Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques

BACKGROUND: Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system. METHODS: A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan’s year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. RESULTS: ICCs were generated for Taiwan’s year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. CONCLUSION: We recommend using the ICC to annually assess a nation’s year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system

Measurements of Natural Carbonate Rare Earth Elements in Femtogram Quantities by Inductive Coupled Plasma Sector Field Mass Spectrometry

A rapid and precise standard-bracketing method has been developed for measuring femtogram quantity rare earth element (REE) levels in natural carbonate samples by inductively coupled plasma sector field mass spectrometry that does not require chemical separation steps. A desolvation nebulization system was used to effectively reduce polyatomic interference and enhance sensitivity. REE/Ca ratios are calculated directly from the intensities of the ion beams of 46Ca, 139La, 140Ce, 141Pr, 146Nd, 147Sm, 153Eu, 160Gd, 159Tb, 163Dy, 165Ho, 166Er, 169Tm, 172Yb, and 175Lu using external matrix-matched synthetic standards to correct for instrumental ratio drifting and mass discrimination. A routine measurement time of 3 min is typical for one sample containing 20-40 ppm Ca. Replicate measurements made on natural coral and foraminiferal samples with REE/Ca ratios of 2-242 nmol/mol show that external precisions of 1.9-6.5% (2 RSD) can be achieved with only 10-1000 fg of REEs in 10-20 μg of carbonate. We show that different sources for monthly resolved coral ultratrace REE variability can be distinguished using this method. For natural slow growth-rate carbonate materials, such as sclerosponges, tufa, and speleothems, the high sample throughput, high precision, and high temporal resolution REE records that can be produced with this procedure have the potential to provide valuable time-series records to advance our understanding of paleoclimatic and paleoenvironmental dynamics on different time scales

Tracking and Following Algorithms of Mobile Robots for Service Activities in Dynamic Environments

By providing the capability of following a human target in an appropriate manner, the robot can assist people in various ways under different environments. One of the main difficulties when performing human tracking and following is the occlusion problem caused by static as well as dynamic obstacles. The aim of the paper is to tackle the occlusion problem by planning a robotic trajectory of maximizing target visibility and following the moving target. Initially, a laser range finder is used to detect the human target and then robustly track the target using the Kalman filter. Afterward, a human following algorithm based on a look-ahead algorithm, DWA*, is implemented to pursue the target while avoiding any static or dynamic obstacles. Fundamental experiments have been extensively tested to evaluate robot maneuvers and several field tests are conducted in more complex environments such as student cafeteria, computer center, and university library.</span

Manufacturing lot size and product distribution problem with rework, outsourcing and discontinuous inventory distribution policy

Product quality, timely delivery, and lower cost are critical operational goals to nowadays manufacturers, and company managements constantly seek different approaches to achieve these goals in order to stay competitive in turbulent global markets. This study investigates a practical manufacturing lot size and distribution problem with rework, outsourcing, and discontinuous inventory distribution policy. In real manufacturing environments, due to different controllable and/or uncontrollable factors, production of the nonconforming products is inevitable. Careful inspection into identifying nonconforming items and instant correction of the defects are considered in the proposed study. In additions, due to the limited production capacity in real manufacturing environments, sometimes, outsourcing can be used to cope with occasional unsteady demands, or running short of in-house capacity, to allow the management to maintain a smooth operation and/or shorten the production cycle length. Furthermore, in vendor-buyer integrated supply chains, multi-delivery policy is often considered for distributing finished products to customers. Motivated by the aforementioned practical situations, this study develops a mathematical model to explicitly investigate such a manufacturing lot-size and product distribution problem. Optimization techniques are employed to solve the problem and a numerical example is provided to show the applicability of our research results

Co-Overexpression of Cyclooxygenase-2 and Microsomal Prostaglandin E Synthase-1 Adversely Affects the Postoperative Survival in Non-small Cell Lung Cancer

IntroductionCyclooxygenase (COX)-2 and microsomal prostaglandin E synthase (mPGES)-1 have been found to be overexpressed in non-small cell lung cancer (NSCLC). The aim of this study was to investigate the expression profiles of COX-2 and mPGES-1 and their correlation with the clinical characteristics and survival outcomes in patients with resected NSCLC.Methods/ResultsSeventy-nine paired adjacent normal-tumor matched samples were prospectively procured from patients undergoing surgery for NSCLC. The protein levels of COX-2 and mPGES-1 were assessed by Western blot analysis. Overexpression in the tumor sample was defined as more than twofold increase in protein expression compared with the corresponding adjacent normal tissue. Co-overexpression of COX-2 and mPGES-1 were further confirmed by immunohistochemistry. COX-2 was overexpressed in 58% and mPGES-1 in 70% of the tumor samples (p < 0.0001). Co-overexpression of mPGES-1 and COX-2 was noted in 43%, and they were unrelated to each other (p = 0.232). Co-overexpression of both proteins was significantly associated with less tumor differentiation (p = 0.046), tumor size larger than 5 cm (p = 0.038), and worse survival status during the follow-up (p = 0.036). Multivariate analysis showed that in addition to overall stage, co-overexpression of both proteins adversely affected the overall (hazard ratio, 2.40; p = 0.045) and disease-free survivals (hazard ratio, 2.27; p = 0.029).ConclusionsOverexpression of either COX-2 or mPGES-1 is common but unrelated in NSCLC. Co-overexpression of both COX-2 and mPGES-1 adversely affects postoperative overall and disease-free survivals

Trends and characteristics of pethidine use in Taiwan: a six-year-long survey

OBJECTIVES: To investigate the trends and characteristics of pethidine prescriptions and users in Taiwan from 2002 to 2007. METHOD: All pethidine users (n = 3,301,136) in Taiwan from 2002 to 2007 were linked to National Health Insurance claims to identify pethidine prescriptions. We examined the trends in pethidine user prevalence and the proportion of pethidine prescriptions according to health care characteristics. A logistic regression model was used to compare patient demographics and health care characteristics associated with pethidine prescriptions between 2002 and 2007. RESULTS: Despite the decline in the number of pethidine users and prescriptions over the six-year period, more than half a million people were prescribed pethidine annually. In fact, an increasing proportion of pethidine prescriptions were observed in clinics, outpatient settings, and patients who had both operations and cancer diagnoses. Pethidine prescriptions were mostly associated with a non-operation status without a cancer diagnosis (>;60%). However, approximately 10% of the total pethidine prescriptions were found in patients with a cancer diagnosis but no operation. Compared to those in 2002, pethidine prescriptions in 2007 were more likely to be found in people 80 years or older, rural residents, patients from clinics, outpatient settings and operation patients with cancer diagnoses. CONCLUSIONS: A population-based survey in Taiwan demonstrated decreasing consumption of pethidine from 2002 to 2007; however, an increased proportion of prescriptions in certain health care settings was observed. In addition, 10% of the pethidine prescriptions were for cancer patients without operations. These cases need further evaluation for the determination of appropriate pethidine use