The present work considers a one-dimensional fiber bundle model under tapered load sharing (TLS), which assumes load redistribution to both the nearest and next-nearest neighbors in a two-to-one ratio. This rule reflects features found in a discrete mechanics model for load transfer in two-dimensional fiber composites and planar lattices. We assume that elements have strength 1 or 0, with probability p and q=1-p, respectively. We determine the structure and probabilities for critical configurations of broken fibers, which lead to bundle failure under a given load. We obtain rigorous asymptotic results for the strength distribution and size effect, as n-->infinity, with precisely determined constants and exponents. The results are a nontrivial extension of those under LLS in that failure clusters are combinatorially much more complicated and contain many bridging fibers. Consequently, certain probabilities are eigenvalues from recursive equations arising from the structure of TLS. Next-nearest neighbor effects weaken the material beyond what is predicted under LLS keeping only nearest neighbor overloads. Our results question the validity of scaling relationships that are based largely on Monte Carlo simulations on networks of limited size since some failure configurations appear only in extremely large bundles. The dilemma has much in common with the Petersburg paradox.

Journal Article↗

PubMed1991

Endoscopic ventricular fenestration using a "saline torch".

The fiberoptic endoscope has never gained popularity among neurosurgeons although it is ideally suited for navigating within the cerebral ventricles. Recent advances in optics and miniaturization make the application of endoscopy in neurosurgery more practical. The authors report eight children who underwent ventriculoscopic fenestration of symptomatic loculated cerebrospinal fluid (CSF) collections. These CSF collections were either isolated ventricular cysts or trapped lateral ventricles secondary to obstruction at the foramen of Monro. Cyst wall dissection was carried out with a "saline torch" dissector which was introduced through a working channel in the ventriculoscope. The torch was used to coagulate vessels and to sculpt large windows in cyst walls or in the septum pellucidum. Ventriculoscope-guided cyst fenestration can be performed safely and easily under direct vision. The technique may permit simplification of shunt systems in some patients and elimination of shunts in others.

Brain Diseases↗

PubMed2006

Initial guesses generation for Fluorescence Intensity Distribution Analysis.

The growing number of applications of Fluorescence Intensity Distribution Analysis (FIDA) demands for new approaches in data processing, aiming at increased speed and robustness. Iterative algorithms of parameter estimation, although proven to be universal and accurate, require some initial guesses (IG) of the unknown parameters. An essential component of any data processing technology, IG become especially important in case of FIDA, since even with apparently reasonable, and physically admissible but randomly chosen IG, the iterative procedure may converge to situations where the FIDA model cannot be evaluated correctly. In the present work we introduce an approach for IG generation in FIDA experiments based on the method of moments. IG are generated for the sample parameters: brightness, concentration, and for the parameters related to experimental set-up: background, observation volume profile. A number of analytical simplifications were introduced in order to increase the accuracy and robustness of the numerical algorithms. The performance of the developed method has been tested on number of simulations and experimental data. Iterative fitting with generated IG proved to be more robust and at least five times faster than with an arbitrarily chosen IG. Applicability of the proposed method for quick estimation of brightness and concentrations is discussed.

Algorithms↗

PubMed1999

[Efficient learning with data from own practice--experiences from the SATS-project].

Between 1995 and 1998 the Norwegian Medical Association carried out a project to develop and assess a quality improvement tool for use in general practice (SATS). This method combines self-directed learning, documentation of practice and peer group support. SATS defined performance indicators for registration of practice by means of computerised patient records. Groups of four to ten general practitioners used their own consultation data as a basis for learning cycles. The practice evaluation indicates significant improvement in clinical work. Participating doctors found that having their own recorded data examined in a supportive peer environment was a major force for change. They reported satisfaction with the method, and expressed an interest in trying out new topics. However, the project demonstrated the need for simplification of terminology, further development of group process methods and computer software. There is also a need for strong local support of peer review groups.

Clinical Competence↗

PubMed1971

Microbiological and immunological aspects of extended manned space flights.

This paper is concerned with alterations in microbial flora and immunologic response of men during exposure to long-term confinement in a sealed cabin. The above changes depend on the environmental parameters, the duration of the exposure to different environmental factors, as well as on work rest schedules. An interchange of micro-organisms between subjects and activation of some species forming the normal human microflora took place in conditions of isolation. It was demonstrated that under these conditions some significant shifts in intestinal microflora occurred, including its general "simplification". It was found that the immunocompetent lymphoid tissue of the animals that had a simplified (reduced in number of species) intestinal microflora was significantly underdeveloped. Some ways of stimulating the immunocompetent systems of astronauts during long-term space flights were considered. Special attention should be paid to the microbiological examination as part of the selection routine for future astronauts.

Adaptation, Physiological↗

PubMed2004

Simplification of analysis procedures in inter-subject studies with cardiac PET imaging.

Quantitative analysis in positron emission tomography imaging usually necessitates several studies carried out under the same protocol in order to get functional or metabolic parameter values with low variations. Apart from subject preparation and measurements in similar conditions, the data analysis should be done as uniformly as possible. In this work we report PET data obtained in normal and ischemic rats, measured with (13)N-ammonia and (11)C-acetate to extract myocardial blood flow and oxygen consumption, and analysed with the usual region of interest (ROI) drawing method in each rat individually, in comparison to a new method based on resampling all the rat heart images to a common model, then the ROIs are drawn once and copied onto each rat image sequence.

Animals↗

PubMed2005

Electrorheological Kelvin-Helmholtz instability of a fluid sheet.

The present work deals with the gravitational stability of an electrified Maxwellian fluid sheet shearing under the influence of a vertical periodic electric field. The field produces surface charges on the interfaces of the fluid sheet. Due to the rather complicated nature of the problem a mathematical simplification is considered where the weak effects of viscoelastic fluids are taken into account. The solutions of the linearized equations of motion and boundary conditions lead to two simultaneous Mathieu equations with damping terms and having complex coefficients. Stability criteria are discussed through the assumption of symmetric and anti-symmetric deformations. The disappearance of surface charges from the interfaces obeys a certain relation derived in the marginal state. Furthermore, the case dealing with general deformation is discussed through marginal state analysis. The stability behavior in resonant and nonresonant cases are studied. In addition, the stability picture in the case of absence of the field frequency is studied. The numerical examination for stability showed that the relaxation time ratio plays a destabilizing influence in the case of anti-symmetric deformation or in the general deformation. The stabilizing effect for the relaxation time ratio is saved in the case of general deformation in the presence of the field frequency. In the later case the viscosity, the velocity, and the thickness parameter play a stabilizing influence. A dual role is readied for these parameters in the absence of the field frequency or in the anti-symmetric deformation. The field frequency still plays a destabilizing role in both cases.

Journal Article↗

PubMed1995

A time-based approach to agrammatic production.

A time-based approach to agrammatic speech is presented. The paper consists of three parts. In the first part, the literature which deals with agrammatic comprehension as a problem of disrupted timing, that is, as a slow-down of syntactic computation and/or a rapid decay of the results of syntactic processing, is reviewed. In a second part, the hypothesis that similar timing problems cause difficulties in production as well is discussed. Two possible ways in which this can happen are described. First, slow down or rapid decay can lead to desynchronization within the process of syntactic tree formation. Second, a slow down of syntactic processing can cause asynchrony between the production of a syntactic slot and the retrieval of the proper grammatical morpheme from the mental lexicon. This hypothesis predicts that morphemes which are dependent on a relatively complex part of the syntactic tree will elicit relatively many errors. Results from the literature which seem to confirm this prediction are discussed. In the third part of the paper, the possible ways in which a patient can adapt to the reduced temporal window that would result from a timing deficit are discussed. Message simplification will reduce the size of the required temporal window and will therefore have a beneficial effect on the error rate. Restart of the computational process will profit from previously reached activation levels so that synchrony is easier to reach and error rate is reduced. Empirical work which appears to support these hypotheses is reviewed.

Aphasia↗

PubMed1996

[Problems and limits in the utilization of the concept of social class in epidemiologic research: a critical review of the literature]

The application of inductive empirical variables in hegemonic alternatives of Epidemiology in order to treat socioeconomic variations in human groups has displayed certain limitations raising the need for new proposals. The use of social class was thus introduced as an analytical category operated according to place in the productive process for the subjects under study. This choice has already shown potentialities in several studies. This paper was intended to identify some limits and problems occurring when using the social class concept in epidemiological research. Besides the need for an adequate theoretical framework, construction of categories consistent with both their theories and the levels of abstraction employed, and the concern for more carefully analyzing the consumer and working modes for each social class (questions that have been discused elsewhere), this paper approaches several issues, as follows: the treatment of social classes as articulated clusters in the research process, the need to adjust the operational scheme to the particularities of each socioeconomic formation, the simplification resulting from the process of reducing the concept of social class to several linked variables, the need for a relatively large sample, the existence of debate over the definition of the position of class groups not participating in production, and subjects with two or more different positions in production.

Journal Article↗

PubMed1997

Re-engineering the medical staff. Simplification is key.

Medical staffs are finding they must make do with less--less administrative support from financially strapped hospitals, and less volunteer physician member time from physicians who are distracted by managed care and by managing their changing practices. All too often the medical staff tries to do what they have always done, only faster, and with less help. This just frustrates those who were already working hard. The better alternative? Re-engineer the medical staff with the goal of simplifying operations. A critical look at the tasks undertaken by the medical staff often reveals that far too much time is spent doing unnecessary things. When asked, "Why do you do all this?" the answer is often, "because we are required to do it!" Yet scrutiny reveals that it is not required and that the task could be eliminated. Just because something "has always been done that way" does not mean it still must. It is time to look at the medical staff structure and procedures with a new set of questions: What is really required? What has great value for us? What can be jettisoned without affecting our operations?

Constitution and Bylaws↗