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A segmentation-based regularization term for image deconvolution.

This paper proposes a new and original inhomogeneous restoration (deconvolution) model under the Bayesian framework for observed images degraded by space-invariant blur and additive Gaussian noise. In this model, regularization is achieved during the iterative restoration process with a segmentation-based a priori term. This adaptive edge-preserving regularization term applies a local smoothness constraint to pre-estimated constant-valued regions of the target image. These constant-valued regions (the segmentation map) of the target image are obtained from a preliminary Wiener deconvolution estimate. In order to estimate reliable segmentation maps, we have also adopted a Bayesian Markovian framework in which the regularized segmentations are estimated in the maximum a posteriori (MAP) sense with the joint use of local Potts prior and appropriate Gaussian conditional luminance distributions. In order to make these segmentations unsupervised, these likelihood distributions are estimated in the maximum likelihood sense. To compute the MAP estimate associated to the restoration, we use a simple steepest descent procedure resulting in an efficient iterative process converging to a globally optimal restoration. The experiments reported in this paper demonstrate that the discussed method performs competitively and sometimes better than the best existing state-of-the-art methods in benchmark tests.

Algorithms↗

A hybrid hopfield network-simulated annealing approach for frequency assignment in satellite communications systems.

A hybrid Hopfield network-simulated annealing algorithm (HopSA) is presented for the frequency assignment problem (FAP) in satellite communications. The goal of this NP-complete problem is minimizing the cochannel interference between satellite communication systems by rearranging the frequency assignment, for the systems can accommodate the increasing demands. The HopSA algorithm consists of a fast digital Hopfield neural network which manages the problem constraints hybridized with a simulated annealing which improves the quality of the solutions obtained. We analyze the problem and its formulation, describing and discussing the HopSA algorithm and solving a set of benchmark problems. The results obtained are compared with other existing approaches in order to show the performance of the HopSA approach.

Journal Article↗

Benchmark dose calculations for methylmercury-associated delays on evoked potential latencies in two cohorts of children.

Delays in evoked potential latencies were observed at increased exposures to methylmercury from seafood in two cohorts of children. Because this outcome parameter appeared to be virtually independent of confounders, including cultural differences, a joint analysis of benchmark doses was carried out. Comparable cohort members included 382 Faroese and 113 Madeiran children without middle ear infection or neurological disease at age seven years. Maternal hair-mercury concentrations at parturition in the Faroese cohort ranged from 0.6 to 39.1 microg/g (geometric average, 4.49 microg/g). In Madeira, mothers who had not changed their diet since pregnancy had current hair-mercury concentrations ranging from 1.1 to 54.4 microg/g (geometric average 10.14 microg/g). The mercury-associated delay in peak III latencies at two frequencies (20 and 40 Hz) showed similar regression equations in the two groups of children, and benchmark dose calculations were therefore carried out for the two groups separately and jointly. For a doubling of a 5% prevalence of abnormal results of the peak III latencies at 40 Hz in a linear dose-response model, the benchmark dose for the maternal hair-mercury concentration was 8.79 microg/g for the Faroese children; 8.04 microg/g for the Madeiran children; and 9.46 microg/g for both groups. Results were similar for the 20 Hz condition. Benchmark dose results were substantially lower using a logarithmic or square root curve function, although the difference in fit between the curves was far from statistically significant. The benchmark results using evoked potential latencies are in close agreement with results based on neuropsychological test performance.

Adult↗

Three case studies of the GasNet model in discrete domains.

A new neural network model - the GasNet - has been recently reported in the literature, which, in addition to the traditional electric type, point-to-point communication between units, also uses communication through a diffilsable chemical modulator. Here we assess the applicability of this model in three different scenarios, the XOR problem, a food gathering task for a simulated robot, and a docking task for a virtual spaceship. All of them represent discrete domains, a contrast with the one where the GasNet was originally introduced, which had an essentially continuous nature. These scenarios are well-known benchmark problems from the literature and, since they exhibit varying degrees of complexity, they impose distinct performance demands on the GasNet. The experiments were primarily intended to better understand the model, by extending the original problem domain where GasNet was introduced. The results reported point at some difficulties with the current GasNet model.

Neural Networks, Computer↗

Gaussian processes for classification: mean-field algorithms.

We derive a mean-field algorithm for binary classification with gaussian processes that is based on the TAP approach originally proposed in statistical physics of disordered systems. The theory also yields an approximate leave-one-out estimator for the generalization error, which is computed with no extra computational cost. We show that from the TAP approach, it is possible to derive both a simpler "naive" mean-field theory and support vector machines (SVMs) as limiting cases. For both mean-field algorithms and support vector machines, simulation results for three small benchmark data sets are presented. They show that one may get state-of-the-art performance by using the leave-one-out estimator for model selection and the built-in leave-one-out estimators are extremely precise when compared to the exact leave-one-out estimate. The second result is taken as strong support for the internal consistency of the mean-field approach.

Algorithms↗

Patient care guidelines in pediatrics.

The increase in availability of patient care guidelines is consistent with the expansion of managed care health care systems and enhanced efforts of health care providers to deliver evidence-based patient care. When used effectively, guidelines support: 1) the reduction of unexplained variation in health care practice; 2) education of practitioners and health care delivery systems; and 3) the continuous improvement in processes that improve patient outcomes. It is with these goals in mind that Milliman and Robertson released its latest publication of Health Care Management Guidelines entitled Pediatric Health Status Improvement and Management (HSIM). This publication contains comprehensive information on many aspects of pediatric care, from the prenatal period through adolescence, from preventive medicine through chronic care. Like other Milliman and Robertson Health Care Management Guidelines publications, Pediatric HSIM offers both treatment guides and benchmarks that enable health care professionals to provide optimal levels of care and to measure their performance against peers. The primary focus of Pediatric HSIM is on wellness across a child's lifetime, an objective that fits well with our goal as providers of care to children of keeping patients healthy through preventive medicine.

Child↗

Documentation and coding of medical records in a tertiary care center: a pilot study.

BACKGROUND: Since the medical record is the major source of health information, it is necessary to maintain accurate, comprehensive and properly coded patient data. We reviewed 300 medical records from patients at King Faisal Specialist Hospital and Research Center, representing four departments (medicine, surgery, pediatrics and obstetrics and gynecology). METHODS: The records were audited following the guidelines of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for accuracy and completeness of documentation and coding of primary and secondary diagnoses and procedures performed. RESULTS: Of 1051 items abstracted, 876 (83.3%) were accurately documented, 41 (3.9%) were inaccurately documented, and 134 (12.7%) were not documented. Of the items abstracted, 736 (70%) were assigned a correct code, 110 (10.5%) were assigned an incorrect code, and 205 (19.5%) were not coded. More items classified as accurately documented were coded correctly (71.1%) than items inaccurately documented (49.7%) (P < 0.0001). The difference in comprehensiveness of documentation, which reflects physician performance, was not statistically significant among the four departments (P value < 0.234). The difference in the accuracy of coding, which reflects coder performance, was statistically significant (P value < 0.036). CONCLUSIONS: Only 60% of the audited records met the benchmark for good quality medical records with regards to documentation and coding. A positive correlation between the accurate documentation and correct coding was noted, which supports the conclusion that high quality documentation enhances coding accuracy. These data, although encouraging, suggest room for improvement, which can be achieved through the collaboration of clinicians, who have extensive clinical experience, and coding professionals, who have comprehensive classification system expertise.

Documentation↗

Reporting tools for clinical quality improvement.

To support clinical quality improvement (QI), effective quality analysis tools are essential. New strategies that we have incorporated into our routine assessment activities include comparative screening, clinical process benchmarking tables, and run charts for key quality indicators. To target areas for improvement, we use comparative screening. We have access to clinical data for 11 comparable medical centers. Currently, these data are used to identify our ranking relative to the others for mortality, readmission, and length of stay. Diagnosis-related groups and ICD-9-CM clusters serve as clinical groupings with defined minimal case volume requirements to ensure meaningful comparisons. These comparative reports permit our clinical leaders and hospital administrators to focus QI activities. Clinical process benchmarking involves peer-to-peer interfacility communication to identify those factors that create outstanding clinical performance. We successfully have used this tool to support process improvement in cardiac-surgery, administration of patient controlled analgesia, and respiratory therapy. Interdisciplinary QI teams identify the key investigative questions. Team members then contact their counterparts at similar facilities, which differ from our hospital in quality, based on empirical evidence or through comparative screening. The information that is obtained is collated in a tabular format, along with our own information, to permit easy identification of key clinical processes associated with better outcomes. Key quality and utilization goals at our hospital include reducing unplanned readmissions by 10%, achieving a 5% lower average length of stay, and not exceeding Health Care Financing Administration expected mortality rates in any clinical area.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

Benchmarking physicians' practices: trends toward the millennium.

The health care industry has enjoyed--and suffered--no shortage of changes in the last year. Many are the effects of the ongoing trends internal and external to the industry and others are the seemingly spontaneous events the industry is beginning to take as "business as usual." The challenges facing health care come as much from the internal dynamics of an industry in rapid consolidation and transition as from the societal, economic, cultural, and political contexts in which it operates.

Benchmarking↗

[A PCA based efficient stellar spectra classification method].

Stellar spectra classification is an indispensable part of any workable automated recognition system of celestial bodies. This paper introduces an efficient method of automated classification of stellar spectra based on the principal component analysis (PCA). The method consists of two parts. In the first part, the eigen-matrix is built by a standard PCA technique where only the first two eigenvectors are selected due to their predominance. More specifically, the first two eigenvalues are found to always represent more than 95% of the total sum of all the eigenvalues, and much larger than others in our all experiments. The principal component space of stellar (V1, V2) then is constructed from the first two eigenvectors. In the second part, namely classification part, an unknown spectrum X is first mapped to a 2D space with the two coordinates defined respectively as (V1T X, V2T X), then the nearest neighbor approach in this 2D space is employed to determine the spectral type as well as luminosity class of the input spectrum. The experimental results show that our new method can achieve comparable performance with that by the standard MK spectral types classification criterion, which is regarded as a benchmark in astronomy field. Thanks to its high efficiency, our new method appears promising especially for the processing of spectra in large quantities collected from large survey projects, such as LAMOST project in our country.

English Abstract↗

Outcomes and benchmarks in the home medical equipment services industry: the time is now.

The home medical equipment services industry has started to participate in outcomes measurement and benchmarking. As a result, the industry now will be able to capture and to compare treatment, performance, and outcome data to make informed decisions about the benefit and the value of various options to treat illness or to maintain wellness in the home setting.

Durable Medical Equipment↗

Risk-adjusted infection rates in surgery: a model for outcome measurement in hospitals developing new quality improvement programmes.

Assessment of healthcare quality is a major challenge in countries such as Hungary where there is limited experience with measurement of patient outcomes. We sought to develop the capacity for valid outcome measurement in Hungarian hospitals using surgical site infection (SSI) surveillance as a model and to identify areas for improvement by comparing SSI rates in Hungarian hospitals to benchmarks published by the United States Centers for Disease Control and Prevention's National Nosocomial Infection Surveillance (NNIS) System. We surveyed the incidence of SSI among 5126 patients undergoing 6006 procedures in 20 public hospitals in Hungary during 1996 using the Hospitals in Europe Link for Infection Control through Surveillance (HELICS) protocol, a protocol consistent with the methods used by the NNIS System. Cholecystectomy, herniorrhaphy, appendectomy, and open reduction of fracture--four of the five most commonly performed procedures in Hungary in 1996--comprised 85% of the procedures analysed. Cumulative SSI rates for herniorrhaphy and appendectomy were comparable to NNIS System benchmarks. Cumulative SSI rates for cholecystectomy were significantly higher in Hungarian hospitals among risk categories that included open procedures. Nearly half of the hospitals had SSI rates for cholecystectomy that were high outliers (>90% percentile) compared to NNIS System benchmarks. Cumulative SSI rates for open reduction of fracture and mastectomy were significantly higher in Hungarian hospitals due to high rates in a few hospitals. The duration of surgery for all procedure types was substantially shorter in Hungarian hospitals compared with NNIS System hospitals. Future work should focus on optimizing prevention strategies for patients undergoing cholecystectomy, open reduction of fracture, and mastectomy. The effect of the utilization of open vs. laparoscopic cholecystectomy, short procedure duration, and procedure volume on SSI rates should be evaluated further. This programme expanded the capacity of Hungarian hospitals to perform surgical site infection surveillance and can serve as a model for hospitals in other countries with limited experience with outcome measurement.

Benchmarking↗

Carotid endarterectomy using regional anesthesia: a benchmark for stenting.

Regional block (RB) anesthesia for carotid surgery offers the advantage of continuously monitoring the awake patient's neurologic status during carotid cross-clamping. We retrospectively studied our experience with RB for carotid endarterectomy (CEA) procedures performed during the period January 1, 1995 through December 31, 2001. A total of 388 consecutive CEA procedures were performed; RB was used in 314 and general anesthesia (GA) in 74. Three patients required conversion from RB to GA. GA was used only in patients who could not tolerate a block or needed combined coronary artery bypass grafting (CABG) and carotid surgery. New ipsilateral stroke did not occur in RB patients; one patient extended a previous stroke. Three in-hospital deaths occurred; these were all cardiac-related. In GA patients undergoing CEA without CABG (CEA only, n = 58), one stroke and no deaths occurred. The combined stroke and mortality rate for all CEA-only patients was 1.3 per cent (five of 372). RB allows 90 per cent of procedures to be performed without shunting, thus facilitating endarterectomy and patch angioplasty. CEA performed under RB is similar to carotid stenting because both procedures allow monitoring of the awake patient's neurologic status. The very low procedural complication rate in this study warrants the consideration of carotid surgery under regional block as a benchmark for future carotid angioplasty and stenting studies.

Aged↗

Productivity and acuity tool for wound care and hyperbaric medicine centers.

The unique workload and patient acuity in wound care and hyperbaric centers leaves staffing to subjective interpretation; lack of objective data makes it difficult to determine department budgets and appropriate staffing patterns. To address these problems, an objective tool was developed to assess acuity and productivity in hyperbaric and wound care departments. Patient classifications were created to define acuity based on disease and associated procedures. A total of 38 distinct indicators were identified for wound care and 22 for hyperbaric oxygen therapy. Time studies were performed on identified tasks. All patients were scored and placed in acuity classes. The number of hours per patient day was calculated and multiplied by direct care hours to find number of full-time-equivalents (FTEs). The tool was tested for content validity and clinical applicability. The tool was found to accurately reflect patient-care work and suitable as a benchmarking tool for use in monoplace hyperbaric and wound care centers.

Benchmarking↗

Generation and validation of a shielding library based on ENDF/B-VI.8.

For various shielding and reactor pressure vessel dosimetry applications, a pseudo-problem-independent neutron-photon coupled MATXS-format library, based on the last release of ENDF/B-VI, has been generated as a part of the update program for KASHIL-E6, which was based on ENDF/B-VI.5. It has a VITAMIN-B6 neutron and photon energy group structures, i.e. 199 groups for the neutron and 42 groups for the photon. The neutron and photon weighting functions and the Legendre orders of scattering are the same as in KASHIL-E6. The library has been validated through some benchmarks: the PCA-REPLICA and NESDIP-2 experiments for the light-water reactor (LWR) pressure vessel facility benchmark, the Winfrith Iron 88 experiment for the validation of the iron data and the Winfrith Graphite experiment for the validation of the graphite data. These calculations were performed by the TRANSX/DANTSYS code system. In addition, the substitutions of the JENDL-3.3 and JEFF-3.0 data for Fe, Cr, Cu and Ni, which are very important nuclides for shielding analyses, were investigated to estimate the effects on the benchmark calculation results.

Algorithms↗

Benchmarking patient improvement in physical therapy with data envelopment analysis.

PURPOSE: The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting. DESIGN/METHODOLOGY/APPROACH: The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods. FINDINGS: Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension. RESEARCH LIMITATIONS/IMPLICATIONS: The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results. PRACTICAL IMPLICATIONS: This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics. ORIGINALITY/VALUE: DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Arthroplasty, Replacement, Knee↗

Building the road map for a performance-driven organization.

The strategic importance of performance improvement (PI) in healthcare is being recognized across the country. Organizations that recognize PI's importance and support PI will be better prepared for a healthcare future that mandates measurable value. Building the foundation for success is neither a simple task nor a cheap one. It requires a total systems perspective on improving processes and systems, a commitment to continual learning, and recognition of what other industries have already learned--to succeed, you must constantly innovate and improve. This article discusses one organization's approach to building the foundation for a performance-driven 21st-century healthcare system.

Benchmarking↗

What really works.

When it comes to improving business performance, managers have no shortage of tools and techniques to choose from. But what really works? What's critical, and what's optional? Two business professors and a former McKinsey consultant set out to answer those questions. In a ground-breaking, five-year study that involved more than 50 academics and consultants, the authors analyzed 200 management techniques as they were employed by 160 companies over ten years. Their findings at a high level? Business basics really matter. In this article, the authors outline the management practices that are imperative for sustained superior financial performance--their "4+2 formula" for business success. They provide examples of companies that achieved varying degrees of success depending on whether they applied the formula, and they suggest ways that other companies can achieve excellence. The 160 companies in their study--called the Evergreen Project--were divided into 40 quads, each comprising four companies in a narrowly defined industry. Based on its performance between 1986 and 1996, each company in each quad was classified as either a winner (for instance, Dollar General), a loser (Kmart), a climber (Target), or a tumbler (the Limited). Without exception, the companies that outperformed their industry peers excelled in what the authors call the four primary management practices: strategy, execution, culture, and structure. And they supplemented their great skill in those areas with a mastery of any two of four secondary management practices: talent, leadership, innovation, and mergers and partnerships. A company that consistently follows this 4+2 formula has a better than 90% chance of sustaining superior performance, according to the authors.

Benchmarking↗