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Midwest Heart Specialists, a physician-owned cardiovascular practice with 55 specialists serving the Chicago area, saved millions of dollars in 2004 on hospitalization costs for patients with coronary artery disease by integrating performance data collection into its existing electronic medical records system.
Coalition says only 85% of patients receive care that meets basic quality measures. Awareness being raised of hands-on programs to help hospitals improve cardiac care. Hospitals performing below par will be approached with offers of assistance.
A report from the Centers for Disease Control and Prevention can be used to benchmark your department against national averages and offer explanations for what management might call "poor performance." For example: One-third of EDs cite staffing shortages or overcrowding as caused of diversion. Does your ED suffer from one--or both? What are your nursing vacancies? Half of EDs in metropolitan areas had more than 5% of their nursing positions vacant. Since 8% of the hospitals nationwide are not allowed to go on diversion, ED crowding is not just a diversion issue.
OBJECTIVE: To describe the efficiency of HMOs and to test the robustness of these findings across alternative models of efficiency. This study examines whether these models, when constructed in parallel to use the same information, provide researchers with the same insights and identify the same trends. DATA SOURCES: A data set containing 585 HMOs operating from 1985 through 1994. Variables include enrollment, utilization, and financial information compiled primarily from Health Care Investment Analysts, InterStudy HMO Census, and Group Health Association of America. STUDY DESIGN: We compute three estimates of efficiency for each HMO and compare the results in terms of individual performance and industry-wide trends. The estimates are then regressed against measures of case mix, quality, and other factors that may be related to the model estimates. PRINCIPAL FINDINGS: The three models identify similar trends for the HMO industry as a whole; however, they assess the relative technical efficiency of individual firms differently. Thus, these techniques are limited for either benchmarking or setting rates because the firms identified as efficient may be a consequence of model selection rather than actual performance. CONCLUSIONS: The estimation technique to evaluate efficient firms can affect the findings themselves. The implications are relevant not only for HMOs, but for efficiency analyses in general. Concurrence among techniques is no guarantee of accuracy, but it is reassuring; conversely, radically distinct inferences across models can be a warning to temper research conclusions.
Inferring coalescent trees from genomic data has become a major subject in population genetics, particularly with the recent advances in tree sequence reconstruction methods. However, it remains unclear how well these methods perform for imbalanced genealogies. Such imbalances can arise from processes such as cultural transmission of reproductive success (CTRS) or positive selection. Using simulated genomic data, we benchmarked three major software packages, SINGER, Relate, and tsinfer, by comparing the imbalance of reconstructed trees by these methods with that of the true simulated trees, for three indices that quantify this imbalance. The three methods performed well under scenarios yielding balanced trees. However, their accuracy declined as imbalance increased. Performances also varied with mutation rate, recombination rate, and sample size. This study opens possibilities for applying these methods to infer CTRS or positive selection in large-scale genomic datasets, using simulation-based inference such as approximate Bayesian computation.
BACKGROUND: Metagenomic sequencing can potentially transform clinical microbiology by enabling rapid pathogen identification and antimicrobial resistance (AMR) prediction in critically ill patients with bloodstream infections. However, the clinical use of metagenomic sequencing has been constrained by its speed, accuracy, and technical feasibility. Our aim was to develop and evaluate a direct-from-positive blood culture workflow using Oxford Nanopore sequencing that overcomes these limitations and delivers rapid, accurate results. METHODS: In this metagenomic pipeline analysis, 211 positive (130 aerobic and 81 anaerobic) and 62 negative (30 aerobic and 32 anaerobic) randomly selected blood cultures were processed from Oxford University Hospitals for comparing species identification, AMR detection, and time-to-result against standard culture-based diagnostics performed by the hospital's routine microbiology laboratory. Species prediction was performed using Kraken2 with a comprehensive standard database, applying heuristic and random forest classification models. Additionally, we benchmarked AMR classification tools and databases, including ResFinder, CARD, and NCBI AMRFinderPlus. FINDINGS: Across all samples, our method achieved 97% sensitivity and 94% specificity for species identification compared with that of routine culture and matrix-assisted laser desorption ionisation time-of-flight-based diagnostics; both sensitivity and specificity increased to 100% after adjudication of plausible additional infections. We detected 19 additional infections (13 polymicrobial, five previously unidentifiable, and one in a culture-negative sample) and delivered species identification results within 3 h 20 min (IQR 3 h 7 min-3 h 27 min), approximately 10 h earlier than routine diagnostic methods. For the ten most common clinically relevant pathogens, our method yielded AMR results 20 h earlier than current antimicrobial susceptibility testing, with an overall sensitivity of 88% and specificity of 93%. Performance varied by species. For Staphylococcus aureus, the AMR prediction sensitivity was 100% and specificity was 99%, and for Escherichia coli, the prediction sensitivity was 91% and specificity was 94%. INTERPRETATION: These findings show that metagenomic sequencing has the potential to rapidly and comprehensively detect pathogens and AMR in bloodstream infections. Integration into clinical practice could help to close diagnostic gaps, reduce empirical antibiotic use, and enable rapid targeted treatment. Nonetheless, improvements in AMR prediction for some species and drugs, along with further multisite validation, are required before clinical implementation. FUNDING: National Institute for Health Research (NIHR) Oxford Biomedical Research Centre.
The development of effective passive sonar systems depends upon the ability to accurately predict the performance of sonar detection algorithms in realistic ocean environments. Such environments are typically characterized by a high degree of uncertainty, thus limiting the usefulness of performance prediction approaches that assume a deterministic environment. Here we derive closed-form receiver operating characteristic (ROC) expressions for an optimal Bayesian detector and for several typical suboptimal detectors, based on a statistical model of environmental uncertainty. Various scenarios extended from an NRL benchmark shallow-water model were used to check the analytical ROC expressions and to illustrate the effect of environmental uncertainty on detection performance. The results showed that (1) optimal detection performance in an uncertain environment in diffuse noise depends primarily on the signal-to-noise ratio at the receivers and the rank of the signal matrix, where the rank is an effective representation of the scale of environmental uncertainty; (2) the ROC expression for the optimal Bayesian detector provides a more realistic performance upper bound than that obtained from conventional sonar equations that do not incorporate environmental uncertainty; and (3) detection performance predictions can be performed much faster than with commonly used numerical methods such as Monte Carlo performance evaluations.
This paper will review the reasons for the increasing emphasis on quality assurance in American healthcare and laboratory medicine. This emphasis is driven in part by economic, social and regulatory concerns as well as the traditional commitment to the search for excellence in services provided to patients. The Q-Probes Program of the College of American Pathologists (CAP) represents a response to these pressures and will be described in some detail. The program is based upon the historical success of interlaboratory comparison programs developed and sponsored by the CAP in achieving demonstrable improvement in laboratory performance. These programs are dependent on the gathering of data from large numbers of laboratories in order to establish provisional "benchmarks" of quality practice which serve as a baseline for systematic quality improvement efforts. The Q-Probes Program gathers peer-group specific institutional data concerning defined aspects of quality practice in pathology and laboratory medicine. These highly structured programs provide laboratories and pathology services with a format to collect data for submission to the CAP for analysis and to compare their performance against that of appropriately stratified peer groups. Several representative examples chosen from clinical laboratory medicine and pathology will be presented. We will attempt to demonstrate how individual laboratory and pathology services utilize aggregate data to effect specific changes in practice that lead to improvement in processes of patient care and better patient outcomes.
In recent years personal computers, PCs, have become more popular and competitive with other computers, in terms of price and memory, to run Monte Carlo (MC) programmes. A few years ago some work was performed to test computer speed, mainly other than PCs, using the MC code EGS4. In the present work a Monte Carlo neutron and photon code, MCNP version 4.2 and 4A, was used to test the speed of various PCs. A benchmark was written, with previously checked results, to test the PCs' speed. PCs used in the test were based on the Intel 486 (33, 66 and 100 MHz) and pentium 90. The benchmark was also used on an upgraded SunSparcstation 4/360. The pentium speed was found ot be about 3.5, 2 and 1.5 times faster than that of the 33, 66 and 100 MHz, respectively. The 33 MHz speed was comparable to that of the SunSparcstation. It is concluded that the application of MC code, the cost of the PC and the required speed of results may influence the choice of the PC.
One of the main problems in high-throughput research for materials is still the design of experiments. At early stages of discovery programs, purely exploratory methodologies coupled with fast screening tools should be employed. This should lead to opportunities to find unexpected catalytic results and identify the "groups" of catalyst outputs, providing well-defined boundaries for future optimizations. However, very few new papers deal with strategies that guide exploratory studies. Mostly, traditional designs, homogeneous covering, or simple random samplings are exploited. Typical catalytic output distributions exhibit unbalanced datasets for which an efficient learning is hardly carried out, and interesting but rare classes are usually unrecognized. Here is suggested a new iterative algorithm for the characterization of the search space structure, working independently of learning processes. It enhances recognition rates by transferring catalysts to be screened from "performance-stable" space zones to "unsteady" ones which necessitate more experiments to be well-modeled. The evaluation of new algorithm attempts through benchmarks is compulsory due to the lack of past proofs about their efficiency. The method is detailed and thoroughly tested with mathematical functions exhibiting different levels of complexity. The strategy is not only empirically evaluated, the effect or efficiency of sampling on future Machine Learning performances is also quantified. The minimum sample size required by the algorithm for being statistically discriminated from simple random sampling is investigated.
BACKGROUND: The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. METHODS: Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. RESULTS: The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. CONCLUSION: Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with.
The elimination and side reactions involved in the thermal conversion of sulfonyl precursor chains into poly(p-phenylene vinylene) (PPV) have been studied in detail, using Density Functional theory, along with the MPW1K functional. The performance of the MPW1K functional for describing radical dissociation and internal conversion reactions of sulfonyl precursors has been assessed against the results of benchmark CCSD(T) calculations. Enthalpies as well as entropies are calculated at different temperatures at the level of the rigid rotor-harmonic oscillator approximation. Entropy effects on internal elimination reactions are very limited. In sharp contrast, at the temperatures under which the conversion is usually performed (550 K), entropy contributions to the activation energies are found to be very significant and to strongly favor direct radical dissociations of the precursors. Further radical side reactions following an E(i) conversion through an alkyl substituent may also significantly contribute to the formation of sp(3) defects and/or cross-linked structures in the polymer-an advantageous feature for the making of materials with improved photoluminescence efficiencies.
BACKGROUND: Large-scale sequence comparison is a powerful tool for biological inference in modern molecular biology. Comparing new sequences to those in annotated databases is a useful source of functional and structural information about these sequences. Using software such as the basic local alignment search tool (BLAST) or HMMPFAM to identify statistically significant matches between newly sequenced segments of genetic material and those in databases is an important task for most molecular biologists. Searching algorithms are intrinsically slow and data-intensive, especially in light of the rapid growth of biological sequence databases due to the emergence of high throughput DNA sequencing techniques. Thus, traditional bioinformatics tools are impractical on PCs and even on dedicated UNIX servers. To take advantage of larger databases and more reliable methods, high performance computation becomes necessary. RESULTS: We describe the implementation of SS-Wrapper (Similarity Search Wrapper), a package of wrapper applications that can parallelize similarity search applications on a Linux cluster. Our wrapper utilizes a query segmentation-search (QS-search) approach to parallelize sequence database search applications. It takes into consideration load balancing between each node on the cluster to maximize resource usage. QS-search is designed to wrap many different search tools, such as BLAST and HMMPFAM using the same interface. This implementation does not alter the original program, so newly obtained programs and program updates should be accommodated easily. Benchmark experiments using QS-search to optimize BLAST and HMMPFAM showed that QS-search accelerated the performance of these programs almost linearly in proportion to the number of CPUs used. We have also implemented a wrapper that utilizes a database segmentation approach (DS-BLAST) that provides a complementary solution for BLAST searches when the database is too large to fit into the memory of a single node. CONCLUSIONS: Used together, QS-search and DS-BLAST provide a flexible solution to adapt sequential similarity searching applications in high performance computing environments. Their ease of use and their ability to wrap a variety of database search programs provide an analytical architecture to assist both the seasoned bioinformaticist and the wet-bench biologist.
The goal of occupational risk assessment is often to estimate excess lifetime risk for some disabling or fatal health outcome in relation to a fixed workplace exposure lasting a working lifetime. For sub-chronic or sub-clinical health effects measured as continuous variables, the benchmark dose method can be applied, but poses issues in defining impairment and in specifying acceptable levels of excess risk. Such risks may also exhibit a dose-rate effect and partial reversibility such that effects depend on how the dose is distributed over time. Neurological deficits as measured by a variety of increasingly sensitive neurobehavioral tests represent one such outcome, and the development of a parkinsonian syndrome among welders exposed to manganese fume presents a specific instance. Welders employed in the construction of piers for a new San Francisco-Oakland Bay Bridge in San Francisco were previously evaluated using a broad spectrum of tests. Results for four of those tests (Rey-Osterrieth Complex Figure Test, Working Memory Index, Stroop Color Word Test and Auditory Consonant Trigrams Test) were used in the benchmark dose procedure. Across the four outcomes analyzed, benchmark dose estimates were generally within a factor of 2.0, and decreased as the percentile of normal performance defining impairment increased. Estimated excess prevalence of impairment, defined as performance below the 5th percentile of normal, after 2 years of exposure at the current California standard (0.2 mg/m3, 8 h TWA), ranged 15-32% for the outcomes studied. Because these exposures occurred over a 1-2-year period, generalization to lifetime excess risk requires further consideration of the form of the exposure response and whether short-term responses can be generalized to equivalent 45-year period. These results indicate unacceptable risks at the current OSHA PEL for manganese (5.0 mg/m3, 15 min) and likely at the Cal OSHA PEL as well.
The need for mechanisms to assess the competence and performance of the behavioral health workforce has received increasing attention. This article reviews strategies used in general medicine and other disciplines for assessing trainees and practitioners. The possibilities and limitations of various approaches are reviewed, and the implications for behavioral health are addressed. A conceptual model of competence is presented, and practical applications of this model are reviewed. Finally, guidelines are proposed for building competency assessment protocols for behavioral health.
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Explore the source record for details and available documents.