Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.

A theoretical study on modelling the respiratory tract with ladder networks by means of intrinsic fractal geometry

Fractional order modeling of biological systems has received significant interest in the research community. Since the fractal geometry is characterized by a recurrent structure, the self-similar branching arrangement of the airways makes the respiratory system an ideal candidate for the application of fractional calculus theory. To demonstrate the link between the recurrence of the respiratory tree and the appearance of a fractional-order model, we develop an anatomically consistent representation of the respiratory system. This model is capable of simulating the mechanical properties of the lungs and we compare the model output with in vivo measurements of the respiratory input impedance collected in 20 healthy subjects. This paper provides further proof of the underlying fractal geometry of the human lungs, and the consequent appearance of constant-phase behavior in the total respiratory impedance.

Urban land use change analysis and modelling: a case study of Setubal-Sesimbra, Portugal

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies

Pseudo-fractional ARMA modelling using a double Levinson recursion

IET Control Theory & Applications, Vol. 1, Nº 1

Human and climatic change impact modelling on the habitat suitability for the chimpanzee (Pan troglodytes ellioti) – Case study: The proposed Mount Cameroon National Park

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies

Dynamical modelling of a genetic algorithm

This work addresses the signal propagation and the fractional-order dynamics during the evolution of a genetic algorithm (GA). In order to investigate the phenomena involved in the GA population evolution, the mutation is exposed to excitation perturbations during some generations and the corresponding fitness variations are evaluated. Three distinct fitness functions are used to study their influence in the GA dynamics. The input and output signals are studied revealing a fractional-order dynamic evolution, characteristic of a long-term system memory.

Modelling text file evaluation processes

Text file evaluation is an emergent topic in e-learning that responds to the shortcomings of the assessment based on questions with predefined answers. Questions with predefined answers are formalized in languages such as IMS Question & Test Interoperability Specification (QTI) and supported by many e-learning systems. Complex evaluation domains justify the development of specialized evaluators that participate in several business processes. The goal of this paper is to formalize the concept of a text file evaluation in the scope of the E-Framework – a service oriented framework for development of e-learning systems maintained by a community of practice. The contribution includes an abstract service type and a service usage model. The former describes the generic capabilities of a text file evaluation service. The later is a business process involving a set of services such as repositories of learning objects and learning management systems.

Modelling an e-learning environment for learning programming languages

It is widely accepted that solving programming exercises is fundamental to learn how to program. Nevertheless, solving exercises is only effective if students receive an assessment on their work. An exercise solved wrong will consolidate a false belief, and without feedback many students will not be able to overcome their difficulties. However, creating, managing and accessing a large number of exercises, covering all the points in the curricula of a programming course, in classes with large number of students, can be a daunting task without the appropriated tools working in unison. This involves a diversity of tools, from the environments where programs are coded, to automatic program evaluators providing feedback on the attempts of students, passing through the authoring, management and sequencing of programming exercises as learning objects. We believe that the integration of these tools will have a great impact in acquiring programming skills. Our research objective is to manage and coordinate a network of eLearning systems where students can solve computer programming exercises. Networks of this kind include systems such as learning management systems (LMS), evaluation engines (EE), learning objects repositories (LOR) and exercise resolution environments (ERE). Our strategy to achieve the interoperability among these tools is based on a shared definition of programming exercise as a Learning Object (LO).

Modelling a network of heterogeneous e-learning systems

In recent years emerged several initiatives promoted by educational organizations to adapt Service Oriented Architectures (SOA) to e-learning. These initiatives commonly named eLearning Frameworks share a common goal: to create flexible learning environments by integrating heterogeneous systems already available in many educational institutions. However, these frameworks were designed for integration of systems participating in business like processes rather than on complex pedagogical processes as those related to automatic evaluation. Consequently, their knowledge bases lack some fundamental components that are needed to model pedagogical processes. The objective of the research described in this paper is to study the applicability of eLearning frameworks for modelling a network of heterogeneous eLearning systems, using the automatic evaluation of programming exercises as a case study. The paper surveys the existing eLearning frameworks to justify the selection of the e-Framework. This framework is described in detail and identified the necessary components missing from its knowledge base, more precisely, a service genre, expression and usage model for an evaluation service. The extensibility of the framework is tested with the definition of this service. A concrete model for evaluation of programming exercises is presented as a validation of the proposed approach.

Integrated ecological-economic modelling and assessment aproach for coastal ecosystem management

Thesis submitted to the Faculty of Sciences and Technology, New University of Lisbon, for the degree of Doctor of Philosophy in Environmental Sciences

Fuzzy modelling of prescribed burning effects on soil physical properties

This paper presents the preliminary work of an approach where Fuzzy Boolean Nets (FBN) are being used to extract qualitative knowledge regarding the effect of prescribed fire burning on soil chemical physical properties. FBN were chosen due to the scarcity on available quantitative data.

Project, modelling and simulation of air stripping columns for the treatment of groundwater contaminated with volatile organic compounds

Volatile organic compounds are a common source of groundwater contamination that can be easily removed by air stripping in columns with random packing and using a counter-current flow between the phases. This work proposes a new methodology for the column design for any particular type of packing and contaminant avoiding the necessity of a pre-defined diameter used in the classical approach. It also renders unnecessary the employment of the graphical Eckert generalized correlation for pressure drop estimates. The hydraulic features are previously chosen as a project criterion and only afterwards the mass transfer phenomena are incorporated, in opposition to conventional approach. The design procedure was translated into a convenient algorithm using C++ as programming language. A column was built in order to test the models used either in the design or in the simulation of the column performance. The experiments were fulfilled using a solution of chloroform in distilled water. Another model was built to simulate the operational performance of the column, both in steady state and in transient conditions. It consists in a system of two partial non linear differential equations (distributed parameters). Nevertheless, when flows are steady, the system became linear, although there is not an evident solution in analytical terms. In steady state the resulting system of ODE can be solved, allowing for the calculation of the concentration profile in both phases inside the column. In transient state the system of PDE was numerically solved by finite differences, after a previous linearization.

New insights into pseudo-fractional ARMA modelling

Proceedings of the International Conference on Computational Cybernetics, Vienna University of Technology, August 30 - September 1, 2004

Conceptual analogy for modelling entrapped air action in hydraulic systems

Hydraulic systems are dynamically susceptible in the presence of entrapped air pockets, leading to amplified transient reactions. In order to model the dynamic action of an entrapped air pocket in a confined system, a heuristic mathematical formulation based on a conceptual analogy to a mechanical spring-damper system is proposed. The formulation is based on the polytropic relationship of an ideal gas and includes an additional term, which encompasses the combined damping effects associated with the thermodynamic deviations from the theoretical transformation, as well as those arising from the transient vorticity developed in both fluid domains (air and water). These effects represent the key factors that account for flow energy dissipation and pressure damping. Model validation was completed via numerical simulation of experimental measurements.