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. ^

Lecturas sobre The Foundation. A Great American Secret (2007), Joel L. Fleishman, New York, Public Affairs

Fil: Quesada, Fernando. Universidad Nacional de Cuyo. Facultad de Filosofía y Letras. Instituto Multidisciplinario de Estudios Sociales Contemporáneos

The shift of paradigm in the organizations like foundation of the style of ethical leadership

La presente investigación tiene por objeto analizar el cambio de paradigma en las organizaciones como fundamento del liderazgo ético desde una realidad postmoderna a fin de detectar la necesidad de un liderazgo ético en las organizaciones donde los líderes sean formadores de valores a través del modelaje directivo; es un estilo de liderazgo en el que la visión ética, sistémica e integradora son unas de las principales aptitudes que el líder ético ha de poner en la práctica. Se han desarrollado teorías de liderazgo centradas no tanto en los rasgos o comportamientos de los líderes, sino en la relación entre líder y sus seguidores

The foundation of the Mexican welfare state and social security reform in the 1990s

Before 1982 Mexico's welfare state regime was a limited conservative one that put priority on the social security of organized labor. But following the country's debt crisis in 1982, this regime changed to a hybrid liberal model. The Ernest Zedillo government (1995-2000) in particular pushed ahead with liberal reform of the social security system. This paper examines the characteristics and the policy making of the social security reforms in the 1990s. The results suggest that underlying these reforms was the restructuring of the economy and the need to cope with the cost of this restructuring. The paper also points out that one of the main factors making possible the rapid execution of the reforms were the weakened political clout of the officialist labor unions due to their steady breakdown during the 1990s and the increase in the monopolistic power of the state vis-a-vis the position of labor during the negotiations on social security reforms.

Towards the foundation of a global modes concept

A contribution is presented, intended to provide theoretical foundations for the ongoing efforts to employ global instability theory for the analysis of the classic boundary-layer flow, and address the associated issue of appropriate inflow/outflow boundary conditions to close the PDE-based global eigenvalue problem in open flows. Starting from a theoretically clean and numerically simple application, in which results are also known analytically and thus serve as a guidance for the assessment of the performance of the numerical methods employed herein, a sequence of issues is systematically built into the target application, until we arrive at one representative of open systems whose instability is presently addressed by global linear theory applied to open flows, the latter application being neither tractable theoretically nor straightforward to solve by numerical means. Experience gained along the way is documented. It regards quantification of the depar- ture of the numerical solution from the analytical one in the simple problem, the generation of numerical boundary layers at artificially truncated boundaries, no matter how far the latter are placed from the region of highest flow gradients and, ultimately the impracti- cally large number of (direct and adjoint) modes necessary to project an arbitrary initial perturbation and follow its temporal evolution by a global analysis approach, a finding which may question the purported robustness reported in the literature of the recovery of optimal perturbations as part of global analyses yielding under-resolved eigenspectra.

Intensive Metrics for the Study of the Evolution of Open Source Projects: Case Studies from Apache Software Foundation Projects

Based on the empirical evidence that the ratio of email messages in public mailing lists to versioning system commits has remained relatively constant along the history of the Apache Software Foundation (ASF), this paper has as goal to study what can be inferred from such a metric for projects of the ASF. We have found that the metric seems to be an intensive metric as it is independent of the size of the project, its activity, or the number of developers, and remains relatively independent of the technology or functional area of the project. Our analysis provides evidence that the metric is related to the technical effervescence and popularity of project, and as such can be a good candidate to measure its healthy evolution. Other, similar metrics -like the ratio of developer messages to commits and the ratio of issue tracker messages to commits- are studied for several projects as well, in order to see if they have similar characteristics.

Brain rhythms alterations and their effect in functional networks: A simultaneous EEG/fMRI study in Fixation-off epilepsy

Fixation-off sensitivity (FOS) denotes the forms of EEG abnormalities, which are elicited by elimination of central vision or fixation. The phenomenon seems to depend on variables that modulate the alpha rhythm, however, the cerebral mechanisms underlying FOS remain unclear [1]. The scarce previous fMRI findings related to FOS have shown activation in extrastriate cortex [2] and also in frontal areas [3][4]. On the other hand, simultaneous EEG-fMRI technique has been used to assess the relationship between spontaneous power fluctuations of electrical rhythms and associated fMRI signal modulations. These studies have identified that lateral frontoparietal networks show a negative correlation with alpha band in healthy subjects. This neuroanatomical pattern is related to attentional processes and cognitive resources. Moreover, a sub-beta band (17-23 Hz) has been identified with posterior cingulate, temporoparietal junction and dorso-medial prefrontal cortex activations, which correspond to the DMN [5][6].

Altered brain rhythms and functional network disruptions involved in patients with generalized fixation-off epilepsy

Fixation-off sensitivity (FOS) denotes the forms of epilepsy elicited by elimination of fixation. FOS-IGE patients are rare cases [1]. In a previous work [2] we showed that two FOS-IGE patients had different altered EEG rhythms when closing eyes; only beta band was altered in patient 1 while theta, alpha and beta were altered in patient 2. In the present work, we explain the relationship between the altered brain rhythms in these patients and the disruption in functional brain networks.

Functional and effective connectivity in MEG. Application to the study of epilepsy

Nuestro cerebro contiene cerca de 1014 sinapsis neuronales. Esta enorme cantidad de conexiones proporciona un entorno ideal donde distintos grupos de neuronas se sincronizan transitoriamente para provocar la aparición de funciones cognitivas, como la percepción, el aprendizaje o el pensamiento. Comprender la organización de esta compleja red cerebral en base a datos neurofisiológicos, representa uno de los desafíos más importantes y emocionantes en el campo de la neurociencia. Se han propuesto recientemente varias medidas para evaluar cómo se comunican las diferentes partes del cerebro a diversas escalas (células individuales, columnas corticales, o áreas cerebrales). Podemos clasificarlos, según su simetría, en dos grupos: por una parte, la medidas simétricas, como la correlación, la coherencia o la sincronización de fase, que evalúan la conectividad funcional (FC); mientras que las medidas asimétricas, como la causalidad de Granger o transferencia de entropía, son capaces de detectar la dirección de la interacción, lo que denominamos conectividad efectiva (EC). En la neurociencia moderna ha aumentado el interés por el estudio de las redes funcionales cerebrales, en gran medida debido a la aparición de estos nuevos algoritmos que permiten analizar la interdependencia entre señales temporales, además de la emergente teoría de redes complejas y la introducción de técnicas novedosas, como la magnetoencefalografía (MEG), para registrar datos neurofisiológicos con gran resolución. Sin embargo, nos hallamos ante un campo novedoso que presenta aun varias cuestiones metodológicas sin resolver, algunas de las cuales trataran de abordarse en esta tesis. En primer lugar, el creciente número de aproximaciones para determinar la existencia de FC/EC entre dos o más señales temporales, junto con la complejidad matemática de las herramientas de análisis, hacen deseable organizarlas todas en un paquete software intuitivo y fácil de usar. Aquí presento HERMES (http://hermes.ctb.upm.es), una toolbox en MatlabR, diseñada precisamente con este fin. Creo que esta herramienta será de gran ayuda para todos aquellos investigadores que trabajen en el campo emergente del análisis de conectividad cerebral y supondrá un gran valor para la comunidad científica. La segunda cuestión practica que se aborda es el estudio de la sensibilidad a las fuentes cerebrales profundas a través de dos tipos de sensores MEG: gradiómetros planares y magnetómetros, esta aproximación además se combina con un enfoque metodológico, utilizando dos índices de sincronización de fase: phase locking value (PLV) y phase lag index (PLI), este ultimo menos sensible a efecto la conducción volumen. Por lo tanto, se compara su comportamiento al estudiar las redes cerebrales, obteniendo que magnetómetros y PLV presentan, respectivamente, redes más densamente conectadas que gradiómetros planares y PLI, por los valores artificiales que crea el problema de la conducción de volumen. Sin embargo, cuando se trata de caracterizar redes epilépticas, el PLV ofrece mejores resultados, debido a la gran dispersión de las redes obtenidas con PLI. El análisis de redes complejas ha proporcionado nuevos conceptos que mejoran caracterización de la interacción de sistemas dinámicos. Se considera que una red está compuesta por nodos, que simbolizan sistemas, cuyas interacciones se representan por enlaces, y su comportamiento y topología puede caracterizarse por un elevado número de medidas. Existe evidencia teórica y empírica de que muchas de ellas están fuertemente correlacionadas entre sí. Por lo tanto, se ha conseguido seleccionar un pequeño grupo que caracteriza eficazmente estas redes, y condensa la información redundante. Para el análisis de redes funcionales, la selección de un umbral adecuado para decidir si un determinado valor de conectividad de la matriz de FC es significativo y debe ser incluido para un análisis posterior, se convierte en un paso crucial. En esta tesis, se han obtenido resultados más precisos al utilizar un test de subrogadas, basado en los datos, para evaluar individualmente cada uno de los enlaces, que al establecer a priori un umbral fijo para la densidad de conexiones. Finalmente, todas estas cuestiones se han aplicado al estudio de la epilepsia, caso práctico en el que se analizan las redes funcionales MEG, en estado de reposo, de dos grupos de pacientes epilépticos (generalizada idiopática y focal frontal) en comparación con sujetos control sanos. La epilepsia es uno de los trastornos neurológicos más comunes, con más de 55 millones de afectados en el mundo. Esta enfermedad se caracteriza por la predisposición a generar ataques epilépticos de actividad neuronal anormal y excesiva o bien síncrona, y por tanto, es el escenario perfecto para este tipo de análisis al tiempo que presenta un gran interés tanto desde el punto de vista clínico como de investigación. Los resultados manifiestan alteraciones especificas en la conectividad y un cambio en la topología de las redes en cerebros epilépticos, desplazando la importancia del ‘foco’ a la ‘red’, enfoque que va adquiriendo relevancia en las investigaciones recientes sobre epilepsia. ABSTRACT There are about 1014 neuronal synapses in the human brain. This huge number of connections provides the substrate for neuronal ensembles to become transiently synchronized, producing the emergence of cognitive functions such as perception, learning or thinking. Understanding the complex brain network organization on the basis of neuroimaging data represents one of the most important and exciting challenges for systems neuroscience. Several measures have been recently proposed to evaluate at various scales (single cells, cortical columns, or brain areas) how the different parts of the brain communicate. We can classify them, according to their symmetry, into two groups: symmetric measures, such as correlation, coherence or phase synchronization indexes, evaluate functional connectivity (FC); and on the other hand, the asymmetric ones, such as Granger causality or transfer entropy, are able to detect effective connectivity (EC) revealing the direction of the interaction. In modern neurosciences, the interest in functional brain networks has increased strongly with the onset of new algorithms to study interdependence between time series, the advent of modern complex network theory and the introduction of powerful techniques to record neurophysiological data, such as magnetoencephalography (MEG). However, when analyzing neurophysiological data with this approach several questions arise. In this thesis, I intend to tackle some of the practical open problems in the field. First of all, the increase in the number of time series analysis algorithms to study brain FC/EC, along with their mathematical complexity, creates the necessity of arranging them into a single, unified toolbox that allow neuroscientists, neurophysiologists and researchers from related fields to easily access and make use of them. I developed such a toolbox for this aim, it is named HERMES (http://hermes.ctb.upm.es), and encompasses several of the most common indexes for the assessment of FC and EC running for MatlabR environment. I believe that this toolbox will be very helpful to all the researchers working in the emerging field of brain connectivity analysis and will entail a great value for the scientific community. The second important practical issue tackled in this thesis is the evaluation of the sensitivity to deep brain sources of two different MEG sensors: planar gradiometers and magnetometers, in combination with the related methodological approach, using two phase synchronization indexes: phase locking value (PLV) y phase lag index (PLI), the latter one being less sensitive to volume conduction effect. Thus, I compared their performance when studying brain networks, obtaining that magnetometer sensors and PLV presented higher artificial values as compared with planar gradiometers and PLI respectively. However, when it came to characterize epileptic networks it was the PLV which gives better results, as PLI FC networks where very sparse. Complex network analysis has provided new concepts which improved characterization of interacting dynamical systems. With this background, networks could be considered composed of nodes, symbolizing systems, whose interactions with each other are represented by edges. A growing number of network measures is been applied in network analysis. However, there is theoretical and empirical evidence that many of these indexes are strongly correlated with each other. Therefore, in this thesis I reduced them to a small set, which could more efficiently characterize networks. Within this framework, selecting an appropriate threshold to decide whether a certain connectivity value of the FC matrix is significant and should be included in the network analysis becomes a crucial step, in this thesis, I used the surrogate data tests to make an individual data-driven evaluation of each of the edges significance and confirmed more accurate results than when just setting to a fixed value the density of connections. All these methodologies were applied to the study of epilepsy, analysing resting state MEG functional networks, in two groups of epileptic patients (generalized and focal epilepsy) that were compared to matching control subjects. Epilepsy is one of the most common neurological disorders, with more than 55 million people affected worldwide, characterized by its predisposition to generate epileptic seizures of abnormal excessive or synchronous neuronal activity, and thus, this scenario and analysis, present a great interest from both the clinical and the research perspective. Results revealed specific disruptions in connectivity and network topology and evidenced that networks’ topology is changed in epileptic brains, supporting the shift from ‘focus’ to ‘networks’ which is gaining importance in modern epilepsy research.

Seismic performance case study of bridge pile cap foundation

The purpose of this report is to build a model that represents, as best as possible, the seismic behavior of a pile cap bridge foundation by a nonlinear static (analysis) procedure. It will consist of a reproduction of a specimen already built in the laboratory. This model will carry out a pseudo static lateral and horizontal pushover test that will be applied onto the pile cap until the failure of the structure, the formation of a plastic hinge in the piles due to the horizontal deformation, occurs. The pushover test consists of increasing the horizontal load over the pile cap until the horizontal displacement wanted at the height of the pile cap is reached. The output of this model will be a Skeleton curve that will plot the lateral load (kN) over the displacement (m), so that the maximum movement the pile cap foundation can reach before its failure can be calculated. This failure will be achieved when the load at that specific shift is equal to 85% of the maximum. The pile cap foundation finite element model was based on pile cap built for a laboratory experiment already carried out by the Master student Deming Zhang at Tongji University. Two different pile caps were tested with a difference in height above the ground level. While one has 0:3m, the other rises 0:8m above the ground level. The computer model was calibrated using the experimental results. The pile cap foundation will be programmed in a finite element environment called OpenSees (Open System for Earthquake Engineering Simulation [28]). This environment is a free software developed by Berkeley University specialized, as it name says, in the study of earthquakes and its effects on structures. This specialization is the main reason why it is being used for building this model as it makes it possible to build any finite element model, and perform several analysis in order to get the results wanted. The development of OpenSees is sponsored by the Pacific Earthquake Engineering Research Center through the National Science Foundation engineering and education centers program. OpenSees uses Tcl language to program it, which is a language similar to C++.

Technical criteria for the desing of foundation slabs and perimetral wall in difficult terrain in Madrid. Spain

This paper explains a procedure for the choice of ballast modules used for the design of direct continuous foundation in karst terrain. The presence of dangerous cavities is introduced in this procedure thereby evaluating risk failure. It also provides pertinent guidelines to direct the geotechnical survey of the terrain.

Technical criteria for the design of foundation slabs and perimetral wall in difficult terrain in south east Madrid, Spain

This paper explains a procedure for the choice of ballast modules used for the design of direct continuous foundation in karst terrain. The presence of dangerous cavities is introduced in this procedure thereby evaluating risk failure. It also provides pertinent guidelines to direct the geotechnical survey of the terrain.

Elsa Peretti Foundation

Elsa Peretti Foundation [Proyecto]

Offshore wind foundation design: some key issues

Despite the growth of the offshore wind industry, there are currently doubts relating to the design of wind facilities in the sea. This paper expounds current, already identified structural uncertainties: problems for soil characterization and transition piece (TP) design. This document also introduces new doubts or issues to be researched in the near future in this field (wave theory, scour process, wave load actions, scale difficulty, etc.), not as yet identified due to the scarce experience in the offshore wind industry. With this in mind, technical offshore wind standards related to foundation design have been reviewed.

Construction History in Spain: the Discipline's Foundation

In the past two decades the History of Construction has started to become an independent discipline. On one hand, the number of articles, theses and books that could be assigned to this field has grown exponentially. Furthermore, there have been numerous and remarkably successful Congresses: 12 National (Spain 8; France 2; United Kingdom 1; Germany 1) and 4 International Congresses (Madrid 2003, Cambridge 2006, Cottbus 2009, Paris 2012), see Table 1 below. However, the situation is far from that corresponding to an already recognized discipline, such as the History of Art or the History of Science. There are no University chairs and departments, and in the reference databases “Construction History” is not listed as a common descriptor. This is not surprising; it reflects the inertia of academia to accept new disciplines. In what follows we will discuss the current state of discipline in Spain. Previous articles have tackled the matter. We will try to avoid unnecessary repetitions and concentrate on: 1) The activities of the Spanish Society of Construction History; 2) Its consequences on teaching and research, taken as a case study the experience in the School of Architecture of Madrid, and 3) We will give a provisional List of dissertations on Construction History read in Spain in the last forty years. First, we will try to define with the least possible ambiguity its field and its objectives. The intention is not to enter into the actual debate on the "definition" of Construction History, but to expose, in as detached as possible way, the ideas behind the actions made.