Data Mining to Identify Quality of Care Factors Associated with Liability Claims and Risk Management Strategies in Florida Nursing Homes

The challenges facing the nursing home industry are increasingly important to the population of the United States. As the population grows older, the number of people that will require services from a nursing home will increase. In today\u27s environment the nursing home business is facing many challenges that will define the future of the industry. Among them is the plaintiff attorney lawsuit against nursing homes, rising liability costs and vulnerability to lawsuits. A reduction in liability claims should allow nursing homes in Florida to remain solvent and stay in business to take care of those who cannot take care of themselves. This demographic shift has to be supported by a vibrant, efficient, and high-quality nursing home system. The purpose of this study was to examine the influence that quality of care factors and risk management strategies have on liability claims in nursing homes, and to create a risk management model. Four research questions and a hypothesis were tested. The research design was an exploratory and predictive quantitative design using data mining of secondary data. The study analyzed the quality of care factors associated with liability claims and model risk management in order to predict and generate strategies that can decrease claims in Florida nursing homes. The data sets that were used in the study consisted of data from 106 nursing homes from 67 counties in Florida. The study used data mining software application to conduct data mining analysis and create risk management models. The data models developed were used to identify quality of care factors associated with liability claims in Florida nursing homes. Findings indicated that (a) there was a strong correlation between quality of care indicators and the incidents that led to liability claims; (b) various risk management strategies have been used in Florida, of which the most common seem to be methods for training staff; (c) while various risk management strategies such as training and educating staff do have an effect on the number and severity of lawsuits, they are not necessarily sufficient to decrease nursing homes\u27 exposure to risk substantially; and, (d) the success of the measurements indicated that there are indeed diagnostic tools that can identify areas of risk, but the external factors noted in the answer to the previous question still apply. The implications and recommendations were essentially that the solution to the problems facing the nursing home industry requires a holistic focus on the legal and financial context of that industry. That holistic focus, in conjunction with efforts to further improve the nursing home industry itself, could help ensure that as millions of Americans begin to retire, they have the necessary resources and infrastructure to support them

Phenotypic and Genetic Consequences of Size Selection at the Larval Stage in the Pacific Oyster (Crassostrea gigas)

The life histories of oysters in the genus "Crassostrea", like those of most marine bivalves, are typified by high fecundity and low survival in nature. Rearing conditions in hatcheries however ensure optimized density, diet, and temperature. Hatcheries are becoming increasingly important for the production of juveniles in aquaculture, and their culture practices often include culling of slow growing larvae to reduce and synchronize the time taken to reach settlement. Because previous studies have found substantial genetic variation for early life developmental traits in "Crassostrea gigas", these culling practices are likely to cause highly different selective pressures in hatcheries from those in the natural environment. We studied the phenotypic and genetic impact of such culling practices in a factorial cross between 10 males and 3 females subjected to progressive culling of the smallest 50% of larvae, compared with a non-culled control. Measurements were made on larval growth, survival, time taken to attain pediveliger stage and settlement success. Culling had a larger effect on the variance of these larval traits than on their means. The larvae in culled cultures were approximately 10% larger than those in controls, whereas the coefficient of variation was reduced by 30 -40%. Culling also reduced the mean time to settlement by 12% and its variance by 55%. Using a multiplexed set of microsatellite markers to trace parentage, we also estimated the variance in reproductive success in a controlled experiment to quantify the consequences of intensive hatchery rearing practices. We also focused on changes in effective population size and genetic structure over time (and developmental stages). Our results show a loss of genetic diversity following removal of the smallest larvae by culling, as well as temporally varying genetic structure of the larval population. This supports the existence of genetic variability in early life developmental traits in C. gigas. Culling in hatcheries, like size-related selective pressures in the wild, are likely to have a significant genetic impact, through their effects on the timing of settlement

Summer Mortality of Hatchery-produced Pacific Oyster Spat (Crassostrea gigas). I. Estimation of Genetic Parameters for Survival and Growth

The multidisciplinary project "MOOREST" aims to improve our understanding of causes of summer mortality in "Crassostrea gigas" juveniles in France and to reduce its its impact on oyster production. As part of the MOREST project, 43 full-sib families nested within 17 half-sib families were produced, planted out and tested in 3 sites during summer 2001 to assess to what extent genetic variability exists for this trait. A strong genetic basis was found for survival as narrow-sense heritability estimates ranged from 0.47 to 1.08, with higher values in sites where summer mortality was higher. Genetic correlations across sites were positive and very high for survival, indicating no genotype by environment interaction. In contrast, lower genetic variation was observed for growth in all sites. Finally, genetic correlations between growth and survival were low, in all sites. Selective breeding in a single site should therefore be an efficient means of improving survival in oysters less than one year old along the French Atlantic and Channel coastlines with only very limited effects on growth. As yield mostly depends on survival and growth, this approach should significantly improve harvestable yield. Possible reasons why a high genetic variance for survival appears to be maintained in wild populations are discussed

Maturation Trends Suggestive of Rapid Evolution Preceded the Collapse of Northern Cod

Northern cod, comprising populations of Atlantic cod (Gadus morhua) off southern Labrador and eastern Newfoundland, supported major fisheries for hundreds of years. But in the late 1980s and early 1990s, northern cod underwent one of the worst collapses in the history of fisheries. The Canadian government closed the directed fishing for northern cod in July 1992, but even after a decade-long offshore moratorium, population sizes remain historically low. Here we show that, up until the moratorium, the life history of northern cod continually shifted towards maturation at earlier ages and smaller sizes. Because confounding effects of mortality changes and growth-mediated phenotypic plasticity are accounted for in our analyses, this finding strongly suggests fisheries-induced evolution of maturation patterns in the direction predicted by theory. We propose that fisheries managers could use the method described here as a tool to provide warning signals about changes in life history before more overt evidence of population decline becomes manifest

Early detection of myocardial fibrosis in type II diabetic patients using MR T1-mapping

ORAL PRESENTATIONInternational audienc

Echocardiographic Evidence for Valvular Toxicity of Benfluorex: A Double-Blind Randomised Trial in Patients with Type 2 Diabetes Mellitus

OBJECTIVES: REGULATE trial was designed to compare the efficacy and safety of benfluorex versus pioglitazone in type 2 diabetes mellitus (DM) patients. METHODS: Double-blind, parallel-group, international, randomised, non-inferiority trial. More than half of the 196 participating centres were primary care centres. Patients eligible had type 2 DM uncontrolled on sulfonylurea. 846 were randomised. They received study treatment for 1 year. 423 patients were allocated to benfluorex (150 to 450 mg/day) and 423 were allocated to pioglitazone (30 to 45 mg/day). Primary efficacy criterion was HbA(1c). Safety assessment included blinded echocardiographic evaluation of cardiac and valvular status. RESULTS: At baseline, patients were 59.1 ± 10.5 years old with HbA1c 8.3 ± 0.8%, and DM duration 7.1 ± 6.0 years. During the study, mean HbA1c significantly decreased in both groups (benfluorex: from 8.30 ± 0.80 to 7.77 ± 1.31 versus pioglitazone: from 8.30 ± 0.80 to 7.45 ± 1.30%). The last HbA1c value was significantly lower with pioglitazone than with benfluorex (p<0.001) and non-inferiority of benfluorex was not confirmed (p = 0.19). Among the 615 patients with assessable paired echocardiography (310 benfluorex, 305 pioglitazone), 314 (51%) had at least one morphological valvular abnormality and 515 (84%) at least one functional valvular abnormality at baseline. Emergent morphological abnormalities occurred in 8 patients with benfluorex versus 4 with pioglitazone (OR 1.99), 95% CI (0.59 to 6.69). Emergent regurgitation (new or increased by one grade or more) occurred more frequently with benfluorex (82 patients, 27%) than with pioglitazone (33 patients, 11%) (OR 2.97), 95% CI (1.91 to 4.63) and were mainly rated grade 1; grade 2 (mild) was detected in 2 patients with benfluorex and 3 with pioglitazone. There was no moderate or severe regurgitation. CONCLUSION: After 1 year of exposure, our results show a 2.97 fold increase in the incidence of valvular regurgitation with benfluorex and provide evidence for the valvular toxicity of this drug