Overdispersion in health care performance data: Laney's approach.
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This article presents a new incremental learning algorithm for classification tasks, called NetLines, which is well adapted for both binary and real-valued input patterns. It generates small, compact feedforward neural networks with one hidden layer of binary units and binary output units. A convergence theorem ensures that solutions with a finite number of hidden units exist for both binary and real-valued input patterns. An implementation for problems with more than two classes, valid for any binary classifier, is proposed. The generalization error and the size of the resulting networks are compared to the best published results on well-known classification benchmarks. Early stopping is shown to decrease overfitting, without improving the generalization performance.
The Rosenbrock function is a well-known benchmark for numerical optimization problems, which is frequently used to assess the performance of Evolutionary Algorithms. The classical Rosenbrock function, which is a two-dimensional unimodal function, has been extended to higher dimensions in recent years. Many researchers take the high-dimensional Rosenbrock function as a unimodal function by instinct. In 2001 and 2002, Hansen and Deb found that the Rosenbrock function is not a unimodal function for higher dimensions although no theoretical analysis was provided. This paper shows that the n-dimensional (n = 4 approximately 30) Rosenbrock function has 2 minima, and analysis is proposed to verify this. The local minima in some cases are presented. In addition, this paper demonstrates that one of the "local minima" for the 20-variable Rosenbrock function found by Deb might not in fact be a local minimum.
Pregnant Sprague-Dawley rats received a single oral dose of 0, 20, 60, or 180 ng/kg 2,3,7,8-tetrachlorodibenzo-p-dioxin on day 8 of gestation. Each litter contributed a single male-female pair trained to press a lever to obtain food pellets under two operant behavior procedures. Initially, each lever press was reinforced. The fixed-ratio (FR) requirement was then increased every four sessions from the initial setting of 1 to values between 6 and 71. We then studied responses for 30 days under a multiple schedule combining FR 11 and another schedule requiring a pause of at least 10 sec between responses (DRL 10-sec). TCDD evoked a sexually dimorphic response pattern. Generally, TCDD-exposed males responded at lower rates than control males. In contrast, exposed females responded at higher rates than controls. Each response measure from the mult-FR DRL schedule yielded a male-female difference score. We used the differences in response rate to calculate benchmark doses based on the relative displacement from modeled zero-dose performance of the effective dose at 1% (ED(01)) and 10% (ED(10)), as determined by a second-order polynomial fit to the dose-effect function. For the male-female difference in FR rate of responding, the mean ED(10) was 2.77 ng/kg with a 95% lower bound of 1.81 ng/kg. The corresponding ED(01) was 0.27 ng/kg with a 95% lower bound of 0.18 ng/kg. For the male-female difference in DRL rate, the mean ED(10) was 2.97 ng/kg with a 95% lower bound of 2.02 ng/kg. The corresponding ED(01) was 0.30 ng/kg with a 95% lower bound of 0.20 ng/kg. These values fall close to, but below, current estimates of human body burdens of 13 ng/kg, based on TCDD toxic equivalents.
We obtained data on laboratory turnaround time (TAT) and emergency department (ED) length of stay (LOS). We correlated potassium test TAT outlier percentage (TAT-OP) with ED LOS and found that for each outlier percentage (potassium result > 40 minutes), a projected impact on ED LOS was approximately 2.8 additional minutes (ED LOS = 2.79 TAT-OP + 78.77). To address this issue, we began implementation of a totally automated chemistry system to decrease TAT-OPs. Our TAT means did not change substantially with automation (potassium, 28 to 27 minutes); however, TAT-OPs decreased substantially (potassium, 18% to 5%). Preautomation average ED LOS correlated best with the TAT-OP (r(2) = 0.98; P = .01), but this relationship weakened substantially after automation (r(2) = 0.29; P > .05), suggesting the laboratory was no longer a factor in ED LOS. The postautomation ED LOS correlated best with ED patient volume (r(2) = 0.88; P = .06). Although laboratories have focused on TAT means for performance assessment, our study suggests TAT-OPs are more clinically relevant benchmarks. Furthermore, our findings suggest that total laboratory automation can effectively improve overall laboratory service reliability and help eliminate the laboratory as a factor in ED LOS.
Modern research techniques have led to exponential growth in the volume and complexity of scientific data. Consequently, managing these volumes securely and efficiently has become a major challenge. While all research domains face these challenges, life science research is particularly affected because current approaches often rely on a large set of different file formats, with metadata stored in separated databases or spreadsheets. This leads to fragmented datasets, orphaned data, and compromised research reproducibility. Traditional solutions also force researchers to choose between security and accessibility, with encrypted files preventing selective access and indexed formats lacking adequate security for sensitive data. These limitations are particularly problematic in large-scale genomic studies where researchers must decompress multi-gigabyte files to access specific regions, creating computational bottlenecks and inefficient network usage when working with cloud-stored datasets. We introduce Pithos, a next-generation file format specifically designed for scientific data management in distributed cloud environments. The format uses content-defined chunking to enable efficient deduplication across distributed storage systems, thereby reducing storage costs and bandwidth requirements. The append-only structure ensures data immutability and allows for incremental updates without compromising content. Benchmark results show that Pithos outperforms existing solutions in read and write performance, with comparable or improved storage efficiency.
OBJECTIVE: To develop and validate a second-generation severity-of-illness score that is applicable to pediatric emergency patients. The Pediatric Risk of Admission (PRISA) score was developed in a single hospital and was recalibrated and validated in 2, previous, small studies from academic pediatric hospitals. This study was performed to develop and validate a score in a larger sample of diverse hospitals. METHODS: Emergency departments (EDs) were block randomly selected as part of a study on ED quality on the basis of 3 care characteristics: annual patient volume (high or low compared with national median), presence or absence of a pediatric emergency medicine subspecialist, and presence or absence of residents. Patients were selected randomly on the basis of daily arrival logs. Medical records were photocopied, and abstracted data included demographic, historical, physiologic, and therapeutic information. The total sample was randomly divided into a 75% development sample and a 25% validation sample. Univariate and multivariate analyses were used to model the risk of mandatory admission, admissions for which preidentified, inpatient medical resources were used. The resulting multiple logistic regression model coefficients were converted to integer scores. Calibration (Hosmer-Lemeshow goodness of fit) and discrimination (area under the ROC curve) were used to measure performance. As a measure of construct validity, proportions of patients in ordered risk intervals were correlated with the outcomes of admission, mandatory admission, and ICU admission. RESULTS: Sixteen EDs enrolled 11664 patients. Mean patient age (+/-SD) was 6.8 +/- 5.8 years, and 53% were male. Nine percent arrived by emergency medical services, and 6.9% were admitted. The most common diagnoses were minor injuries, otitis media, and fever. The multivariate analysis yielded a score with 7 historical variables, 8 physiologic variables, 1 therapy (oxygen) term, and 1 interaction term. Calibration was excellent. In the development sample, 442 mandatory admissions were predicted and 442 were observed (total chi2 = 2.275), and in the validation sample, 136.6 were predicted and 145 were observed (chi2 = 8.575). The area under the receiver operator characteristic curve was 0.82 +/- 0.01 (SE) in the development sample and 0.77 +/- 0.02 in the validation sample. In ordered predicted risk intervals, the proportion of patients with admissions, mandatory admissions, and ICU admissions increased in a linear manner. CONCLUSIONS: The second-generation PRISA II score for pediatric ED patients has been developed and validated in a large sample of diverse hospitals. Performance characteristics indicate that PRISA II will be useful for institutional comparisons, benchmarking, and controlling for severity of illness when enrolling patients in clinical trials.
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Hospitals need to analyze, develop, and implement realistic, effective productivity standards. The first step in a productivity analysis is to collect performance data for each hospital department. A workload measure should be assigned to every department. Comparing historical performance data for each department highlights problem areas. Gaining executive commitment and department manager acceptance is essential to productivity-improvement initiatives. Even in departments that experience a change in function, historical data can be used to monitor performance and determine where improvement is needed. A weighting system can be employed to capture historical data and establish a standard against which to measure future performance.
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It is the one Home Health Compare measures that has not improved in three years. It has been a major area of concern for most home care agencies in the country. It is THE focus of QIOs quality improvement efforts. And, it has serious implications to agencies quality status in a pay-for-performance environment.
OBJECTIVES: To assess the resident's phacoemulsification learning curve as a risk factor for vitreous loss and to determine the incidence of vitreous loss among the residents performing phacoemulsification. DESIGN: Retrospective matched case-control study MATERIAL AND METHOD: A case-control study comparing all consecutive cases of attempted phacoemulsification with intraocular lens (IOL) implantation from January 1st, 1998 to December 31st, 1999. The surgeon variable will be categorized into two groups, the third year ophthalmology residents, representing resident's phacoemulsification learning curve, and faculty staffs. The study group consisted of eyes that had had intraoperative complication of vitreous loss. The control group consisted of eyes that had not had vitreous loss. Continuous variables were compared with the 2-sided unpaired t-test. Categorical variables were compared between groups using analytical matched case-control study with relative risk or odd ratio, Mc Nemar's (Marginal) o 2 test and 95% confident interval of relative risk. RESULTS: The odds that the eyes in the resident group would have an intraoperative complication of vitreous loss were 4 times the odds that the eyes in the faculty staff group would have such complication (P = 0.0052, 95% confidential interval (CI) of relative risk (RR) = 1.516-10.556). The incidence of vitreous loss among residents was 6.93% (28/404) and 2.06% (28/1358) among the faculty staffs. The overall incidence of vitreous loss was 3.18% (56/1762). CONCLUSION: The incidence of intraoperative complication of vitreous loss, the relative risk of such complication performed by the learning curve surgeon in the present study serve as benchmarks for residents-in-training, beginning and surgeon-in-practice converting to phacoemulsification.
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