Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model

BACKGROUND: The majority of curative health care is organized in hospitals. As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In previous studies on allocation of hospital infrastructure, the allocation is usually only based on accessibility and/or efficiency of hospital care. In this paper, we explore the possibilities to include a quality function in the objective function, to give global directions to how the ‘optimal’ hospital infrastructure would be in the Dutch context. METHODS: To create optimal societal value we have used a mathematical mixed integer programming (MIP) model that balances quality, efficiency and accessibility of care for 30 ICD-9 diagnosis groups. Typical aspects that are taken into account are the volume-outcome relationship, the maximum accepted travel times for diagnosis groups that may need emergency treatment and the minimum use of facilities. RESULTS: The optimal number of hospital locations per diagnosis group varies from 12-14 locations for diagnosis groups which have a strong volume-outcome relationship, such as neoplasms, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD). CONCLUSIONS: In conclusion, our study shows a new approach for allocating hospital infrastructure over a country or certain region that includes quality of care in relation to volume per provider that can be used in various countries or regions. In addition, our model shows that within the Dutch context chronic care may be too concentrated and complex and/or acute care may be too dispersed. Our approach can relatively easily be adopted towards other countries or regions and is very suitable to perform a ‘what-if’ analysis

Women with anorexia nervosa and bulimia nervosa : Individual and family characteristics, with particular emphasis on perfectionism

This study investigated socio-cultural, family and individual factors associated with anorexia and bulimia nervosa, with particular emphasis on dysfunctional perfectionism, and adopting a general social learning perspective. Theories of the development of eating disorders were interwoven with theories of the development of perfectionism. A model was proposed for the development of anorexia and bulimia nervosa via a dysfunctional perfectionism pathway. The 135 participants, aged 18 to 40 years, were women with anorexia nervosa (N=25), bulimia nervosa (N=32), Type 1 diabetes (N= 53, a North Canterbury population-based sample), and healthy women students (N=25). The women with eating disorders were recruited from various treatment centres throughout New Zealand. Participants completed a battery of seven self-report psychometric tests, namely, the Eating Disorder Inventory-2 (EDI-2), Beck Depression Inventory (BDI), Multidimensional Perfectionism Scale (MPS), Setting Conditions for Anorexia Nervosa Scale (SCANS), Tridimensional Personality Questionnaire (TPQ), Parental Bonding Instrument (PBI), and Family Environment Scale (FES). Analysis of Covariance, using the BDI as a covariate, revealed that, in addition to measures concerned with weight, shape and dieting, both anorexia and bulimia nervosa group means were significantly higher than both healthy and diabetes group means for EDI-2 Interpersonal Distrust and Social Insecurity; MPS Concern over Mistakes, Personal Standards, and Parental Criticism; and TPQ Harm A voidance, and significantly different from the healthy group mean for MPS Parental Expectations; SCANS Perfectionism; and PBI Maternal Protection, Maternal Care, and Paternal Care. Correlational analyses confirmed hypothesized moderate or strong associations between some perfectionism measures and other characteristics of women with eating disorders, such as a harm-avoidant temperament, and perceptions of maternal overprotection. Discriminant function analysis revealed seven variables, in combination, that maximally discriminated between eating disordered and non-eating disordered groups: three EDI-2 variables of Drive for Thinness, Ineffectiveness, and Social Insecurity, three MPS subscales of Concern over Mistakes, Personal Standards, and Doubts about Actions, and the BDI. Of the three instruments measuring perfectionism, in this study, only the MPS effectively discriminated between eating disordered and non-eating disordered groups. Findings indicated the importance of controlling for depression when comparing eating disordered groups with other groups, and that dysfunctional perfectionism is largely independent of the mood of the respondent. Findings suggest that the PBI may be limited by cultural sensitivity. Findings led to questioning of the applicability of the EDI-SC to diabetes groups and of the validity of the Novelty Seeking and Reward Dependence Dimensions of the TPQ. In concluding that dysfunctional perfectionism is a key personality characteristic of women with anorexia and bulimia nervosa, it is argued that multidimensional measures of perfectionism provide more insight than unidimensional measures into the dysfunctional facets of perfectionism, and that perfectionism per se is not necessarily problematic. Dysfunctional perfectionism may distinguish psychopathology associated with anorexia and bulimia nervosa from numerous other forms of psychopathology, including depression. Although aetiological factors were not assessed in this study, the MPS and PBI, considered in conjunction with the theoretical literature, may provide insight into the development of dysfunctional perfectionism. This has implications for the treatment and prevention of eating disorders

The prevalence and severity of fatigue in meningioma patients and its association with patient-, tumor-and treatment-related factors

Background: Fatigue is a commonly reported and severe symptom in primary brain tumor patients, but the exact occurrence in meningioma patients is unknown. This study aimed to determine the frequency and severity of fatigue in meningioma patients as well as associations between the level of fatigue and patient-, tumor-, and treatment-related factors. Methods: In this multicenter cross-sectional study, meningioma patients completed questionnaires on fatigue (MFI-20), sleep (PSQI), anxiety and depression (HADS), tumor-related symptoms (MDASI-BT), and cognitive functioning (MOS-CFS). Multivariable regression models were used to evaluate the independent association between fatigue and each patient-, tumor-, and treatment-related factor separately, corrected for relevant confounders. Results: Based on predetermined in-and exclusion criteria, 275 patients, on average 5.3 (SDa=a2.0) year since diagnosis, were recruited. Most patients had undergone resection (92%). Meningioma patients reported higher scores on all fatigue subscales compared to normative data and 26% were classified as fatigued. Having experienced a complication due to resection (OR 3.6, 95% CI: 1.8-7.0), having received radiotherapy (OR 2.4, 95% CI: 1.2-4.8), a higher number of comorbidities (OR 1.6, 95% CI: 1.3-1.9) and lower educational level (low level as reference; high level OR 0.3, 95% CI: 0.2-0.7) were independently associated with more fatigue. Conclusions: Fatigue is a frequent problem in meningioma patients even many years after treatment. Both patient-and treatment-related factors were determinants of fatigue, with the treatment-related factors being the most likely target for intervention in this patient population.</p

Cerebral cortical microinfarcts in patients with internal carotid artery occlusion

Cerebral cortical microinfarcts (CMI) are small ischemic lesions that are associated with cognitive impairment and probably have multiple etiologies. Cerebral hypoperfusion has been proposed as a causal factor. We studied CMI in patients with internal carotid artery (ICA) occlusion, as a model for cerebral hemodynamic compromise. We included 95 patients with a complete ICA occlusion (age 66.2 +/- 8.3, 22% female) and 125 reference participants (age 65.5 +/- 7.4, 47% female). Participants underwent clinical, neuropsychological, and 3 T brain MRI assessment. CMI were more common in patients with an ICA occlusion (54%, median 2, range 1-33) than in the reference group (6%, median 0; range 1-7; OR 14.3; 95% CI 6.2-33.1; p<.001). CMI were more common ipsilateral to the occlusion than in the contralateral hemisphere (median 2 and 0 respectively; p<.001). In patients with CMI compared to patients without CMI, the number of additional occluded or stenosed cervical arteries was higher (p=.038), and cerebral blood flow was lower (B -6.2 ml/min/100 ml; 95% CI -12.0:-0.41; p=.036). In conclusion, CMI are common in patients with an ICA occlusion, particularly in the hemisphere of the occluded ICA. CMI burden was related to the severity of cervical arterial compromise, supporting a role of hemodynamics in CMI etiology.Cardiovascular Aspects of RadiologyNeuro Imaging Researc

Coseismic fault lubrication by viscous deformation

Despite the hazard posed by earthquakes, we still lack fundamental understanding of the processes that control fault lubrication behind a propagating rupture front and enhance ground acceleration. Laboratory experiments show that fault materials dramatically weaken when sheared at seismic velocities (>0.1 m s−1). Several mechanisms, triggered by shear heating, have been proposed to explain the coseismic weakening of faults, but none of these mechanisms can account for experimental and seismological evidence of weakening. Here we show that, in laboratory experiments, weakening correlates with local temperatures attained during seismic slip in simulated faults for diverse rock-forming minerals. The fault strength evolves according to a simple, material-dependent Arrhenius-type law. Microstructures support this observation by showing the development of a principal slip zone with textures typical of sub-solidus viscous flow. We show evidence that viscous deformation (at either sub- or super-solidus temperatures) is an important, widespread and quantifiable coseismic lubrication process. The operation of these highly effective fault lubrication processes means that more energy is then available for rupture propagation and the radiation of hazardous seismic waves

MRBrainS Challenge: Online Evaluation Framework for Brain Image Segmentation in 3T MRI Scans

Many methods have been proposed for tissue segmentation in brain MRI scans. The multitude of methods proposed complicates the choice of one method above others. We have therefore established the MRBrainS online evaluation framework for evaluating (semi) automatic algorithms that segment gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) on 3T brain MRI scans of elderly subjects (65-80 y). Participants apply their algorithms to the provided data, after which their results are evaluated and ranked. Full manual segmentations of GM, WM, and CSF are available for all scans and used as the reference standard. Five datasets are provided for training and fifteen for testing. The evaluated methods are ranked based on their overall performance to segment GM, WM, and CSF and evaluated using three evaluation metrics (Dice, H95, and AVD) and the results are published on the MRBrainS13 website. We present the results of eleven segmentation algorithms that participated in the MRBrainS13 challenge workshop at MICCAI, where the framework was launched, and three commonly used freeware packages: FreeSurfer, FSL, and SPM. The MRBrainS evaluation framework provides an objective and direct comparison of all evaluated algorithms and can aid in selecting the best performing method for the segmentation goal at hand.This study was financially supported by IMDI Grant 104002002 (Brainbox) from ZonMw, the Netherlands Organisation for Health Research and Development, within kind sponsoring by Philips, the University Medical Center Utrecht, and Eindhoven University of Technology. The authors would like to acknowledge the following members of the Utrecht Vascular Cognitive Impairment Study Group who were not included as coauthors of this paper but were involved in the recruitment of study participants and MRI acquisition at the UMC Utrecht (in alphabetical order by department): E. van den Berg, M. Brundel, S. Heringa, and L. J. Kappelle of the Department of Neurology, P. R. Luijten and W. P. Th. M. Mali of the Department of Radiology, and A. Algra and G. E. H. M. Rutten of the Julius Center for Health Sciences and Primary Care. The research of Geert Jan Biessels and the VCI group was financially supported by VIDI Grant 91711384 from ZonMw and by Grant 2010T073 of the Netherlands Heart Foundation. The research of Jeroen de Bresser is financially supported by a research talent fellowship of the University Medical Center Utrecht (Netherlands). The research of Annegreet van Opbroek and Marleen de Bruijne is financially supported by a research grant from NWO (the Netherlands Organisation for Scientific Research). The authors would like to acknowledge MeVis Medical Solutions AG (Bremen, Germany) for providing MeVisLab. Duygu Sarikaya and Liang Zhao acknowledge their Advisor Professor Jason Corso for his guidance. Duygu Sarikaya is supported by NIH 1 R21CA160825-01 and Liang Zhao is partially supported by the China Scholarship Council (CSC).info:eu-repo/semantics/publishedVersio

Do Biofilm Formation and Interactions with Human Cells Explain the Clinical Success of Acinetobacter baumannii?

BACKGROUND: The dramatic increase in antibiotic resistance and the recent manifestation in war trauma patients underscore the threat of Acinetobacter baumannii as a nosocomial pathogen. Despite numerous reports documenting its epidemicity, little is known about the pathogenicity of A. baumannii. The aim of this study was to obtain insight into the factors that might explain the clinical success of A. baumannii. METHODOLOGY/PRINCIPAL FINDINGS: We compared biofilm formation, adherence to and inflammatory cytokine induction by human cells for a large panel of well-described strains of A. baumannii and compared these features to that of other, clinically less relevant Acinetobacter species. Results revealed that biofilm formation and adherence to airway epithelial cells varied widely within the various species, but did not differ among the species. However, airway epithelial cells and cultured human macrophages produced significantly less inflammatory cytokines upon exposure to A. baumannii strains than to strains of A. junii, a species infrequently causing infection. CONCLUSION/SIGNIFICANCE: The induction of a weak inflammatory response may provide a clue to the persistence of A. baumannii in patients