OLAP for health statistics: how to turn a simple spreadsheet into a powerful analytical tool

Over the last ten years, Online Analytical Processing (OLAP) has become a very popular tool for interactive analysis of multidimensional information. Providing online operation and flexible summarising, tabulating and charting options, it has become an essential part of the decision support process in corporate setting. Our aim is to demonstrate how easily applicable and useful OLAP can be in the public sector. To achieve that, we used data compiled from different sources for the purpose of exploring the relations between causes of death (according to ICD-10) and socio-economic characteristics (educational level, marital status, profession, etc.) for selected years 1992, 1995 and 1998 in Slovenia. Using a standard personal computer and the Windows® platform, the application was implemented in Microsoft® Excel 2000, without any programming. After data cleansing (elimination of incorrect entries, duplicates and inconsistencies based on exploratory statistical methods), the case-based spreadsheet data was instantly converted into an OLAP application with the user-friendly pivot table technology. A bonus of this approach is that the results can be made directly accessible over the WWW by publishing the workbook to a web server. Provided that the user has Microsoft® Internet Explorer and Microsoft® Office 2000 installed, all the drill-in, drill-out and dimension-swapping capabilities are accessible within the browser, while the data source remains fully protected. Privacy constraints are respected since all the information is only provided at the aggregate level. Even though our dataset provides exhaustive coverage of mortality at the national level, storage and processing capabilities did not prove to be an issue. Hence, we argue that OLAP methodology should find a place in health statistics. With proper data collection and/or transformations, informative comparisons within the study population and with international databases become readily accessible. The key advantage of OLAP over relational database management systems and ordinary tables is interactive browsing of multidimensional and hierarchical data, while OLAP can also aid data integrity checking and reporting

Dynamical tunneling in mushroom billiards

We study the fundamental question of dynamical tunneling in generic two-dimensional Hamiltonian systems by considering regular-to-chaotic tunneling rates. Experimentally, we use microwave spectra to investigate a mushroom billiard with adjustable foot height. Numerically, we obtain tunneling rates from high precision eigenvalues using the improved method of particular solutions. Analytically, a prediction is given by extending an approach using a fictitious integrable system to billiards. In contrast to previous approaches for billiards, we find agreement with experimental and numerical data without any free parameter.Comment: 4 pages, 4 figure

Dissociation of a Hubbard--Holstein bipolaron driven away from equilibrium by a constant electric field

Using a variational numerical method we compute the time-evolution of the Holstein-Hubbard bipolaron from its ground state when at t=0 the constant electric field is switched on. The system is evolved taking into account full quantum effects until it reaches a quasi-stationary state. In the zero-field limit the current shows Bloch oscillations characteristic for the adiabatic regime where the electric field causes the bipolaron to evolve along the quasiparticle band. Bipolaron remains bound and the net current remains zero in this regime. At larger electric fields the system enters the dissipative regime with a finite steady-state current. Concomitantly, the bipolaron dissociates into two separate polarons. By examining different parameter regimes we show that the appearance of a finite steady-state current is inevitably followed by the dissociation of the bipolaron.Comment: 9 pages, 7 figure

Diagnostic accuracy of haemophilia early arthropathy detection with ultrasound (HEAD-US): A comparative magnetic resonance imaging (MRI) study

Background. Repeated haemarthroses affect approximately 90% of patients with severe haemophilia and lead to progressive arthropathy, which is the main cause of morbidity in these patients. Diagnostic imaging can detect even subclinical arthropathy changes and may impact prophylactic treatment. Magnetic resonance imagining (MRI) is generally the gold standard tool for precise evaluation of joints, but it is not easily feasible in regular follow-up of patients with haemophilia. The development of the standardized ultrasound (US) protocol for detection of early changes in haemophilic arthropathy (HEAD-US) opened new perspectives in the use of US in management of these patients. The HEAD-US protocol enables quick evaluation of the six mostly affected joints in a single study. The aim of this prospective study was to determine the diagnostic accuracy of the HEAD-US protocol for the detection and quantification of haemophilic arthropathy in comparison to the MRI. Patients and methods. The study included 30 patients with severe haemophilia. We evaluated their elbows, ankles and knees (overall 168 joints) by US using the HEAD-US protocol and compared the results with the MRI using the International Prophylaxis Study Group (IPSG) MRI score. Results. The results showed that the overall HEAD-US score correlated very highly with the overall IPSG MRI score (r = 0.92). Correlation was very high for the evaluation of the elbows and knees (r 48 0.95), and slightly lower for the ankles (r 48 0.85). Conclusions. HEAD-US protocol proved to be a quick, reliable and accurate method for the detection and quantification of haemophilic arthropathy

Complex paths for regular-to-chaotic tunneling rates

In generic Hamiltonian systems tori of regular motion are dynamically separated from regions of chaotic motion in phase space. Quantum mechanically these phase-space regions are coupled by dynamical tunneling. We introduce a semiclassical approach based on complex paths for the prediction of dynamical tunneling rates from regular tori to the chaotic region. This approach is demonstrated for the standard map giving excellent agreement with numerically determined tunneling rates.Comment: 5 pages, 4 figure

Upregulation of nitric oxide synthase in mice with severe hypoxia-induced pulmonary hypertension

BACKGROUND: The importance of nitric oxide (NO) in hypoxic pulmonary hypertension has been demonstrated using nitric oxide synthase (NOS) knockout mice. In that model NO from endothelial NOS (eNOS) plays a central role in modulating pulmonary vascular tone and attenuating hypoxic pulmonary hypertension. However, the normal regulation of NOS expression in mice following hypoxia is uncertain. Because genetically engineered mice are often utilized in studies of NO, we conducted the present study to determine how hypoxia alters NOS expression in wild-type mice. METHOD: Mice were exposed to sea level, ambient conditions (5280 feet) or severe altitude (17,000 feet) for 6 weeks from birth, and hemodynamics and lung NOS expression were assessed. RESULTS: Hypoxic mice developed severe pulmonary hypertension (right ventricular systolic pressure [RVsP] 60 mmHg) as compared with normoxic mice (27 mmHg). Using quantitative reverse-transcription PCR, it was found that expressions of eNOS and inducible NOS (iNOS) increased 1.5-fold and 3.5-fold, respectively, in the lung. In addition, the level of lung eNOS protein was increased, neuronal NOS (nNOS) protein was unchanged, and iNOS was below the limit of detection. Immunohistochemistry demonstrated no change in lung iNOS or nNOS staining in either central or peripheral areas, but suggested increased eNOS in the periphery following hypoxia. CONCLUSION: In mice, hypoxia is associated with increases in lung eNOS, possibly in iNOS, but not in nNOS; this suggests that the pattern of lung NOS expression following hypoxia must be considered in studies using genetically engineered mice

Uncertainty analysis in environmental radioactivity measurements using the Monte Carlo code MCNP5

High Purity Germanium (HPGe) detectors are widely used for environmental radioactivity measurements due to their excellent energy resolution. Monte Carlo (MC) codes are a useful tool to complement experimental measurements in calibration procedures at the laboratory. However, the efficiency curve of the detector can vary due to uncertainties associated with measurements. These uncertainties can be classified into some categories: geometrical parameters of the measurement (distance source-detector, volume of the source), properties of the radiation source (radionuclide activity, branching ratio), and detector characteristics (Ge dead layer, active volume, end cap thickness). The Monte Carlo simulation can be also affected by other kind of uncertainties mainly related to cross sections and to the calculation itself. Normally, all these uncertainties are not well known and it is required a deep analysis to determine their effect on the detector efficiency. In this work, the Noether-Wilks formula is used to carry out the uncertainty analysis. A Probability Density Function (PDF) is assigned to each variable involved in the sampling process. The size of the sampling is determined from the characteristics of the tolerance intervals by applying the Noether Wilks formula. Results of the analysis transform the efficiency curve into a region of possible values into the tolerance intervals. Results show a good agreement between experimental measurements and simulations for two different matrices (water and sand).Gallardo Bermell, S.; Querol Vives, A.; Ortiz Moragón, J.; Ródenas Diago, J.; Verdú Martín, GJ.; Villanueva López, JF. (2015). Uncertainty analysis in environmental radioactivity measurements using the Monte Carlo code MCNP5. Radiation Physics and Chemistry. 116:214-218. doi:10.1016/j.radphyschem.2015.05.023S21421811

Forefoot pathology in rheumatoid arthritis identified with ultrasound may not localise to areas of highest pressure: cohort observations at baseline and twelve months

BackgroundPlantar pressures are commonly used as clinical measures, especially to determine optimum foot orthotic design. In rheumatoid arthritis (RA) high plantar foot pressures have been linked to metatarsophalangeal (MTP) joint radiological erosion scores. However, the sensitivity of foot pressure measurement to soft tissue pathology within the foot is unknown. The aim of this study was to observe plantar foot pressures and forefoot soft tissue pathology in patients who have RA.Methods A total of 114 patients with established RA (1987 ACR criteria) and 50 healthy volunteers were assessed at baseline. All RA participants returned for reassessment at twelve months. Interface foot-shoe plantar pressures were recorded using an F-Scan® system. The presence of forefoot soft tissue pathology was assessed using a DIASUS musculoskeletal ultrasound (US) system. Chi-square analyses and independent t-tests were used to determine statistical differences between baseline and twelve months. Pearson’s correlation coefficient was used to determine interrelationships between soft tissue pathology and foot pressures.ResultsAt baseline, RA patients had a significantly higher peak foot pressures compared to healthy participants and peak pressures were located in the medial aspect of the forefoot in both groups. In contrast, RA participants had US detectable soft tissue pathology in the lateral aspect of the forefoot. Analysis of person specific data suggests that there are considerable variations over time with more than half the RA cohort having unstable presence of US detectable forefoot soft tissue pathology. Findings also indicated that, over time, changes in US detectable soft tissue pathology are out of phase with changes in foot-shoe interface pressures both temporally and spatially.Conclusions We found that US detectable forefoot soft tissue pathology may be unrelated to peak forefoot pressures and suggest that patients with RA may biomechanically adapt to soft tissue forefoot pathology. In addition, we have observed that, in patients with RA, interface foot-shoe pressures and the presence of US detectable forefoot pathology may vary substantially over time. This has implications for clinical strategies that aim to offload peak plantar pressures

Responsible implementation of expanded carrier screening.

This document of the European Society of Human Genetics contains recommendations regarding responsible implementation of expanded carrier screening. Carrier screening is defined here as the detection of carrier status of recessive diseases in couples or persons who do not have an a priori increased risk of being a carrier based on their or their partners' personal or family history. Expanded carrier screening offers carrier screening for multiple autosomal and X-linked recessive disorders, facilitated by new genetic testing technologies, and allows testing of individuals regardless of ancestry or geographic origin. Carrier screening aims to identify couples who have an increased risk of having an affected child in order to facilitate informed reproductive decision making. In previous decades, carrier screening was typically performed for one or few relatively common recessive disorders associated with significant morbidity, reduced life-expectancy and often because of a considerable higher carrier frequency in a specific population for certain diseases. New genetic testing technologies enable the expansion of screening to multiple conditions, genes or sequence variants. Expanded carrier screening panels that have been introduced to date have been advertised and offered to health care professionals and the public on a commercial basis. This document discusses the challenges that expanded carrier screening might pose in the context of the lessons learnt from decades of population-based carrier screening and in the context of existing screening criteria. It aims to contribute to the public and professional discussion and to arrive at better clinical and laboratory practice guidelines.European Journal of Human Genetics advance online publication, 16 March 2016; doi:10.1038/ejhg.2015.271