Polypharmacy as predictor of drug cost, length of hospital stay and mortality rate in nursing homes : a retrospective analysis of pharmacy medication records

Background and objectives: Polypharmacy (PP) is a typical con-sequence of multiple chronic conditions in elderly patients. PP is commonly defined as the use of multiple concurrent drug therapies although a standard definition is not used. The aims of this study were to assess the PP rate among nursing home (NH) residents using the data of the pharmacy medication records and to investigate the threshold level of PP as predictor of drug cost, length of hospital stay and mortality rate

A Computer Based Information System for County Equipment Cost Records, Interim Report, HR-173, 1975

This report describes the work accomplished to date on research project HR-173, A Computer Based Information System for County Equipment Cost Records, and presents the initial design for this system. The specific topics discussed here are findings from the analysis of information needs, the system specifications developed from these findings, and the proposed system design based upon the system specifications. The initial system design will include tentative input designs for capturing input data, output designs to show the output formats and the items to be output for use in decision making, file design showing the organization of information to be kept on each piece of equipment in the computer data file, and general system design explaining how the entire system will operate. The Steering Committee appointed by Iowa Highway Research Board is asked to study this report, make appropriate suggestions, and give approval to the proposed design subject to any suggestions made. This approval will permit the designer to proceed promptly with the development of the computer program implementation phase of the design.

A Computer Based Information System for County Equipment Cost Records, Final Report, HR-173, 1975

This appendix is divided into three sections. The first section contains abstracts of each of the eight computer programs in the system, instructions for keypunching the three input documents, and computer operating instructions pertaining to each program. The second section contains system flowcharts for the entire system as well as program flowcharts for each program. The last section contains PL/l program listings of each program.

Paleohydrological Reconstruction from Late Holocene Records in Interdune Lakes (N'Guigmi, Northern Bank of the Lake Chad, Niger)

An old erg covers the northern part of the Lake Chad basin. This dune landform allowed the formation of many inter- dune ponds of various sizes. Still present in certain zones where the groundwater level is high (e.g. Kanem, southern Manga), these ponds formed in the past a vast network of lacustrine microsystems, as shown by the nature and the dis- tribution of their deposits. In the Manga, these interdune deposits represent the main sedimentary records of the Holo- cene environmental succession. Their paleobiological (pollens, diatoms, ostracods) and geochemical (δ18O, δ13C, Sr/ Ca) contents are often the basis for paleoenvironmental reconstruction. On the other hand, their sedimentological char- acters are rarely exploited. This study of palustro-lacustrine deposits of the Holocene N'Guigmi lake (northern bank of the Lake Chad; Niger) is based on the relationships between the sedimentological features and the climato-hydrological fluctuations. The mineralogical parameters (e.g. calcium carbonate content, clay mineralogy) and the nature of autoch- thonous mineralization (i.e. amorphous silica, clays, calcium carbonates) can be interpreted using a straightforward hy- dro-sedimentary model. Established to explain the geochemical dynamics of Lake Chad, this model is based on a bio- geochemical cycle of the main elements (i.e. silicium, calcium) directly controlled by the local hydrological balance (i.e. rainfall/evaporation ratio). All these results show that a detailed study of sedimentological features can provide impor- tant paleohydrological informations about the regional aridification since ca 6500 14C BP.

The Mixed Management of Patients' Medical Records: Responsibility Sharing Between the Patient and the Physician

Through this article, we propose a mixed management of patients' medical records, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes. The aim of the first process is to provide a patient's administrative data, in order to know where and when the patient received care (name of the health structure or health practitioner, type of care: out patient or inpatient). The aim of the second process is to provide a patient's medical information and to validate it under the accountability of the Medical Practitioner with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. The proposed Medical Record Search Engines will be able to retrieve and to provide upon a request formulated by the Medical ractitioner all the available information concerning a patient who has received care in different health structures without divulging the patient's identity. Our method can lead to improved efficiency of personal medical record management under the mixed responsibilities of the patient and the MP.

Summary of Early Triassic carbon isotope records

Much attention has been given to the negative d13C anomaly nearly coincident with the Permian-Triassic boundary. New data indicate a stepwise decline in d13C initiating before the Latest Permian extinction event followed by highly variable d13C values during the remaining Early Triassic. d13C values appear much less erratic as global metazoan diversity increased in the Middle Triassic. Given the previously unappreciated magnitude of isotopic change and the number of large d13C excursions that occurred during the Early Triassic, catastrophic mechanisms like methane release/bolide impact become less attractive to explain the Early Triassic carbon isotopic record as a whole.

Graphical probabilistic analysis of the combination of items of evidence

Unlike the evaluation of single items of scientific evidence, the formal study and analysis of the jointevaluation of several distinct items of forensic evidence has to date received some punctual, ratherthan systematic, attention. Questions about the (i) relationships among a set of (usually unobservable)propositions and a set of (observable) items of scientific evidence, (ii) the joint probative valueof a collection of distinct items of evidence as well as (iii) the contribution of each individual itemwithin a given group of pieces of evidence still represent fundamental areas of research. To somedegree, this is remarkable since both, forensic science theory and practice, yet many daily inferencetasks, require the consideration of multiple items if not masses of evidence. A recurrent and particularcomplication that arises in such settings is that the application of probability theory, i.e. the referencemethod for reasoning under uncertainty, becomes increasingly demanding. The present paper takesthis as a starting point and discusses graphical probability models, i.e. Bayesian networks, as frameworkwithin which the joint evaluation of scientific evidence can be approached in some viable way.Based on a review of existing main contributions in this area, the article here aims at presentinginstances of real case studies from the author's institution in order to point out the usefulness andcapacities of Bayesian networks for the probabilistic assessment of the probative value of multipleand interrelated items of evidence. A main emphasis is placed on underlying general patterns of inference,their representation as well as their graphical probabilistic analysis. Attention is also drawnto inferential interactions, such as redundancy, synergy and directional change. These distinguish thejoint evaluation of evidence from assessments of isolated items of evidence. Together, these topicspresent aspects of interest to both, domain experts and recipients of expert information, because theyhave bearing on how multiple items of evidence are meaningfully and appropriately set into context.

Earthworms from Mato Grosso, Brazil, and new records of species from the state

The objective of this work was to undertake a qualitative assessment of earthworm diversity in areas under human influence, in a region of Cerrado-Pantanal-Amazon rainforest transition, in the state of Mato Grosso, Brazil. The earthworms were collected in the municipalities of Barra do Bugres and Arenápolis, and were studied together with species previously identified from other municipalities. Seventeen municipalities, at 29 sampling points of Mato Grosso State, have been sampled. Seven species of earthworms were collected and identified in Barra do Bugres: Goiascolex vanzolinii, Pontoscolex (Pontoscolex) corethrurus, Opisthodrillus borellii borellii, Opisthodrillus sp., Dichogaster (Diplothecodrilus) gracilis, Dichogaster sp. and a species of the Criodrilidae family. Four species of earthworms were identified in Arenápolis: Pontoscolex (Pontoscolex) corethrurus, Dichogaster (Diplothecodrilus) gracilis, Dichogaster (Diplothecodrilus) affinis and Dichogaster sp. In total, 32 earthworm species/subspecies are known from Mato Grosso, 22 native and 10 exotic.

A Graphical Pattern Editor for Java Frameworks

Ohjelmistojen uudelleenkäyttö on hyvin tärkeä käsite ohjelmistotekniikan alueella.Ohjelmistojen uudelleenkäyttötekniikat parantavat ohjelmistokehitysprosessin laatua. Yleisiä ratkaisuja sekä ohjelmiston suunnittelun että arkkitehtuurin uudelleenkäyttöön ovat olio-ohjelmointi ja sovelluskehykset. Tähän asti ei ole ollut olemassa yleisiä tapoja sovelluskehysten erikoistamiseen. Monet nykyääntunnetuista sovelluskehyksistä ovat hyvin suuria ja mutkikkaita. Tällaisten sovelluskehyksien käyttö on monimutkaista myös kokeneille ohjelmoijille. Hyvin dokumentoidut uudelleenkäytettävät sovelluskehyksen rajapinnat parantavat kehyksen käytettävyyttä ja tehostavat myös erikoistamisprosessiakin sovelluskehyksen käyttäjille. Sovelluskehyseditori (framework editor, JavaFrames) on prototyyppityökalu, jota voidaan käyttää yksinkertaistamaan sovelluskehyksen käyttöä. Perusajatus JavaFrames lähestymistavassa ovat erikoistamismallit, joita käytetään kuvamaan sovelluskehyksen uudelleenkäytettäviä rajapintoja. Näihin malleihin perustuen JavaFrames tarjoaa automaattisen lähdekoodi generaattorin, dokumentoinninja arkkitehtuurisääntöjen tarkistuksen. Tämä opinnäyte koskee graafisen mallieditorin kehittämistä JavaFrames ympäristöön. Työssä on laadittu työkalu,jonka avulla voidaan esittää graafisesti erikoistamismalli. Editori sallii uusien mallien luomisen, vanhojen käyttämättä olevien poistamisen, kuten myös yhteyksien lisäämisen mallien välille. Tällainen graafinen tuki JavaFrames ympäristöönvoi huomattavasti yksinkertaistaa sen käyttöä ja tehdä sovellusten kehittämisprosessista joustavamman.

Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

Value chain analysis in graphical boards business

Tällä tutkielmalla oli kaksi tavoitetta. Ensimmäinen tavoite oli selvittää, kuinka valittujen tuotteiden arvoa asiakkaiden silmissä voisi lisätä. Toisena tavoitteena oli selvittää tuotteiden arvon lisääntyminen arvoketjun jokaisella portaalla kartonkitehtaaltaloppuasiakkaalle. Tutkimuksen kohteena oli kolme erilaista arvoketjua. Tutkimusoli luonteeltaan kvalitatiivinen ja tarvittavat tiedot kerättiin haastatteluilla. Tutkimuksen tuloksena voidaan mainita, että asiakkaat arvostavat laskua kustannuksissa enemmän kuin lisähyötyjä. Myös prosentuaalinen arvonlisäys valittuihintuotteisiin arvoketjun eri portaissa saatiin selville. Tästä työstä on tehty kaksi versiota; tämä versio, joka tulee julkiseksi neljän vuoden salassapitoajan jälkeen, ja toinen versio, joka sisältää arkaluontoisempaa kustannusinformaatiotaja on siitä syystä kokonaan salainen.

Fishery of the Goliath grouper, Epinephelus itajara (Teleostei: Epinephelidae) based on local ecological knowledge and fishery records in Yucatan, Mexico

The Goliath grouper, Epinephelus itajara, a large-bodied (similar to 2.5 m TL, > 400 kg) and critically endangered fish (Epinephelidae), is highly Vulnerable to overfishing. Although protected from fishing in many countries, its exploitation in Mexico is unregulated; a situation that puts its populations at risk. Fishery records of E. itajara are scarce, which prevents determination of its fishery status. This work aimed to elucidate the E itajara fishery in the northern Yucatan Peninsula by 1) analyzing available catch records and 2) interviewing veteran fishermen (local ecological knowledge) from two traditional landing sites: Dzilam de Bravo and Puerto Progreso. Historic fishery records from two fishing cooperatives were analyzed in order to elucidate the current situation and offer viable alternatives for conservation and management. Catches have decreased severely. Local knowledge obtained from fishermen represented a very important source of information for reconstructing the fisheries history of this species. Conservation measures that incorporate regional and international regulations on critically endangered fish species are suggested

Reporting of methodologic information on trial registries for quality assessment: a study of trial records retrieved from the WHO search portal

Background: Although randomized clinical trials (RCTs) are considered the gold standard of evidence, their reporting is often suboptimal. Trial registries have the potential to contribute important methodologic information for critical appraisal of study results. Methods and Findings: The objective of the study was to evaluate the reporting of key methodologic study characteristics in trial registries. We identified a random sample (n = 265) of actively recruiting RCTs using the World Health Organization International Clinical Trials Registry Platform (ICTRP) search portal in 2008. We assessed the reporting of relevant domains from the Cochrane Collaboration’s ‘Risk of bias’ tool and other key methodological aspects. Our primary outcomes were the proportion of registry records with adequate reporting of random sequence generation, allocation concealment, blinding, and trial outcomes. Two reviewers independently assessed each record. Weighted overall proportions in the ICTRP search portal for adequate reporting of sequence generation, allocation concealment, blinding (including and excluding open label RCT) and primary outcomes were 5.7% (95% CI 3.0–8.4%), 1.4% (0–2.8%), 41% (35–47%), 8.4% (4.1–13%), and 66% (60–72%), respectively. The proportion of adequately reported RCTs was higher for registries that used specific methodological fields for describing methods of randomization and allocation concealment compared to registries that did not. Concerning other key methodological aspects, weighted overall proportions of RCTs with adequately reported items were as follows: eligibility criteria (81%), secondary outcomes (46%), harm (5%) follow-up duration (62%), description of the interventions (53%) and sample size calculation (1%). Conclusions: Trial registries currently contain limited methodologic information about registered RCTs. In order to permit adequate critical appraisal of trial results reported in journals and registries, trial registries should consider requesting details on key RCT methods to complement journal publications. Full protocols remain the most comprehensive source of methodologic information and should be made publicly available.