96 research outputs found
Latent cluster analysis of ALS phenotypes identifies prognostically differing groups
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a degenerative disease predominantly affecting motor neurons and manifesting as several different phenotypes. Whether these phenotypes correspond to different underlying disease processes is unknown. We used latent cluster analysis to identify groupings of clinical variables in an objective and unbiased way to improve phenotyping for clinical and research purposes.
METHODS
Latent class cluster analysis was applied to a large database consisting of 1467 records of people with ALS, using discrete variables which can be readily determined at the first clinic appointment. The model was tested for clinical relevance by survival analysis of the phenotypic groupings using the Kaplan-Meier method.
RESULTS
The best model generated five distinct phenotypic classes that strongly predicted survival (p<0.0001). Eight variables were used for the latent class analysis, but a good estimate of the classification could be obtained using just two variables: site of first symptoms (bulbar or limb) and time from symptom onset to diagnosis (p<0.00001).
CONCLUSION
The five phenotypic classes identified using latent cluster analysis can predict prognosis. They could be used to stratify patients recruited into clinical trials and generating more homogeneous disease groups for genetic, proteomic and risk factor research
Assessing the Relative Performance of Nurses Using Data Envelopment Analysis Matrix (DEAM)
Assessing employee performance is one of the most important issue in healthcare management services. Because of their direct relationship with patients, nurses are also the most influential hospital staff who play a vital role in providing healthcare services. In this paper, a novel Data Envelopment Analysis Matrix (DEAM) approach is proposed for assessing the performance of nurses based on relative efficiency. The proposed model consists of five input variables (including type of employment, work experience, training hours, working hours and overtime hours) and eight output variables (the outputs are amount of hours each nurse spend on each of the eight activities including documentation, medical instructions, wound care and patient drainage, laboratory sampling, assessment and control care, follow-up and counseling and para-clinical measures, attendance during visiting and discharge suction) have been tested on 30 nurses from the heart department of a hospital in Iran. After determining the relative efficiency of each nurse based on the DEA model, the nursesâ performance were evaluated in a DEAM format. As results the nurses were divided into four groups; superstars, potential stars, those who are needed to be trained effectively and question marks. Finally, based on the proposed approach, we have drawn some recommendations to policy makers in order to improve and maintain the performance of each of these groups. The proposed approach provides a practical framework for hospital managers so that they can assess the relative efficiency of nurses, plan and take steps to improve the quality of healthcare delivery
A cost and performance comparison of Public Private Partnership and public hospitals in Spain
© 2016 Caballer-Tarazona and Vivas-Consuelo. Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons license, and indicate if changes were made.The Erratum to this article has been published in Health Economics Review 2016 6:20[EN] Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to
traditional public health systems, with the intention of making them more efficient.
There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts
with the private, up to the complete privatisation of the service. As such, we may say the involvement of the
private sector embraces the development, financing and provision of public infrastructures and delivery services.
In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin
American countries is evaluated for first time: the integrated healthcare delivery Alzira model.
Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the
PPP experience in five hospitals is evaluated to identify the influence of private management in the results.
Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the
average, but not always better than those directly managed. It is necessary to conduct studies with a greater
number of PPP hospitals to obtain conclusive results.Caballer Tarazona, M.; Vivas Consuelo, DJJ. (2016). A cost and performance comparison of Public Private Partnership and public hospitals in Spain. Health Economics Review. 6(17):1-7. doi:10.1186/s13561-016-0095-5S17617La Forgia GM, Harding A. Public-Private Partnerships and Public Hospital Performance in Sao Paulo, Brazil. Health Aff. 2009;28(4):1114â26.Vecchi V, Hellowell M, Longo F. Are Italian healthcare organizations paying too much for their public-private partnerships? Public Money Manage. 2010;30(2):125â32.Hellowell M, Pollock AM. The private financing of NHS hospitals: politics, policy and practice. Econ Aff. 2009;29(1):13â9.McIntosh N, Grabowski A, Jack B, Nkabane-Nkholongo EL, Vian T. A public-private partnership improves clinical performance in a hospital network in Lesotho. Health Aff. 2015;34(6):954â62.Roehrich JK, Lewis MA, George G. Are publicâprivate partnerships a healthy option? A systematic literature review. Soc Sci Med. 2014;113:110â9.Barlow J, Roehrich J, Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff. 2013;32(1):146â54.Hoppe EI, Kusterer DJ, Schmitz PW. Public-private partnerships versus traditional procurement: an experimental investigation. J Econ Behav Organ. 2013;89:145â66.Vivas-Consuelo D, Uso-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martinez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy. 2014;116(2-3):188â95.Lopez-Casasnovas G, Costa-Font J, Planas I. Diversity and regional inequalities in the Spanish âsystem of health care servicesâ. Health Econ. 2005;14 Suppl 1:S221âS35.Spain NHSo. National Health System of Spain. National Health System of Spain; 2010.McKee M, Edwards N, Atun R. Public-private partnerships for hospitals. Bull World Health Organ. 2006;84(11):890â6.Caballer-Tarazona M, Moya-Clemente I, Vivas-Consuelo D, Barrachina-MartĂnez I. A model to measure the efficiency of hospital performance. Math Comput Model. 2010;52(7-8):1095â102.Barlow J, Roehrich JK, Wright S. De facto privatization or a renewed role for the EU? Paying for Europeâs healthcare infrastructure in a recession. J R Soc Med. 2010;103(2):51â5.Herr A, Schmitz H, Augurzky B. Profit efficiency and ownership of German hospitals. Health Econ. 2011;20(6):660â74.Alonso JM, Clifton J, DĂaz-Fuentes D. The impact of New Public Management on efficiency: an analysis of Madridâs hospitals. Health Policy. 2015;119(3):333â40.IASIST. Desarrollo metodolĂłgico de los indicadores ajustados 2009 [cited 2015 July 26]. Available from: ( http://www.iasist.com/archivos/top20-2009-metodologia_161215235006.pdf ). Accessed Sept 2015.Hollingsworth B. The measurement of efficiency and productivity of health care delivery. Health Econ. 2008;17(10):1107â28.Ozgen H, Ozcan YA. A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs. Health Serv Res. 2002;37(3):711â32.Valdmanis VG, Rosko MD, Mutter RL. Hospital quality, efficiency, and input slack differentials. Health Serv Res. 2008;43(5):1830â48.Acerete B, Stafford A, Stapleton P. Spanish healthcare public private partnerships: The âAlzira modelâ. Crit Perspect Account. 2011;22(6):533â49.Allard G, Trabant A. Public-private partnerships in Spain: lessons and opportunities. Int Business Econ Res J. 2008;7(2):1â24.Shaoul J, Stafford A, Stapleton P. The cost of using private finance to build, finance and operate hospitals. Public Money Manage. 2008;28(2):101â8
Femtosecond pulse generation around 650 nm in a passive mode-locked Kiton Red dye laser
Cherenkov radiation emitted by ultrafast laser pulses and the generation of coherent polaritons
We report on the generation of coherent phonon polaritons in ZnTe, GaP and
LiTaO using ultrafast optical pulses. These polaritons are coupled modes
consisting of mostly far-infrared radiation and a small phonon component, which
are excited through nonlinear optical processes involving the Raman and the
second-order susceptibilities (difference frequency generation). We probe their
associated hybrid vibrational-electric field, in the THz range, by
electro-optic sampling methods. The measured field patterns agree very well
with calculations for the field due to a distribution of dipoles that follows
the shape and moves with the group velocity of the optical pulses. For a
tightly focused pulse, the pattern is identical to that of classical Cherenkov
radiation by a moving dipole. Results for other shapes and, in particular, for
the planar and transient-grating geometries, are accounted for by a convolution
of the Cherenkov field due to a point dipole with the function describing the
slowly-varying intensity of the pulse. Hence, polariton fields resulting from
pulses of arbitrary shape can be described quantitatively in terms of
expressions for the Cherenkov radiation emitted by an extended source. Using
the Cherenkov approach, we recover the phase-matching conditions that lead to
the selection of specific polariton wavevectors in the planar and transient
grating geometry as well as the Cherenkov angle itself. The formalism can be
easily extended to media exhibiting dispersion in the THz range. Calculations
and experimental data for point-like and planar sources reveal significant
differences between the so-called superluminal and subluminal cases where the
group velocity of the optical pulses is, respectively, above and below the
highest phase velocity in the infrared.Comment: 13 pages, 11 figure
Assessing the queuing process using data envelopment analysis:an application in health centres
Queuing is one of the very important criteria for assessing the performance and efficiency of any service industry, including healthcare. Data Envelopment Analysis (DEA) is one of the most widely-used techniques for performance measurement in healthcare. However, no queue management application has been reported in the health-related DEA literature. Most of the studies regarding patient flow systems had the objective of improving an already existing Appointment System. The current study presents a novel application of DEA for assessing the queuing process at an Outpatientsâ department of a large public hospital in a developing country where appointment systems do not exist. The main aim of the current study is to demonstrate the usefulness of DEA modelling in the evaluation of a queue system. The patient flow pathway considered for this study consists of two stages; consultation with a doctor and pharmacy. The DEA results indicated that waiting times and other related queuing variables included need considerable minimisation at both stages
Transcriptional and Post-Transcriptional Regulation of SPAST, the Gene Most Frequently Mutated in Hereditary Spastic Paraplegia
Hereditary spastic paraplegias (HSPs) comprise a group of neurodegenerative disorders that are characterized by progressive spasticity of the lower extremities, due to axonal degeneration in the corticospinal motor tracts. HSPs are genetically heterogeneous and show autosomal dominant inheritance in âŒ70â80% of cases, with additional cases being recessive or X-linked. The most common type of HSP is SPG4 with mutations in the SPAST gene, encoding spastin, which occurs in 40% of dominantly inherited cases and in âŒ10% of sporadic cases. Both loss-of-function and dominant-negative mutation mechanisms have been described for SPG4, suggesting that precise or stoichiometric levels of spastin are necessary for biological function. Therefore, we hypothesized that regulatory mechanisms controlling expression of SPAST are important determinants of spastin biology, and if altered, could contribute to the development and progression of the disease. To examine the transcriptional and post-transcriptional regulation of SPAST, we used molecular phylogenetic methods to identify conserved sequences for putative transcription factor binding sites and miRNA targeting motifs in the SPAST promoter and 3âČ-UTR, respectively. By a variety of molecular methods, we demonstrate that SPAST transcription is positively regulated by NRF1 and SOX11. Furthermore, we show that miR-96 and miR-182 negatively regulate SPAST by effects on mRNA stability and protein level. These transcriptional and miRNA regulatory mechanisms provide new functional targets for mutation screening and therapeutic targeting in HSP
Impact of Appropriate Pharmaceutical Therapy for Chronic Conditions on Direct Medical Costs and Workplace Productivity: A Review of the Literature
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