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Data mining to support simulation modeling of patient flow in hospitals.

Spiraling health care costs in the United States are driving institutions to continually address the challenge of optimizing the use of scarce resources. One of the first steps towards optimizing resources is to utilize capacity effectively. For hospital capacity planning problems such as allocation of inpatient beds, computer simulation is often the method of choice. One of the more difficult aspects of using simulation models for such studies is the creation of a manageable set of patient types to include in the model. The objective of this paper is to demonstrate the potential of using data mining techniques, specifically clustering techniques such as K-means, to help guide the development of patient type definitions for purposes of building computer simulation or analytical models of patient flow in hospitals. Using data from a hospital in the Midwest this study brings forth several important issues that researchers need to address when applying clustering techniques in general and specifically to hospital data.

Algorithms↗

Determinations of PCB within a project to develop cleanup methods for PCB-containing elastic sealant used in outdoor joints between concrete blocks in buildings.

Determinations of PCB were carried out as part of a project aimed at developing cleanup methods for PCB-containing elastic sealant used in outdoor joints between concrete blocks. The goals of the project were to develop methods, which minimise the spread of PCB to the outdoor environment and to indoor air, and which keep the PCB levels as low as reasonably possible in the workplace environment whilst removing the elastic sealant. The following PCB determinations were carried out: (1) concentration in the elastic sealant; (2) concentration in the concrete close to the sealant; (3) concentration in soil; (4) concentration in the indoor air; and (5) concentration in the air in the workplace environment. The cleanup process consisted of a number of different steps: (1) cutting the elastic sealant with an oscillating knife; (2) grinding the concrete with a mechanical machine; (3) sawing the concrete with a mechanical saw and (4) cutting the concrete with a mechanical chisel. In all these different steps a high capacity vacuum cleaner connected to the machines was used. The elastic sealant contained 4.7 to 8.1% total PCB of a technical product with a composition most similar to Clophene A40. The concrete close to the sealant (first 2 mm) contained 0.12 and 1.7% total PCB at two different places. The pattern of the PCB in the concrete resembled that of the sealant. PCB concentrations in the soil from the ground close to the building were 0.1 and 0.3 ppm at two different places before the remedial action. The source of the PCB in the soil is most likely the sealant as the PCB pattern is similar for the two materials. The PCB levels in the workplace air at the beginning of the project, when the techniques were not fully developed, were generally above the occupational exposure limit of 10 micrograms m-3 (up to 120 micrograms m-3). Later when the techniques were optimised to better take care of dust and gases produced during the cutting and grinding etc., the levels were below or close to 10 micrograms m-3. The pattern of the PCB in the workplace air was different from that of the sealant and contained higher levels of lighter components. The PCB concentrations in the indoor air were measured before and during the remedial process. The levels were around 600 ng m-3 and there was no significant increase during the removal of the sealant. The PCB level after the remedial action will be measured later. The pattern of the PCB in the indoor air was different from that of the sealant as well as from that of the workplace air. Higher levels of the lighter PCB were present indoors compared to the composition in both workplace air and in sealant. Extracts of PCB were analysed by GC-MS with a SIM method (selected ion monitoring). Standard procedures were used for extraction of solid materials. For the air samples an OVS tube was used with XAD-2 as adsorbent. The filter and adsorbent were extracted with toluene. This work shows that it is important to perform remedial action of PCB-containing elastic sealant as: (1) there is a spread of PCB to the indoor air giving high enough concentrations to make this the main PCB load on humans living in the apartments studied in this project; (2) large amounts are spread to the soil from these sealants; and (3) many of the PCB-containing elastic sealants used need to be changed from a functional perspective.

Air Pollution, Indoor↗

A Decomposition Principle for Complexity Reduction of Artificial Neural Networks.

A decomposition principle is developed for systematic determination of the dimensionality and the connections of Hopfield-type associative memory networks. Given a set of high dimensional prototype vectors of given memory objects, we develop decomposition algorithms to extract a set of lower dimensional key features of the pattern vectors. Every key feature can be used to build an associative memory with the lowest complexity, and more than one key feature can be simultaneously used to build networks with higher recognition accuracy. In the latter case, we further propose a "decomposed neural network" based on a new encoding scheme to reduce the network complexity. In contrast to the original Hopfield network, the decomposed networks not only increase the network's storage capacity, but also reduce the network's connection complexity from quadratic to linear growth with the network dimension. Both theoretical analysis and simulation results demonstrate that the proposed principle is powerful. Copyright 1996 Elsevier Science Ltd

Journal Article↗

Exploring the frontier between life and death in Escherichia coli: evaluation of different viability markers in live and heat- or UV-killed cells.

A number of methods have been proposed to assess the viability of cells without culture. Each method is based on criteria that reflect different levels of cellular integrity or functionality. As a consequence, the interpretation of viability is often ambiguous. The purposes of this work were to evaluate the capacity of current viability markers to distinguish between live and dead Escherichia coli K-12 cells. Methods that assess 'viability' by the demonstration of metabolic activities (esterase activity, active electron transport chain, transport of glucose), cellular integrity (membrane integrity, presence of nucleic acids) or the building up of cellular material (cell elongation) have been evaluated in live and UV- or heat-killed cells. With live cells, viability markers detected cells in counts similar to the colony count. However, these so-called viability markers could stain dead cells for some time after the lethal treatment. For the UV-killed cells, residual activities were detected even after 48 h of storage at 20 degrees C. However, for heat-treated cells, these activities disappeared within hours after heat treatment. Only a combination of fluorescence in situ hybridization with rRNA probes and cell elongation in response to nutrients (in the presence of an inhibitor of cell division) had the ability to differentiate live from dead cells. Problems in the definition of a viable but nonculturable state are in part due to the lack of a clear definition of bacterial death. We consider death as an irreversible state where no growth, cell elongation or protein synthesis may occur.

Bacterial Proteins↗

[Cellular biology and public health].

Within the framework of the National Research and Development Program No. 1/016 /2001 the authors determined the population levels of ionizing and nonionizing radiations, elaborated the system of assays for detection of biological effects including dose-effect relationships, studied the roles of protective and sensitizing factors in the effect modification. The radium content of building materials were determined as well as the indoor radon activity concentrations and the magnetic induction fields around household equipment operating with 50 Hz. Biological dosimetry techniques were categorized according to the indication time. In addition, radiation sensitivity of intracellular antioxidant enzymes and the antioxidant capacity of blood sera were measured.

Air Pollutants, Radioactive↗

Mental health programs seek religious following.

A handful of mental health treatment programs are building therapy around prayer sessions and Bible study in an attempt to attract mainstream Christians who otherwise would be wary about seeking treatment.

Christianity↗

[Olaus Rudbeck as scientist and professor of medicine].

Olaus Rudbeck (1630-1702) was one of the pioneers in the study of lymphatic vessels. As a young student at Uppsala University he began dissecting small animals with great diligence and found the lymphatic connection between the intestines and the circulating blood, leading the prepared nutrients via the thoracic duct to the veins. By applying ligatures to the lymphatic vessels he could observe the direction of the flow. His observations confirmed William Harvey's newly advanced theory about the circulation of the blood and were in agreement with the then modern mechanistic view of body functions. Rudbeck demonstrated his findings for Queen Christina in the spring of 1652 and received from her money for a visit to the University of Leiden, Holland in the autumn of 1653. He had just before his departure published his own discoveries, but the Danish anatomist Thomas Bartholin had reported very similar results slightly before. During his stay in Holland (autumn 1653-summer 1654) where he was admired for his anatomical skillfullness, a priority dispute began between him and one of Bartholin's students, lasting for years. Back in Uppsala Rudbeck began and extensive activity, including the foundations of the botanical garden, the anatomical theatre and other university buildings. He became a professor of medicine in 1660 but soon left his anatomical studies for work in several disciplines and trades. He was a prominent master-builder and garden architect as well as an astronomer, botanist, musician and archaeologist. In the last mentioned capacity he published his ill-famed Atlantica, a gigantic reconstruction of the history of old Sweden from the times of the Flood, through the era of vast conquests including Russia and the Mediterranean region, supposed to have take place in the third and second millenium B.C. Rudbeck mingled philogical methods and mythological explanations with excavations and natural history to reach his phantastic conclusions. At the same time the Atlantica (in three volumes plus one unfinished) is a very personal document, demonstrating i.a. that he had a medical practices, including advanced anatomical surgery, as when helping at the birth of one of his children. The boy was christened "Johannes Caesar" in commemoration of the event, but apparently it was not a regular Caeserian section.

Anatomy↗

A physiological comparison of female body builders and power lifters.

Ten female body builders (FBB) (X age +/- SD = 30.40 +/- 8.22 years) and ten female power lifters (FPL) (X age +/- SD = 25.20 +/- 6.01 years) were studied to determine group differences in body composition, strength and anaerobic characteristics. All subjects had been training a minimum of two years and twelve of the subjects had competed nationally while the remainder had participated in regional or local events. Measures of body build and body composition were obtained via hydrostatic weighing, skinfolds (sum of 7), circumferences (sum of 13) and diameters (sum of 9). Flexion and extension strength of the dominant forearm and leg were measured with a Cybex II dynamometer at 60 degrees/second. Anaerobic power and capacity were determined using the Wingate Anaerobic Test. Independent t-tests indicated the FPL had significantly greater body weight (X +/- SD = 68.60 +/- 3.60 vs 56.47 +/- 0.85 kg), relative fat (21.47 +/- 1.29 vs 13.51 +/- 1.46%), sum of skinfolds (120.76 +/- 7.55 vs 71.46 +/- 7.02 mm), sum of diameters (177.57 +/- 2.97 vs 168.17 +/- 2.55 cm), and sum of circumferences (594.93 +/- 13.10 vs 551.24 +/- 3.17). No significant differences were found for fat-free weight, strength or anaerobic power and capacity. These results demonstrate subtle but specific differences between well-trained FBB and FPL reflecting the leaner physiques and smaller skeletal structures of the FBB necessary for the definition and symmetry demanded by the sport. The lack of differences in strength and anaerobic characteristics reflect the similarity of the groups in basic training techniques.

Adult↗

Swimming performances and stroking parameters in non skilled grammar school pupils: relation with age, gender and some anthropometric characteristics.

OBJECTIVE: It was hypothesized that swimming velocity (V) and stroking parameters such as stroke length (SL), stroke rate (SR) and stroke index (SI) are influenced by age, gender, and some anthropometric characteristics. EXPERIMENTAL DESIGN: Cross-sectional study. SETTING: Grammar school pupils from French schools. PARTICIPANTS: One thousand and ninety-seven males and 961 females non skilled swimmers aged from 11 to 17. INTERVENTIONS: Usual swimming sessions (6 +/- 2 h.year-1) during a physical education program at school. MEASURES: V, SL, SF and SI (SI = V.SL) were measured or calculated from a 50-m crawl sprint and height, arm span and body mass were measured for all subjects. RESULTS: The results showed that V, SL and SI increased regularly (p < 0.01) in relation to age in both genders. SL was never significantly different between males and females. SF remained unchanged according to age and was significantly higher in males than in females. V, SL and SI were influenced by age and arm span but not SF. CONCLUSIONS: As males and females were submitted to the same swimming teaching program at school, a higher increase in muscle power and anaerobic capacity in males could explain the gender differences. These results observed in non skilled swimmers showed that the differences in stroking parameters between genders were the reverse of those of top level swimmers and that they can be used by swimming teachers in order to build some assessment tools and to better understand the improvements in swimming in relation to growth and gender.

Adolescent↗

beta-Glycosides of 2,3-Diazido-2,3-dideoxy-D-mannose, a Synthetic Precursor of a Rare Bacterial Cell-Wall Building Unit.

2,3-Diazido-2,3-dideoxy-beta-D-mannopyranoside derivatives were synthesized in order to prepare beta-glycosides of 2,3-diacetamido-2,3-dideoxy-D-mannuronic acid, a rare moiety of bacterial oligosaccharides. A direct glycosyl donor, 4,6-di-O-acetyl-2,3-diazido-2,3-dideoxy-alpha-D-mannopyranosyl bromide, was prepared, and its synthetic capacity was tested in glycosylation reactions. An indirect route was also elaborated: 3-azido-3-deoxy-beta-D-glucopyranosides were converted into beta-D-mannopyranosides. The cis vicinal diazido function successfully tolerated the conditions of mild acidic hydrolysis, tritylation, Jones oxidation, TEMPO oxidation, acetolysis, and bromination with TiBr(4).

Journal Article↗

Working in swine-confinement buildings causes an accelerated decline in FEV1: a 7-yr follow-up of Danish farmers.

Work in swine confinement units causes exposure to high levels of organic dust and is associated with a high prevalence of work-related respiratory symptoms and probably with accelerated decline in forced expiratory volume in one second (FEV1). A 7-yr follow-up on FEV1, forced vital capacity (FVC), bronchial reactivity, and respiratory symptoms was performed on 181 Danish farmers. The participation rate was 76.3% and nonparticipants had more symptoms, were more likely to be current-smokers and had lower lung function in the first survey than participants in both surveys. Farmers who worked exclusively with pigs in the follow-up had an accelerated decline in FEV1 but not in FVC compared with dairy farmers, where the observed decline in FEV1 was close to the expected. For a nonsmoking pig farmer compared to a nonsmoking dairy farmer the mean additional decline in FEV1 was 17 mL x yr(-1) (53.0 mL x yr(-1) versus 36.1 mL x yr(-1)). The authors conclude that working in swine confinement units causes an accelerated decline in forced expiratory volume in one second but not in forced vital capacity. The mean decline is approximately 0.5 L during a working life and some farmers will develop clinically significant airway obstruction due to work in swine confinement units.

Adult↗

Optimization of the xylan degradation activity of monolithic enzymatic membranes as a function of their composition using design of experiments.

The aim of this work was the development and optimization of enzymatic monolithic membranes with high catalytic activity for the degradation of xylan into xylooligosaccharides. The chemometric tool design of experiments has been utilized here for the first time for the optimization of the enzymatic activity of the monolithic membranes based on their constituents. The effect of three process variables, including the amount of various monomer contents and the porogenic solvents ratio, has been studied on the enzymatic activity of the resulted membranes. The experimental design chosen was a central face centred with six central points in order to obtain an orthogonal model, with the precision of the results being independent of the range of values considered for each parameter. The software Modde(c) 6.0 from Umetrics(c) was used to build and analyze the results of the experimental design using partial least squares regression. The optimization of the suggested model provided the best membrane composition to achieve maximum enzymatic activity, which can be related to the amount of enzyme immobilized on the monolithic membrane. The predictive capacity of the model was evaluated performing additional experiments.

Biodegradation, Environmental↗

Determination of airborne, volatile amines from polyurethane foams by sorption onto a high-capacity cation-exchange resin based on poly(succinic acid).

A high-capacity carboxylic acid-functionalized resin prepared by ring-opening metathesis polymerization based on cross-linked endo,endo-poly(norborn-2-ene-5,6-dicarboxylic acid) was used for the sampling of volatile, airborne amines from polyurethane (PU) foams. Six tertiary amines which represent commonly used promotors for the formation of PUs from diisocyanates and polyols, namely pentamethyldiethylenetriamine, diazabicyclooctane, N-methylmorpholine, N-ethylmorphine, 1,4-dimethylpiperazine and N,N-dimethylethanolamine, were sorbed onto the new resin. The sorption behavior of the new material was investigated in terms of loading capacities, the influence of concentration, flow-rate as well as of the amount of resin. Breakthrough curves were recorded from each single component as well as of mixtures thereof. Finally, the resin was used for the sampling of amines evaporating from PU foams applied in buildings. Further information about time dependent concentration profiles were obtained using a combination of GC-MS and Fourier transform IR spectroscopy.

Adsorption↗

Cellular proliferation and transformation induced by HOXB4 and HOXB3 proteins involves cooperation with PBX1.

The products of PBX homeobox genes, which were initially discovered in reciprocal translocations occurring in human leukemias, have been shown to cooperate in the in vitro DNA binding with HOX proteins. Despite the growing body of data implicating Hox genes in the development of various cancers, little is known about the role of HOX-PBX interactions in the regulation of proliferation and induction of transformation of mammalian cells. We build on the existing model of Hox-induced transformation of Rat-1 cells to show that both cellular transformation and proliferation induced by Hoxb4 and Hoxb3 are greatly modulated by the levels of available PBX1 present in these cells. Furthermore, we show that the transforming capacity of these two HOX proteins depends on their conserved tetrapeptide and homeodomain regions which mediate binding to PBX and DNA, respectively. Taken together, results of this study demonstrate that cooperation between HOX and PBX proteins modulates cellular proliferation and strongly suggest that cooperative DNA binding by these two groups of proteins represent the basis for Hox-induced cellular transformation.

Amino Acid Sequence↗

Health informatics and oncology nursing.

OBJECTIVES: To provide an overview of the essential role of health and nursing informatics in meeting the 21st century call to provide state-of-the-art oncology care. DATA SOURCES: Published articles, research studies, and documents relating to informatics. CONCLUSIONS: Health and nursing informatics encompass the pivotal roles of data and information; identifying and documenting essential data using nursing vocabularies; ensuring adequate computer-based patient record systems; accessing and building knowledge; using telecommunications to support care delivery; empowering the consumer through health informatics; transforming education; and enhancing decision making in oncology nursing through national research agendas. IMPLICATIONS FOR NURSING PRACTICE: The information age calls us to explore digital and information technologies as extensions of human capacity. Oncology nursing practice is especially positioned to contribute to the health of our population.

Forecasting↗

Factors affecting the demand for congregate meals at nutrition sites.

This paper examines the relative importance of factors affecting attendance by elderly persons at congregate meal sites, with particular attention to need and service variables. A 25% systematic random sample survey of nutrition projects was conducted; those project sites where attendance was not limited by a lack of capacity were then analyzed. A demand model which predicts the number of daily meals served at a congregate site was estimated via generalized least squares regression methods. The study determined that measures of the quality of services provided--such as method of food preparation, type of building used, and the presence of other nutrition programs in the community--were more important in predicting attendance at nutrition sites than conventional demographic measures of need such as persons with incomes below poverty, minority status, or living alone.

Aged↗

Performance enhancement with maintenance of resting immune status after intensified cycle training.

BACKGROUND: Unaccustomed intense endurance exercise is associated with short-term suppression of natural immunity. However, it is not established whether intensified endurance training alters resting immune status or increases the risk of upper respiratory infection (URI). PURPOSE: This study examined the effect of intensified endurance training for performance enhancement on resting immune status in nine healthy, male competitive cyclists. DESIGN: Data were collected during 4 weeks of usual training (baseline), followed by prescribed cycle training that consisted of volume-building at customary training intensity (V phase, 6 weeks), unaccustomed very high intensity interval training at 100% maximal heart rate (I phase, 18 days), and an unloading taper (U phase, 10 days). METHODS: The main performance criterion was a simulated 20 km time-trial. Aerobic capacity measures included power output at ventilatory threshold (POT(vent)) and maximal oxygen uptake (VO(2max)). Markers of immune status (lymphocyte subset counts, serum cytokine levels, and new URI cases) and physiological indicators of training stress (cycling economy, 24-hour urinary cortisol excretion, and serum testosterone concentration) were evaluated in the rested state, 36 to 44 hours postexercise, during baseline, and after each training phase. RESULTS: Time-trial performance, POT9(vent), VO(2max), and cycling economy improved significantly (p < 0.001) after the V phase, and remained higher than baseline (p < 0.001) after the I and U phases. As compared with the V phase, performance time was faster after the U phase (p < 0.01). In contrast, lymphocyte counts, cytokine levels, incidence of URI, cortisol excretion, and serum testosterone concentration were not significantly different from baseline in any phase. CONCLUSIONS: Cycling efficiency and performance improved while resting immune status was maintained throughout the 10-week training program. This study provides encouraging data in support of immunological robustness during intensified endurance training.

Adult↗

An analysis of the development of a successful medical collaboration to create and sustain family physician anaesthesiology capacity in rural Canada.

BACKGROUND: Initial efforts to increase the availability of training positions, standardise training, and obtain national recognition for family physicians who wished to practise anaesthesia had stalled. OBJECTIVE: To describe the work undertaken to create and sustain family medicine anaesthesiology capacity in Canada. METHODS: In our review, we examined the critical aspects of successful intersectoral work, namely, involvement by key stakeholders; the development of decision-making mechanisms; clearly defined objectives, roles and responsibilities; official support and legitimisation from participating organisations and adequate resources for partnership building. SETTING: Canadian rural family medicine anaesthesiology practice. RESULTS: A small steering committee obtained funding for a national meeting of stakeholders and subsequent committee work over an 18-month period. The national meeting brought together the necessary stakeholders to review and discuss the issues and agree on a group-determined agenda, determine a work plan, identify priority areas and allow the College of Family Physicians of Canada to be the lead organisation in moving the work ahead. Within 18 months, the boards of the key organisations had accepted a common set of standards for training and a national curriculum. Work remains in the longer term to identify sustainable funding for training of family physician as well as the provision of continuing medical education for those trained. CONCLUSIONS: Appropriate attention to the key components of successful intersectoral work may enable previously stalled and complex work to move ahead despite opposition.

Anesthesiology↗