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NLCD: A method to discover nonlinear causal relations among genes.

Distinguishing correlation from causation is a fundamental challenge in many scientific fields, including biology, especially when interventions like randomized controlled trials are infeasible and only observational data are available. Methods based on statistical tests of conditional independence within the Mendelian Randomization framework can detect causality between two observed variables that are each associated with a third instrumental variable. However, these methods for detecting causal relationships between traits (e.g., two gene expression or clinical traits associated with a genetic variant, all observed in the same population) often assume a linear relationship, thereby hindering the discovery of causal gene networks from genomics data. We have developed NLCD, a method for NonLinear Causal Discovery from genomics data based on nonlinear regression modeling and conditional feature importance scoring. NLCD uses these techniques to extend the statistical tests in an existing linear causal discovery method called the Causal Inference Test (CIT). We benchmarked NLCD against current state-of-the-art methods: CIT, Findr, and MRPC. On simulated datasets, NLCD performs comparably to most methods in detecting linear relations (Average AUPRC (Area Under the Precision-Recall Curve) of NLCD = 0.94, CIT = 0.94, Findr = 0.94, and MRPC = 0.99), and outperforms them in detecting nonlinear (sine and sawtooth type) relations between two genes (Average AUPRC of NLCD = 0.76, CIT = 0.60, Findr = 0.56, and MRPC = 0.73). When tested on a nonlinear subset of a yeast genomic dataset to recover known causal relations involving transcription factors, NLCD and CIT performed comparable to each other and slightly better than Findr and MRPC (Average AUPRC of NLCD = 0.82, CIT = 0.81, Findr = 0.71, and MRPC = 0.54). On application to a human genomic dataset, NLCD revealed active causal gene pairs (IRF1 → PSME1 and HLA-C → HLA-T) in the muscle tissue, and clarified the promises and challenges in discovering causal gene networks in tissues under in vivo human settings.

Humans↗

Improving oxygen concentration control in activated sludge process with estimation of respiration and scheduling control.

The paper presents an efficient and simple model-based method of on-line estimation of respiration from the current values of dissolved oxygen concentration and airflow signals. Fast estimation of respiration is important because respiration appears as the most important disturbance signal in the control of dissolved oxygen concentration, and could therefore be used for improving control efficiency. A parameter scheduling PI (proportional and integral) control scheme is proposed, where the estimated respiration signal is used for scheduling of the PI controller parameters, by using local linearization of the process dynamics. The performance of the scheduling controller is compared to a conventional PI controller in simulation using the COST simulation benchmark, and experimentally on an activated sludge process pilot plant.

Aerobiosis↗

Proactive performance measures.

Adoption of a process of careful selection and implementation generating the appropriate proactive (leading) performance measures will provide an important tool with which to progress. When used in combination with traditional financial performance measures, proactive performance measures contribute to our cache of competitive weapons.

Benchmarking↗

The balanced scorecard: an integrative approach to performance evaluation.

In addition to strict financial outcomes, healthcare financial managers should assess intangible assets that affect the organization's bottom line, such as clinical processes, staff skills, and patient satisfaction and loyalty. The balanced scorecard, coupled with data-warehousing capabilities, offers a way to measure an organization's performance against its strategic objectives while focusing on building capabilities to achieve these objectives. The balanced scorecard examines performance related to finance, human resources, internal processes, and customers. Because the balanced scorecard requires substantial amounts of data, it is a necessity to establish an organizational data warehouse of clinical, operational, and financial data that can be used in decision support. Because it presents indicators that managers and staff can influence directly by their actions, the balanced-scorecard approach to performance measurement encourages behavioral changes aimed at achieving corporate strategies.

Benchmarking↗

Colonoscopy procedures at a small rural hospital.

BACKGROUND: Screening for colon cancer by colonoscopy is increasingly recommended in the medical literature. There are few, if any, reports in the medical literature regarding the provision of colonoscopy services in small rural hospitals by non-specialist endoscopists. OBJECTIVE: This study, carried out in a small rural hospital in northern Ontario, tracks the development of a colonoscopy service provided by a general practitioner with some basic colonoscopy training. It compares the GP's past and present level of expertise with literature-derived benchmarks and gauges the safety and effectiveness of the procedure. METHODS: A retrospective chart review of 616 colonoscopies performed by this GP between April 1992 and September 2003. RESULTS: The results of the study support the idea that colonoscopy in a rural setting can be provided safely and effectively. CONCLUSION: Colonoscopy has a high safety profile when provided by general practitioners, and training in the procedure should be available to interested family practitioners and family practice residents.

Aged↗

The road to transparency.

A growing number of hospitals are putting transparency at the forefront of their strategic agendas, seeing it not only as the key to better performance, but as an important tool for improving community trust.

Benchmarking↗

Mix of national, local benchmarks are critical for perspective.

You need a range of national and local data to make your benchmarking successful: national to help you keep your finger on the pulse and local to help you differentiate your service. Never rely on national averages. Instead, find a better performer and study its processes to find out the reasons behind the data. No matter what your local situation is, you always can learn from someone else, particularly if they're different from you.

Benchmarking↗

Management and control of public hospitals--the use of performance measures in Norwegian hospitals. A case-study.

This paper investigates the use of performance measures in the management control and decision-making processes in the Norwegian hospital sector. The motivation for the study is to understand the implementation of performance-based management systems which is an element in the international New Public Management (NPM) reforms waves now affecting the hospital sector. The theoretical framework is based on the description of hospitals as complex and decoupled organizations. The use of benchmarking is discussed, and the focus is put on the information biases that exist in such data. The main finding in the empirical study is that the ambiguous information which exists in the performance measures used at the hospital department level, maintains the decoupling between the clinical activities and the management control practices. This decoupling creates management control problems because it hampers the knowledge on the cause-effects of actions, which is important in order to undertake strategic decisions and diagnostic action. In order to increase transparency, cost information should be decomposed as to develop practical indicators for interactive control purposes in clinical departments.

Efficiency, Organizational↗

Performance evaluation of arterial femoral sheath removal by registered nurses after PCI.

BACKGROUND: Sheath removal after PCI by registered nurses can improve patients' comfort and shorten immobilisation time. As sheath removal is not without risk, it is important to assure the quality of performance. AIMS: The aim was (a) to check if nurses' performance in 1999 and 2005 was in accordance with the protocol for arterial sheath removal and (b) to compare both measurements to explore differences in performance over time. METHODS: We trained registered nurses in sheath removal and observed them during sheath removal in elective uncomplicated PCI-patients. We developed and used a checklist, including 10 elements and 65 items. RESULTS: Both in 1999 (n=43 observations with 13 nurses) and 2005 (n=42 observations with 16 nurses) the norm of more than 90% for the total score was not achieved: we found 82% and 80%, respectively. Four elements scored more than 90%, and three elements scored less than 80% at both points in time. The results on the other three elements differed significantly over time. CONCLUSION: Registered nurses achieved the norm for good performance (80-89%) of removing arterial sheaths according to protocol after a training programme and this is stable in time. Since the norm for excellent performance (> or =90%) was not achieved, current performance could be improved, e.g. by yearly repetition of training and observation of skills. More research is needed, and could focus on the validation of the instrument. Also multi-centre studies with this checklist could test the association between the quality of arterial femoral sheath removal and the occurrence of vascular complications.

Adult↗

Reliability of concentric and eccentric torque during isokinetic knee extension in post-stroke hemiparesis.

BACKGROUND: Emerging evidence on the velocity-dependent nature of force impairment in post-stroke hemiparesis has emphasized the complexity of strength and motor performance assessments in this clinical population. The need to establish reliability and responsiveness of muscle performance measures across a broad range of concentric and eccentric movement speeds is therefore clear, as these metrics will provide benchmarks both for making clinical inference and evaluating meaningful clinical change following interventions. METHODS: Isokinetic knee extensor strength was tested at 14 angular velocities in 17 adults with chronic post-stroke hemiparesis (>18 months), and 13 non-disabled controls. Identical tests were conducted on two occasions separated by two days. Test-retest reliability of maximal isokinetic torque was evaluated using intraclass correlation. Absolute reliability was assessed using standard error of measurement from which smallest real differences were derived. FINDINGS: Overall, intraclass correlation coefficients were excellent for both hemiparetic (0.891) and control (0.937) groups. Intraclass correlation coefficients for each criterion speed were also high for both groups (>0.86). Measurement error relative to the mean torque varied between 14.1% and 26.3% for hemiparetic subjects and 6.0-18.1% for controls. The smallest real difference relative to mean torque was 39.0-72.7% and 16.6-50.2% for hemiparetic and control subjects, respectively. INTERPRETATION: Isokinetic knee extension torque can be measured reliably in persons with chronic post-stroke hemiparesis and in non-disabled controls across a full functional range of concentric and eccentric speeds. Established measurement error and smallest real differences will aid interpretation of longitudinal observations of muscle performance in this clinical population.

Adult↗

Profile of movement demands of national football players in Australia.

Descriptive data on game movement demands of contemporary players in the Australian National Soccer League (NSL, now the A League) are lacking. The purpose of this study was to profile movement demands of NSL games and specifically analyse distance covered, time in various speed categories (e.g., walking, jogging, striding, etc.), number of sprint speed efforts and overall mean player speed. Video tapes of 45 players from the 2002 to 2003 NSL season were analysed for whole- and half-game movement patterns and game statistics using Trak Performance software. Bivariate and ANOVA statistics were used for between game halves and positional comparisons. Results showed no changes to the frequency and speed of high intensity demands in both halves of the game. However, a 14% slower overall speed in the second half of the game when compared with the first half was attributed to fewer observations of the low intensity movements (9.0% less walking and 12.4% less jogging) and more stationary periods. Engagement in game events such as kicking and passing was also 11.2% less frequent in the second versus first half of games. Position-specific results of higher movement speeds of midfield players (7.2kmh(-1)), compared with defenders (6.1kmh(-1)), agree with previous results from international professional leagues. The results provide position-specific directions for future conditioning drills and benchmark fitness requirements in high level soccer players. The results also highlight the challenge to ensure consistency of second-half performances for elite level soccer players in Australia.

Adult↗

Comparison of variance components and sibpair-based approaches to quantitative trait linkage analysis in unselected samples.

We compared the statistical performance of sibpair-based and variance components approaches to multipoint linkage analysis of a quantitative trait in unselected samples. As a benchmark dataset, we used the simulated family data from Genetic Analysis Workshop 10 [Goldin et al., 1997], and each method was used to screen all 200 replications of the GAW10 genome for evidence of linkage to quantitative trait Q1. The sibpair and variance components methods were each applied to datasets comprising single-sibpairs and complete sibships, and for further comparison we also applied the variance components method to the nuclear family and extended pedigree datasets. For each analysis, the unbiasedness and efficiency of parameter estimation, the power to detect linkage, and the Type I error rate were estimated empirically. Sibpair and variance components methods exhibited comparable performance in terms of the unbiasedness of the estimate of QTL location and the Type I error rate. Within the single-sibpair and sibship sampling units, the variance components approach gave consistently superior power and efficiency of parameter estimation. Within each method, the statistical performance was improved by the use of the larger and more informative sampling units.

Chromosome Mapping↗

Benchmarking graduate health administration programs: stakeholders' perceptions.

The purpose of this study was to identify and compare among key stakeholders the factors in graduate health care administration education that are perceived to be important for ranking, or benchmarking, based on the opinions of those stakeholders, i.e., program directors, faculty, graduate students, and accrediting agency commissioners. We used an original survey to obtain stakeholders' perceptions and opinions about important process and outcome measures. We sent it to all ACEHSA-accredited graduate health care administration programs in the United States, Canada, and Puerto Rico; to full-time faculty members in each program; to three current graduate students in each program, and to all ACEHSA commissioners. We performed frequency of responses, Analysis of Variances (ANOVA) tests, and Dunnett T3 tests. A response rate of 32 percent (n = 156) was achieved for all stakeholders. A total of 67 percent of all respondents reported that benchmarking graduate health care administration programs was important. The study results revealed a significant difference between populations on the importance of evaluating certain process and outcome measures related to curriculum, research, student characteristics, and resources. However, most of the stakeholders reported that curriculum, faculty, and graduate student performance were the key quality indicators of a program. The results of this study provide preliminary information for health care administration programs to begin to develop an educational benchmarking effort.

Accreditation↗

Responsibility-centered management: a 10-year nursing assessment.

In 1988-89, Indiana University became the first public university to implement responsibility-centered management (RCM) comprehensively. This article describes and assesses the implementation of RCM on the core campus of Indiana University School of Nursing in Indianapolis. It describes how RCM encouraged an information-rich environment, particularly with the advent of economic modeling; decision making linked to strategic goals/objectives; and a performance-based reward structure (e.g., merit pay increases and incentive plans). It ends with a discussion about the worth of RCM and the changes that frame-work produced, particularly in reconceptualizing the roles of the business officer and dean. The most profound consequence of RCM may be the effect it has in encouraging rethinking of what it means to be a school of nursing at this point in time.

Benchmarking↗

Epilepsy in the accident and emergency department--developing a code of safe practice for adult patients. South East and South West Thames Accident and Emergency Specialty Sub-committees.

OBJECTIVES: To benchmark current practice in the management of adult patients presenting with seizures to the accident and emergency (A&E) departments by performing a comparative interdepartmental audit. To assess the quality and degree of completeness of documentation in A&E records and to develop a proforma for the documentation of any case presenting with a seizure which would incorporate management guidelines for use by A&E doctors. METHODS: This was a retrospective, criterion based audit carried out in 12 A&E departments in the South Thames region. It involved 1200 adult patients who presented to A&E departments after a seizure. The degree of completeness of A&E records was assessed using criteria identified by A&E consultants and neurologists. Guidelines for use in the management of patients with seizures have been produced. RESULTS: Important aspects of the history and examination were frequently unrecorded in patients' notes. The recording of vital signs was particularly poor. A diversity of practice was shown between the departments that were audited and the number of investigations performed in each department varied considerably. Hospital admissions for patients with first seizures varied widely between departments, ranging from between 34.6% to 91.7% of cases. Documentation of advice given to patients about driving was evident in just 0.9% of cases. CONCLUSIONS: Wide interdepartmental variation exists in both the quality of information recorded in A&E records and in the management of patients. Deficiencies could be minimised and potential improvements in the quality of documentation might be achieved by the introduction of a structured proforma incorporating pre-defined management guidelines.

Adolescent↗