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Reactivity and binding energies of transition metal halide ions with benzene.

We have generated novel halogen-ligated transition metal ions MX(n)+ (M = Sc, Ti, V, and Fe, X = Cl, Br and I, n = 1-3). We have explored their reactions with benzene, a typical aromatic hydrocarbon. Attachment of one benzene molecule is usually rapid, whereas attachment of a second benzene molecule is generally much slower. The kinetics were analyzed to estimate binding energies, modeling the attachment reaction as a radiative association process. In all cases the Standard Hydrocarbon semiquantitative estimation approach was employed, and in some cases the more accurate variational transition state (VTST) kinetic modeling approach was also applied. Density functional (DFT) quantum calculations were also performed to give computed binding energies for some of the complexes. Taking previously determined binding energies for halogen-ligated alkaline-earth ions as benchmarks, it is concluded that binding of the first benzene molecule to the transition-metal species is strongly enhanced by specific chemical interactions, while binding of the second benzene molecule is more nearly electrostatic. The binding energies are not strongly dependent on the identity of the transition metal ion, and the metal-ion dependences can be rationalized in terms of valence-orbital occupations of the metals. The binding energies are nearly independent of the identity of the halogen ligands.

Journal Article↗

How DRGs hurt academic health systems.

BACKGROUND: Academic health centers continue their mission of clinical care, education, and research. This mission predisposes them to accept patients regardless of their individual clinical variation and financial risk. The purpose of this study is to assess the variation in costs and the attendant financial risk associated with these patients. In addition, we propose a new reimbursement methodology for academic health center high-end DRGs that better aligns financial risks. STUDY DESIGN: We reviewed clinical and financial data from the University of Michigan data warehouse for FY1999 (n = 39,804). The diagnosis-related groups were classified by volume (group 1, low volume to group 4, high volume). The coefficient of variation for total cost per admission was then calculated for each DRG classification. A regression analysis was also performed to assess how costs in the first 3 days estimated total costs. A hybrid methodology to estimate costs was then determined and its accuracy benchmarked against actual Medicare and Blue Cross reimbursements. RESULTS: Low-volume DRGs (< 75 annual admissions) had the highest coefficient of variation relative to each of the three other DRG classifications (moderate to high volume, groups 2, 3, and 4). The regression analysis accurately estimated costs (within 25% of actual costs) in 64.7% of patients with a length of stay > or = 4 days (n = 16,287). This regression fared well compared with actual FY 1999 DRG-based Medicare and Blue Cross reimbursements (n = 9,085 with length of stay > or = 4 days), which accurately reimbursed the University of Michigan Health System in only 43.9% of cases. CONCLUSIONS: Academic health centers receive a disproportionate number of admissions to low-volume, high-variation DRGs. This clinical variation translates into financial risk. Traditional risk management strategies are difficult to use in health care settings. The application of our proposed reimbursement methodology better distributes risk between payers and providers, and reduces adverse selection and incentive problems ("moral hazard").

Academic Medical Centers↗

Replantation and revascularization of the digits in a community microsurgical practice.

One-hundred and twenty-seven digits in Verdan zones I and II, and 24 thumbs in 106 patients were reviewed from 1979 to 1995. Patients were all followed for a minimum of 5 months to assess early results and complications, and to determine if a short course (minimum 3 days) of dextran 40 anticoagulation adversely affected digit survival. The total survival rate was 88 percent. Digits with only a single artery and vein repaired had a significantly higher rate of failure (p > .05). Index and small fingers also showed a trend toward lower survival. Vein grafts were used in 22 percent of cases. No vascular problems were noted after 5 days. Variables not affecting survival were: presence of a joint fusion, type of fixation, level of injury, number of digits, mechanism of injury, and use of vein grafts. The average hospital stay for the group was 6.5 days (+/-SD 3.3). No complications were seen with dextran use. A total of 51 complications were seen overall and the non-union rate was 10 percent. Community-based replantation and revascularization can be performed with early results equivalent to prior published studies. Complications are to be expected and demand expeditious treatment. Functional recovery of severed digits remains the benchmark for success in these injuries, however, lost digits never work.

Adolescent↗

A psychometric analysis of the Needs Assessment Checklist (NAC).

DESIGN: Consecutive series, psychometric validation study. OBJECTIVE: To evaluate the psychometric reliability and validity of a clinically focused measure of rehabilitation outcome, known as the Needs Assessment Checklist (NAC). SETTING: Tertiary care, spinal cord injury centre (National Spinal Injuries Centre), Stoke Mandeville Hospital, UK. PARTICIPANTS: In total, 43 spinal cord injured (SCI) in-patients (38 male and five female). During this study all patients actively participated in a comprehensive, multidisciplinary Goal Planning and Needs Assessment Rehabilitation Programme. INTERVENTION: Test-retest and concurrent assessment, conducted in one administration, within a week of routine clinical assessment. Reliability analyses were performed examining the NAC's internal consistency, test-retest reliability, and concurrent validity. MAIN OUTCOME MEASURES: The NAC is a rehabilitation outcome measure, specifically developed for the SCI population, which is used to assess patient attainment in core rehabilitation areas at mobilisation and prior to discharge. The Spinal Cord Independence Measure (SCIM) and Hospital Anxiety and Depression Scale (HADS) were also employed as comparable benchmark assessment measures with established psychometric properties. Patient comments were gained during this administration, rating the NAC with regard to its usefulness, clarity, and personal relevance. RESULTS: Reliability analyses yielded high internal consistency coefficients (mean alpha = 0.8587, SD = 0.918). All subscales performed above the specified level (0.7). The mean item-internal validity correlation for NAC subscales was 0.5921 (SD = 0.1411). Test-retest correlations ranged between 0.694 (Bladder Management) and 0.904 (Skin Management) (P < or = 0.01). The mean percentage of agreement between clinical and test-retest assessment over all NAC subscales was 75.5% (SD = 5.01%). Concurrent validity analyses correlating individual subscale scores with SCIM and HADS subscales produced high correlations between 0.850 (Activities of Daily Living with SCIM Self-Care, P < or = 0.01) and -0.466 (Psychological Issues with HADS-Depression, P < or = 0.01). Significant differences were identified between injury category within NAC subscales; however, this was not consistent. The NAC achieved high patient ratings, attaining mean ratings of seven (out of 10) for usefulness, and eight for its clarity and personal relevance. CONCLUSION: The findings of this study indicate that the NAC is a psychometrically reliable and valid clinical measure of rehabilitation outcome.

Activities of Daily Living↗

Benchmarking the CATMA microarray. A novel tool for Arabidopsis transcriptome analysis.

Transcript profiling is crucial to study biological systems, and various platforms have been implemented to survey mRNAs at the genome scale. We have assessed the performance of the CATMA microarray designed for Arabidopsis (Arabidopsis thaliana) transcriptome analysis and compared it with the Agilent and Affymetrix commercial platforms. The CATMA array consists of gene-specific sequence tags of 150 to 500 bp, the Agilent (Arabidopsis 2) array of 60mer oligonucleotides, and the Affymetrix gene chip (ATH1) of 25mer oligonucleotide sets. We have matched each probe repertoire with the Arabidopsis genome annotation (The Institute for Genomic Research release 5.0) and determined the correspondence between them. Array performance was analyzed by hybridization with labeled targets derived from eight RNA samples made of shoot total RNA spiked with a calibrated series of 14 control transcripts. CATMA arrays showed the largest dynamic range extending over three to four logs. Agilent and Affymetrix arrays displayed a narrower range, presumably because signal saturation occurred for transcripts at concentrations beyond 1,000 copies per cell. Sensitivity was comparable for all three platforms. For Affymetrix GeneChip data, the RMA software package outperformed Microarray Suite 5.0 for all investigated criteria, confirming that the information provided by the mismatch oligonucleotides has no added value. In addition, taking advantage of replicates in our dataset, we conducted a robust statistical analysis of the platform propensity to yield false positive and false negative differentially expressed genes, and all gave satisfactory results. The results establish the CATMA array as a mature alternative to the Affymetrix and Agilent platforms.

Arabidopsis↗

Managing human resources in healthcare: learning from world class practices--Part I.

This paper, which is presented in two parts, is intended to demonstrate that practices related to the area of human resources management, adopted by model organisations that have dominated their markets consistently, can lend themselves very well to the healthcare sector, which is primarily a "people-oriented" sector. As change in a modern business context is set to continue in an unrelenting way, most organisations will be presented with the challenge of developing the necessary skills and areas of expertise to enable them to cope with the demands on them, master technological opportunities at their disposal, learn how to exploit modern management concepts and optimise value to all the stakeholders they intend to serve. This paper draws from best practices using the experiences of quality recognised organisations and many admired names through pioneering human resource policies and practices and through clear demonstrations on the benefits of relying on people as the major "asset". Part I of this article addresses the importance of human resources as revealed through models of management for organisational excellence. In particular, the paper refers to the criteria for excellence in relation to people management using the following prestigious and integrative management models: Deming Prize (Japan); European Quality Award Model (Europe); and Malcolm Baldrige National Quality Award (USA). In addition, this paper illustrates several case studies using organisations known for their pioneering approaches to people management and which led them to win very prestigious quality awards and various international accolades. The paper concludes by reinforcing the point that human resource management in a healthcare context has to be viewed as an integrated set of processes and practices which need to be adhered to from an integrated perspective in order to optimise individuals' performance levels and so that the human potential can be exploited fully.

Awards and Prizes↗

Diversity leadership and organizational transformation: performance indicators for health services organizations.

Health services organizations can follow a five-part process to reposition themselves through diversity leadership. The first part of the process, discovery, refers to the emerging awareness of racial and ethnic diversity as a significant strategic issue; the second part, assessment, refers to systematic review of the organization's racial and ethnic diversity climate; the third part, exploration, denotes systematic training initiatives to improve the health services organization's ability to effectively manage diversity; the fourth part, transformation, refers to fundamental changes in organizational practices that result in a culture in which racial and ethnic diversity is valued; and the final part, revitalization, refers to renewal and expansion of racial and ethnic diversity initiatives to reward change agents and to include additional identity groups among the health services organization's diversity initiatives. This article presents a series of behaviorally based performance indicators for each of the five parts of the diversity leadership process. Healthcare executives are encouraged to assess their organization's strategic positioning against best demonstrated practices, as represented by the performance indicators. A method for analyzing organizational performance against the diversity leadership indicators is outlined as are suggestions for future research.

Benchmarking↗

Managing the consequences of hospital cutbacks: the role of workforce reduction practices.

In recent years, hospitals in Canada as elsewhere have witnessed unprecedented downsizing of their workforces. It is generally assumed that planned workforce reductions can have deleterious consequences on an organization's human resources. Scholars and practitioners alike have identified a number of humane or progressive approaches that are widely considered to be effective for organizations undergoing downsizing. This study examines the impact that workforce reduction approaches have on perceptions of organizational performance in a large sample of Canadian hospitals undergoing workforce reductions.

Benchmarking↗

Building human resources capability in health care: a global analysis of best practice--Part I.

This paper is one of a series of three, covering very comprehensively human resource practices in a global and generic context. The series of papers presents practices which are directly of relevance to the health-care context, and which are based on proven, effective and pioneering approaches. The first paper covers practices based on British and European experiences, gathered from world-class organisations that have either been finalists or went on to win prestigious quality awards such as the British and European Quality Awards. The benchmarking analysis presented in this paper is based on the sub-criteria prescribed by the European Quality Awards Model, which include: how people resources are planned and improved; how the skills and capabilities of people are preserved and developed through recruitment, training and career progression; how people and teams agree targets and continuously review performance; how the involvement of everyone in continuous improvement is prompted and people empowered to take appropriate action; how effective top-down and bottom-up communication is achieved.

Benchmarking↗

[Regional clinical audit, guideline targets, and local and regional benchmarks].

Regional clinical Audit, guideline Targets and local and regional Benchmarks In order to improve the quality of dialysis treatment, we have devised some routines, particularly suitable for electronic data management systems. First, we suggest a systematic monthly analysis of 10 common clinical performance measures (CPM), with the following guideline based targets: predialysis systolic blood pressure (SBP) < 140 mmHg; session length >/= 240 min; dialysis dose (spKt/V) >/=1.3; normalized protein catabolic rate (NPCR) >/=1.2 g/kg/d; hemoglobin (Hb) >/=11 g/dL; serum calcium (Ca) 8.4-9.5 mg/dL; serum phosphorus (P) 3.5-5.5 mg/dL; Ca x P </=55 mg 2 /dL 2 ; serum bicarbonate (HCO3) >/=20 mmol/L; serum potassium (K) 3.5-6.0 mmol/L. The Hb target should be reached in at least 85% of all maintenance hemodialysis (HD) patients in the unit; for all other targets, an arbitrary >/=80% is proposed. Since the above percentages are quite difficult to reach on a short-term basis, an intermediate local or regional standard (benchmark) could be devised as an average of the percentage of patients who actually reach the targets for each CPM at any dialysis unit in a given regional area; and therefore, from truly comparable patients. As an example, we simulated a regional audit by using the above targets with available data from 398 patients from southern Italy. A further step in this process was to find the cause(s) of failure in each patient who did not reach the targets. To this end, we suggest a systematic search of the well-known factors that could affect each CPM, for each failed patient. As an example, we screened all patients with Hb < 11 g/dL at a single unit, to establish the presence/absence of any common cause associated with inadequate response to epoetin treatment. Moreover, by using criteria for prescribing iron therapy or increasing epoetin dose, we found that some patients did not receive the appropriate therapy after blood sampling results. To avoid this possible common problem, we suggest the need for a monthly report of failure cases for any particular CPM and a check that the appropriate treatment has been delivered to all patients at the dialysis unit. This should also favor guideline implementation.

Benchmarking↗

Without a vision, a business may perish.

The process described is not only viable for a company, but also can be used by any group that is gathered to perform any task. The process serves to explore strengths and weaknesses so the group can use one and shore up the other. It looks at the outside forces that may affect the work and allows the group to place its effort in the areas it can influence. By looking at what is or about to occur, the process may be able to create synergism or prevent disaster. A vision or direction statement that many if not all had some input into is easier to understand and support. Referral to these benchmarks or compass points makes the journey easier.

Commerce↗

The validation of three human reliability quantification techniques--THERP, HEART and JHEDI: Part II--Results of validation exercise.

This is the second of three papers dealing with the validation of three Human Reliability Assessment (HRA) techniques. The first paper introduced the need for validation, the techniques themselves and pertinent validation issues. This second paper details the results of the validation study carried out on the Human Reliability Quantification techniques THERP, HEART and JHEDI. The validation study used 30 real Human Error Probabilities (HEPs) and 30 active Human Reliability Assessment (HRA) assessors, 10 per technique. The results were that 23 of the assessors showed a significant correlation between their estimates and the real HEPs, supporting the predictive accuracy of the techniques. Overall precision showed 72% (60-87%) of all HEPs to be within a factor of 10 of the true HEPs, with 38% of all estimates being within a factor of three of the true values. Techniques also tended to be pessimistic rather than optimistic, when they were imprecise. These results lend support to the empirical validity of these three approaches.

Benchmarking↗

US EPA's acute reference exposure methodology for acute inhalation exposures.

The US Environmental Protection Agency (EPA) National Center for Environmental Assessment is engaged in the development of a methodology for Agency use to perform risk assessments for non-cancer effects due to acute inhalation exposures. The methodology will provide general guidance for deriving chemical-specific acute exposure benchmarks called acute reference exposures (AREs). Chemical-specific AREs are analogous to reference concentra tions (RfCs) for chronic non-cancer effects and will be incorporated in chemical-specific files in the US EPA's Integrated Risk Information System (IRIS) as they are developed and reviewed. AREs will have wide applicability in assessing the potential health risks of accidental and routine acute releases of chemicals to the environment. The proposed methodology for ARE development provides a framework for choosing an optimal derivation approach, depending on the type of data available, from the no-observed-adverse-effect level (NOAEL), benchmark concentration (BMC), or categorical regression approaches. Uncertainty factors are applied to the point of departure, determined by one of the recommended approaches, to derive the ARE. Due to the capability to use more exposure-response information than the NOAEL approach allows, exposure-response analyses such as BMC and categorical regression are favored as methods to develop the point of departure when the available database will support such analyses. The NOAEL approach is suitable when the data are insufficient to support exposure-response modeling. Applications of the proposed ARE methodology are illustrated by the derivation of example AREs for hydrogen sulfide and hexachlorocyclopentadiene, which showcase the categorical regression and NOAEL approaches, respectively. In addition, a recent review of the proposed ARE methodology by the US EPA Risk Assessment Forum is discussed.

Air Pollutants↗

Quantification and interpretation of total petroleum hydrocarbons in sediment samples by a GC/MS method and comparison with EPA 418.1 and a rapid field method.

Total petroleum hydrocarbons (TPH) as a lumped parameter can be easily and rapidly measured or monitored. Despite interpretational problems, it has become an accepted regulatory benchmark used widely to evaluate the extent of petroleum product contamination. Three currently used methods (GC/MS, conventional EPA 418.1, and a rapid field method PetroFLAG) were performed to quantify the TPH content in samples collected from a site contaminated by transformer oil. To standardize the method and improve the comparability of TPH data, crucial GC-based quantification issues were examined, e.g., quantification based on internal standards (ISTD) vs external standards (ESTD), single vs multiple ISTD, and various area integration approaches. The interpretation of hydrocarbon chromatographic results was examined in the context of field samples. The performance of the GC/MS method was compared with those of EPA 418.1 and PetroFLAG. As a result, it was observed that the ISTD quantification method was preferred to the ESTD method, multiple ISTD might be better than single ISTD, and three different area integration approaches did not have a significant effect on TPH results. Evaluation of the chromatograms between a reference sample and three unknown samples showed that the extent of contamination varied appreciably with sample depth. It was also found that there existed a good positive correlation between GC/MS and both EPA 418.1 and PetroFLAG, and that EPA 418.1 produced the higher overall estimate while GC/MS and PetroFLAG resulted in lower, more statistically comparable TPH values.

Chemistry Techniques, Analytical↗

State-of-the-art density matrix renormalization group and coupled cluster theory studies of the nitrogen binding curve.

We study the nitrogen binding curve with the density matrix renormalization group (DMRG) and single-reference and multireference coupled cluster (CC) theory. Our DMRG calculations use up to 4000 states and our single-reference CC calculations include up to full connected hextuple excitations. Using the DMRG, we compute an all-electron benchmark nitrogen binding curve, at the polarized, valence double-zeta level (28 basis functions), with an estimated accuracy of 0.03 mEh. We also assess the performance of more approximate DMRG and CC theories across the nitrogen curve. We provide an analysis of the relative strengths and merits of the DMRG and CC theory under different correlation conditions.

Journal Article↗

A multiplicative correction factor for tissue heterogeneities.

A new multiplicative correction factor for tissue heterogeneities based on an exact expression for homogeneous non-unit-density media is proposed. O'Connor's density scaling theorem is invoked to evaluate the medium-specific tissue-maximum ratios used in the exact formulation. Monte Carlo calculations were performed at energies ranging from 60Co to 15 MV to test the technique for single- and multiple-slab geometries as well as for the clinical benchmark problem described recently by Orton et al consisting of a six-field lung plan. Within the level of statistical uncertainty (less than 2%) in the Monte Carlo calculations, the new correction factor agrees with the calculated data for single slabs of non-unit-density material. For the multiply layered geometries, the correction factor accurately represents the data beyond the build-up region at any interface, but is less reliable close to a boundary. For high energies, however, it is more accurate in the build-up region than other commonly used correction techniques such as the ratio-of-TMR or Batho methods. For all energies considered, the new correction factor agrees with the data measured by Orton et al to within 1.5%. It is more accurate than other correction factors considered by Orton et al at high energies, and is competitive with the Batho and equivalent TAR methods at low energies.

Cobalt Radioisotopes↗

HI-FEVER: a Nextflow pipeline for the high-throughput discovery and annotation of endogenous viral elements.

SUMMARY: Endogenous viral elements (EVEs) offer valuable insights into virus and host evolution, but their detection remains computationally and biologically challenging. We present HI-FEVER, a user-friendly Nextflow pipeline for the discovery of EVEs in eukaryotic host genomes. HI-FEVER is highly parallelizable and customizable, ensuring computational efficiency while allowing researchers to fine-tune parameters to their specific needs. Its output provides a comprehensive analysis of discovered EVEs, including detailed annotations which can provide evolutionary insights. HI-FEVER scales seamlessly to handle millions of viral protein queries across multiple host genomes on both laptops and high-performance computing nodes. AVAILABILITY AND IMPLEMENTATION: The HI-FEVER source code is available on GitHub at https://github.com/PaleovirologyLab/hi-fever. Minimal reference databases, test datasets and benchmarking results are hosted on the Open Science Framework at https://osf.io/y357r. A detailed wiki is available at https://github.com/PaleovirologyLab/hi-fever/wiki, including usage instructions, parameter descriptions, and guidance on interpreting outputs. The pipeline includes a Pixi environment compatible with Conda and Apptainer containerization, and Docker images. HI-FEVER has been tested on Linux, Windows (via WSL2), and macOS (Intel and ARM64).

Software↗

The Quality of Surgical Care Project: a model to evaluate surgical outcomes in Western Australia using population-based record linkage.

BACKGROUND: The aim of this study is to establish a model to evaluate surgical outcomes and, where indicated, recommend changes to improve the quality of surgical care in Western Australia (WA). Open resection for aneurysm of the abdominal aorta was the first procedure evaluated and the results are reported in an accompanying paper. METHODS: The Quality of Surgical Care Project (QSCP) is conducted under the aegis of the Royal Australasian College of Surgeons (RACS) in WA, and brings together a multidisciplinary team of surgeons, public health researchers and health service administrators. The Western Australia Health Services Research Linked Database (the WA Linked Database) is used to provide linked chains of patients records residing in the state health department from the following sources: hospital morbidity data system, birth and death records, mental health services data, cancer registrations and midwives' notifications. This links 16 years of population-based patient records from 1980, including all public and private hospital admissions and re-admissions. The Quality of Surgical Care Project was established to use and to correlate the data from the WA Linked Database. RESULTS: The result is a powerful database for a contained population that is available for scientific analysis by a multidisciplinary team of clinical epidemiologists, surgeons and health service managers. Users will have the ability to establish benchmark standards for the outcomes of surgical procedures in WA for use in quality improvement programmes run by the College and will facilitate self-directed performance auditing activities as a commitment to greater community accountability. CONCLUSIONS: The Quality of Surgical Care Project provides a potential model of benefits to be realized by both the medical profession and the community through multidisciplinary collaboration supported by adequate information. Although migration from WA is relatively low, future linkage to the state electoral roll will allow correction for any population change.

Aortic Aneurysm, Abdominal↗