Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, CI95% $595-$895, n = 13) were significantly lower (p < 0.01) than the hospital group ($2543, CI95% $1766-$3321, n = 12). There was an improvement in lung function in the hospital-managed group at the Outpatient Department review, decreased anxiety in the Emergency Department in the home-managed group and equal patient satisfaction with care delivery. Acute care at home schemes can substitute for usual hospital care for some patients without adverse effects, and potentially release resources. A funding model that allows adequate resource delivery to the community will be needed if there is a move to devolve acute care to community providers.

An EM-based Semi-Parametric Mixture Model Approach to the Regression Analysis of Competing-Risks Data

We consider a mixture model approach to the regression analysis of competing-risks data. Attention is focused on inference concerning the effects of factors on both the probability of occurrence and the hazard rate conditional on each of the failure types. These two quantities are specified in the mixture model using the logistic model and the proportional hazards model, respectively. We propose a semi-parametric mixture method to estimate the logistic and regression coefficients jointly, whereby the component-baseline hazard functions are completely unspecified. Estimation is based on maximum likelihood on the basis of the full likelihood, implemented via an expectation-conditional maximization (ECM) algorithm. Simulation studies are performed to compare the performance of the proposed semi-parametric method with a fully parametric mixture approach. The results show that when the component-baseline hazard is monotonic increasing, the semi-parametric and fully parametric mixture approaches are comparable for mildly and moderately censored samples. When the component-baseline hazard is not monotonic increasing, the semi-parametric method consistently provides less biased estimates than a fully parametric approach and is comparable in efficiency in the estimation of the parameters for all levels of censoring. The methods are illustrated using a real data set of prostate cancer patients treated with different dosages of the drug diethylstilbestrol. Copyright (C) 2003 John Wiley Sons, Ltd.

Integrable generalized spin ladder models based on the SU(1|3) and SU(3|1) algebras

We present two integrable spin ladder models which possess a general free parameter besides the rung coupling J. The models are exactly solvable by means of the Bethe ansatz method and we present the Bethe ansatz equations. We analyze the elementary excitations of the models which reveal the existence of a gap for both models that depends on the free parameter. (C) 2003 American Institute of Physics.

Improving learning in undergraduate control engineering courses using context-based learning models

Control Engineering is an essential part of university electrical engineering education. Normally, a control course requires considerable mathematical as well as engineering knowledge and is consequently regarded as a difficult course by many undergraduate students. From the academic point of view, how to help the students to improve their learning of the control engineering knowledge is therefore an important task which requires careful planning and innovative teaching methods. Traditionally, the didactic teaching approach has been used to teach the students the concepts needed to solve control problems. This approach is commonly adopted in many mathematics intensive courses; however it generally lacks reflection from the students to improve their learning. This paper addresses the practice of action learning and context-based learning models in teaching university control courses. This context-based approach has been practised in teaching several control engineering courses in a university with promising results, particularly in view of student learning performances.

The development of retinotectal maps: A review of models based on molecular gradients

Information about the world is often represented in the brain in the form of topographic maps. A paradigm example is the topographic representation of the visual world in the optic tectum/superior colliculus. This map initially forms during neural development using activity-independent molecular cues, most notably some type of chemospecific matching between molecular gradients in the retina and corresponding gradients in the tectum/superior colliculus. Exactly how this process might work has been studied both experimentally and theoretically for several decades. This review discusses the experimental data briefly, and then in more detail the theoretical models proposed. The principal conclusions are that (1) theoretical models have helped clarify several important ideas in the field, (2) earlier models were often more sophisticated than more recent models, and (3) substantial revisions to current modelling approaches are probably required to account for more than isolated subsets of the experimental data.

Prediction of protein continuum secondary structure with probabilistic models based on NMR solved structures

Background: The structure of proteins may change as a result of the inherent flexibility of some protein regions. We develop and explore probabilistic machine learning methods for predicting a continuum secondary structure, i.e. assigning probabilities to the conformational states of a residue. We train our methods using data derived from high-quality NMR models. Results: Several probabilistic models not only successfully estimate the continuum secondary structure, but also provide a categorical output on par with models directly trained on categorical data. Importantly, models trained on the continuum secondary structure are also better than their categorical counterparts at identifying the conformational state for structurally ambivalent residues. Conclusion: Cascaded probabilistic neural networks trained on the continuum secondary structure exhibit better accuracy in structurally ambivalent regions of proteins, while sustaining an overall classification accuracy on par with standard, categorical prediction methods.

Physiologically based synthetic models of hepatic disposition

Current Physiologically based pharmacokinetic (PBPK) models are inductive. We present an additional, different approach that is based on the synthetic rather than the inductive approach to modeling and simulation. It relies on object-oriented programming A model of the referent system in its experimental context is synthesized by assembling objects that represent components such as molecules, cells, aspects of tissue architecture, catheters, etc. The single pass perfused rat liver has been well described in evaluating hepatic drug pharmacokinetics (PK) and is the system on which we focus. In silico experiments begin with administration of objects representing actual compounds. Data are collected in a manner analogous to that in the referent PK experiments. The synthetic modeling method allows for recognition and representation of discrete event and discrete time processes, as well as heterogeneity in organization, function, and spatial effects. An application is developed for sucrose and antipyrine, administered separately and together PBPK modeling has made extensive progress in characterizing abstracted PK properties but this has also been its limitation. Now, other important questions and possible extensions emerge. How are these PK properties and the observed behaviors generated? The inherent heuristic limitations of traditional models have hindered getting meaningful, detailed answers to such questions. Synthetic models of the type described here are specifically intended to help answer such questions. Analogous to wet-lab experimental models, they retain their applicability even when broken apart into sub-components. Having and applying this new class of models along with traditional PK modeling methods is expected to increase the productivity of pharmaceutical research at all levels that make use of modeling and simulation.

A rigorous foundation for pattern based design models

This paper presents a way to describe design patterns rigorously based on role concepts. Rigorous pattern descriptions are a key aspect for patterns to be used as rules for model evolution in the MDA context, for example. We formalize the role concepts commonly used in defining design patterns as a role metamodel using Object-Z. Given this role metamodel, individual design patterns are specified generically as a formal pattern role model using Object-Z. We also formalize the properties that must be captured in a class model when a design pattern is deployed. These properties are defined generically in terms of role bindings from a pattern role model to a class model. Our work provides a precise but abstract approach for pattern definition and also provides a precise basis for checking the validity of pattern usage in designs.