New medical registration and segmentation techniques using information-theoretic tools

El processament d'imatges mèdiques és una important àrea de recerca. El desenvolupament de noves tècniques que assisteixin i millorin la interpretació visual de les imatges de manera ràpida i precisa és fonamental en entorns clínics reals. La majoria de contribucions d'aquesta tesi són basades en Teoria de la Informació. Aquesta teoria tracta de la transmissió, l'emmagatzemament i el processament d'informació i és usada en camps tals com física, informàtica, matemàtica, estadística, biologia, gràfics per computador, etc. En aquesta tesi, es presenten nombroses eines basades en la Teoria de la Informació que milloren els mètodes existents en l'àrea del processament d'imatges, en particular en els camps del registre i la segmentació d'imatges. Finalment es presenten dues aplicacions especialitzades per l'assessorament mèdic que han estat desenvolupades en el marc d'aquesta tesi.

Medical Malpractice in Public Healthcare Systems: An Empirical Investigation of Scheduled Damages

In the last decades, medical malpractice has been framed as one of the most critical issues for healthcare providers and health policy, holding a central role on both the policy agenda and public debate. The Law and Economics literature has devoted much attention to medical malpractice and to the investigation of the impact of malpractice reforms. Nonetheless, some reforms have been much less empirically studied as in the case of schedules, and their effects remain highly debated. The present work seeks to contribute to the study of medical malpractice and of schedules of noneconomic damages in a civil law country with a public national health system, using Italy as case study. Besides considering schedules and exploiting a quasi-experimental setting, the novelty of our contribution consists in the inclusion of the performance of the judiciary (measured as courts’ civil backlog) in the empirical analysis. The empirical analysis is twofold. First, it investigates how limiting compensations for pain and suffering through schedules impacts on the malpractice insurance market in terms of presence of private insurers and of premiums applied. Second, it examines whether, and to what extent, healthcare providers react to the implementation of this policy in terms of both levels and composition of the medical treatments offered. Our findings show that the introduction of schedules increases the presence of insurers only in inefficient courts, while it does not produce significant effects on paid premiums. Judicial inefficiency is attractive to insurers for average values of schedules penetration of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Moreover, the implementation of schedules tends to reduce the use of defensive practices on the part of clinicians, but the magnitude of this impact is ultimately determined by the actual degree of backlog of the court implementing schedules.

Behavioral Economics and Physician Behavior

This study seeks to answer whether the availability heuristic leads physicians to utilize more medical care than is economically efficient. Do rare, salient events alter physicians' perceptions about the probability of patient harm? Do these events lead physicians to overutilize certain medical procedures? This study uses Pennsylvania inpatient hospital admissions data from 2009 aggregated at the physician level to investigate these questions. The data come from the 2009 Pennsylvania Health Care Cost Containment Council (PHC4). The study is divided into two parts. In Part I, we examine whether bad outcomes during childbirth (defined as maternal mortality, an obstetric fistula or a uterine rupture) lead physicians to utilize more cesarean sections on future patients. In Part II, we examine whether bad outcomes associated with appendicitis (defined as patient death, a perforated or ruptured appendix or sepsis) lead physicians to perform more negative appendectomies (appendectomies performed when the patient did not have appendicitis) on future patients. Overall the study does not find evidence to support the claim that the availability heuristic leads physicians to overutilize medical care on future patients. However, the study does find evidence that variations in health care utilization are strongly correlated with individual physician practice patterns. The results of the study also imply that physicians' financial incentives may be a source of variation in health care utilization.

The Economics of Incentive-Based Health Care Plans

Medical savings accounts (MSAs) belong to a larger class of incentive-based health care plans. Using a model that allows the consumer to invest in healthy activities, we examine the efficiency properties of incentive plans and compare them to traditional full- coverage and deductible plans, under both experience rating and community rating. The model also is extended to include utilization of preventive health care. Properly constructed incentive plans have the capacity to induce socially efficient levels of healthy activities and preventive care, raising the expected wealth of consumers without reducing insurers' profits.

Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

Medical Building. Chemical Laboratory

A. J. Jordan, architect. Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. Pharmacology occupied north wing 1908-1981. Destroyed by fire Christmas Eve 1981.On mount: T.D. Tooker Photographer

M. U. Economics Building

Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. Pharmacology occupied north wing 1908-1981. Destroyed by fire Christmas Eve 1981. On verso: M.U. Information Services #1182 July 1959.

M. U. Economics Bldg.

Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. On verso: M.U. Information Services. Econ 3. April 1952.

The book of household management : comprising information for the mistress, housekeeper, cook, kitchen-maid, butler, footman, coachman, valet, upper and under house maids, lady's-maid, maid-of-all-work, laundry-maid, nurse and nurse-maid, monthly, wet, and sick nurses, etc. etc. : also, sanitary, medical, and legal memoranda : with a history of the origin, properties, and uses of all things connected with home life and comfort /

Includes index.

The new Columbian White House cookery : containing toilet, medical, and cooking receipts, comprehending economical and practical information pertaining to the successful management of the home /

Includes samples of menus; household hints; some recipes include wine or liquor as an ingredient. Sample recipes: Chicken cream soup, Eels a la tartare, Lemon brandy (for cakes and puddings), Spiced nutmeg melon.

Economics of reproductive and infant health : an annotated bibliography from 1980 to 1993 /

Includes indexes.

Physician control of Blue Shield plans : staff report of the Bureau of Economics to the Federal Trade Commission /

"November 1979."

Economics Building Fire [View through window to interior and hole in roof]

Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. Pharmacology occupied north wing 1908-1981. Destroyed by fire Christmas Eve 1981. View through window to interior and hole in roof.

Economics Building Fire [Exterior with fire escape]

Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. Pharmacology occupied north wing 1908-1981. Destroyed by fire Christmas Eve 1981. Exterior with fire escape.

Economics Building Fire [Window and fire escape]

Built in 1856. First chemical laboratory at a state university. Building served medical students and others as both laboratory and classroom. Situated just west and south of the original medical building. Additions made to the one-story building in 1861, 1866, 1868, 1874. In 1880 a two-story addition was added with subsequent additions in 1889 and 1901. Became Economics Building in 1908. Pharmacology occupied north wing 1908-1981. Destroyed by fire Christmas Eve 1981. Window and fire escape.