Development of a risk model for adverse drug events in the elderly

The aim of this study was to develop a predictive model for adverse drug events (ADEs) in elderly patients. Socio-demographic and medical data were collected from chart reviews, computerised information and a patient interview, for a population of 929 elderly patients (aged greater than or equal to 65 years) whose admission to the Waveney/B raid Valley Hospital in Northern Ireland was not scheduled. A further 204 patients formed a validation group. An ADE score was assigned to each patient using a modified Naranjo algorithm scoring system. The ADE scores ranged from 0 to 8. For the purposes of developing a risk model, scores of 4 or more were considered to constitute a high risk of an ADE.

Towards Utilizing Model-Driven Engineering of Composite Applications for Business Performance Analysis

Composite Applications on top of SAPs implementation of SOA (Enterprise SOA) enable the extension of already existing business logic. In this paper we show, based on a case study, how Model-Driven Engineering concepts are applied in the development of such Composite Applications. Our Case Study extends a back-end business process which is required for the specific needs of a demo company selling wine. We use this to describe how the business centric models specifying the modified business behaviour of our case study can be utilized for business performance analysis where most of the actions are performed by humans. In particular, we apply a refined version of Model-Driven Performance Engineering that we proposed in our previous work and motivate which business domain specifics have to be taken into account for business performance analysis. We additionally motivate the need for performance related decision support for domain experts, who generally lack performance related skills. Such a support should offer visual guidance about what should be changed in the design and resource mapping to get improved results with respect to modification constraints and performance objectives, or objectives for time.

Towards utilizing Model-Driven Engineering of Composite Applications for business performance analysis

Composite Applications on top of SAPs implementation of SOA (Enterprise SOA) enable the extension of already existing business logic. In this paper we show, based on a case study, how Model-Driven Engineering concepts are applied in the development of such Composite Applications. Our Case Study extends a back-end business process which is required for the specific needs of a demo company selling wine. We use this to describe how the business centric models specifying the modified business behaviour of our case study can be utilized for business performance analysis where most of the actions are performed by humans. In particular, we apply a refined version of Model-Driven Performance Engineering that we proposed in our previous work and motivate which business domain specifics have to be taken into account for business performance analysis. We additionally motivate the need for performance related decision support for domain experts, who generally lack performance related skills. Such a support should offer visual guidance about what should be changed in the design and resource mapping to get improved results with respect to modification constraints and performance objectives, or objectives for time.

A 1-D Vaneless Diffuser Model Accounting for the Effects of Spanwise Flow Stratification

The radial vaneless diffuser, though comparatively simple in terms of geometry, poses a significant challenge in obtaining an accurate 1-D based performance prediction due to the swirling, unsteady and distorted nature of the flow field. Turbocharger compressors specifically, with the ever increasing focus on achieving a wide operating range, have been recognised to operate with significant regions of spanwise separated flow, particularly at off design conditions.
Using a combination of single passage Computational Fluid Dynamics (CFD) simulations and extensive gas stand test data for three geometries, the current study aims to evaluate the onset and impact of spanwise flow stratification in radial vaneless diffusers, and how the extent of the aerodynamic blockage presented to the flow throughout the diffuser varies with both geometry and operating condition. Having analysed the governing performance parameters and flow phenomena, a novel 1-D modelling method is presented and compared to an existing baseline method as well as test data to quantify the improvement in prediction accuracy achieved.

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities.

Development of a Business Model that Supports Mobile Value-Added Services Market Creation in Emerging Countries

Tutkielman tavoitteena on luoda liiketoimintamalli, joka tukee langattomien matkaviestintäpalveluiden markkinoiden luomista kehittyvillä markkinoilla. Teoreettinen osa tarkastelee langattomien matkaviestintäpalveluiden liiketoimintamallin kehittämisen tärkeimpiä elementtejä CIS maissa. Teoreettisen kappaleen tuloksena saadaan puitteet, jonka avulla liiketoimintamalli matkaviestintäpalveluille voidaan kehittää. Tutkielman empiirinen osa on toteutettu case tutkimuksena, jonka tavoitteena on ollut langattomien matkaviestintäpalvelujen markkinoiden luominen CIS maissa. Pääasiallinen empiirisen tiedon lähde on ollut teemahaastattelut. Tuloksena saatuja empiirisen osan tietoja verrataan teoriakappaleen vastaaviin tuloksiin Tulokset osoittavat, että radikaalin korkean teknologian innovaation markkinoiden luominen on hidas prosessi, joka vaatii kärsivällisyyttä yritykseltä. Markkinoiden, teknologian ja strategian epävarmuustekijät tuovat epävarmuutta kehittyvälle toimialalle ja markkinoille, joka vaikeuttaa liiketoimintamallin kehittämistä. Tärkein tekijä on palvelujen markkinointi ennemmin kuin teknologian. Avain kyvykkyys markkinoiden luomisessa on oppiminen, ei tietäminen.

International Transmission of the Business Cycle in a Multi-Sector Model.

Multi-country models have not been very successful in replicating important features of the international transmission of business cycles. Standard models predict cross-country correlations of output and consumption which are respectively too low and too high. In this paper, we build a multi-country model of the business cycle with multiple sectors in order to analyze the role of sectoral shocks in the international transmission of the business cycle. We find that a model with multiple sectors generates a higher cross-country correlation of output than standard one-sector models, and a lower cross-country correlation of consumption. In addition, it predicts cross-country correlations of employment and investment that are closer to the data than the standard model. We also analyze the relative effects of multiple sectors, trade in intermediate goods, imperfect substitution between domestic and foreign goods, home preference, capital adjustment costs, and capital depreciation on the international transmission of the business cycle.

Regulation of the memory T cell development and islet beta-cell survival by DAPK-related apoptosis-inducing protein kinase 2 (Drak2)

Drak2 est un membre de la famille des protéines associées à la mort et c’est une sérine/thréonine kinase. Chez les souris mutantes nulles Drak2, les cellules T ne présentent aucune défectuosité apparente en apoptose induite par activation, après stimulation avec anti-CD3 et anti-CD28, mais ont un seuil de stimulation réduit, comparées aux cellules T de type sauvage (TS). Dans notre étude, l’analyse d’hybridation in situ a révélé que l’expression de Drak2 est ubiquiste au stade de la mi-gestation chez les embryons, suivie d’une expression plus focale dans les divers organes pendant la période périnatale et l’âge adulte, notamment dans le thymus, la rate, les ganglions lymphatiques, le cervelet, les noyaux suprachiasmatiques, la glande pituitaire, les lobes olfactifs, la médullaire surrénale, l’estomac, la peau et les testicules. Nous avons créé des souris transgéniques (Tg) Drak2 en utilisant le promoteur humain beta-actine. Ces souris Tg montraient des ratios normaux entre cellules T versus B et entre cellules CD4 versus CD8, mais leur cellularité et leur poids spléniques étaient inférieurs comparé aux souris de type sauvage. Après activation TCR, la réponse proliférative des cellules T Tg Drak2 était normale, même si leur production d’interleukine (IL)-2 et IL-4 mais non d’interféron-r était augmentée. Les cellules T Tg Drak2 activées ont démontré une apoptose significativement accrue en présence d’IL-2 exogène. Au niveau moléculaire, les cellules T Tg Drak2 ont manifesté une augmentation moins élevée des facteurs anti-apoptotiques durant l’activation; un tel changement a probablement rendu les cellules vulnérables aux attaques subséquentes d’IL-2. L’apoptose compromise dans les cellulesT Tg Drak2 a été associée à un nombre réduit de cellules T ayant le phénotype des cellules mémoires (CD62Llo) et avec des réactions secondaires réprimées des cellules T dans l’hypersensibilité de type différé. Ces résultats démontrent que Drak2 s’exprime dans le compartiment des cellules T mais n’est pas spécifique aux cellules T; et aussi qu’il joue des rôles déterminants dans l’apoptose des cellules T et dans le développement des cellules mémoires T. En outre, nous avons recherché le rôle de Drak2 dans la survie des cellules beta et le diabète. L’ARNm et la protéine Drak2 ont été rapidement induits dans les cellules beta de l’îlot après stimulation exogène par les cytokines inflammatoires ou les acides gras libres et qui est présente de façon endogène dans le diabète, qu’il soit de type 1 ou de type 2. La régulation positive de Drak2 a été accompagnée d’une apoptose accrue des cellules beta. L’apoptose des cellules beta provoquée par les stimuli en question a été inhibée par la chute de Drak2 en utilisant petit ARNi. Inversement, la surexpression de Drak2 Tg a mené à l’apoptose aggravée des cellules beta déclenchée par les stimuli. La surexpression de Drak2 dans les îlots a compromis l’augmentation des facteurs anti-apoptotiques, tels que Bcl-2, Bcl-xL et Flip, sur stimulation par la cytokine et les acides gras libres. De plus, les expériences in vivo ont démontré que les souris Tg Drak2 étaient sujettes au diabète de type 1 dans un modèle de diabète provoqué par de petites doses multiples de streptozotocine et qu’elles étaient aussi sujettes au diabète de type 2 dans un modèle d’obésité induite par la diète. Nos données montrent que Drak2 est défavorable à la survie des cellules beta. Nous avons aussi étudié la voie de transmission de Drak2. Nous avons trouvé que Drak2 purifiée pouvait phosphoryler p70S6 kinase dans une analyse kinase in vitro. Lasurexpression de Drak2 dans les cellules NIT-1 a entraîné l’augmentation de la phosphorylasation p70S6 kinase tandis que l’abaissement de Drak2 dans ces cellules a réduit la phosphorylation. Ces recherches mécanistes ont prouvé que p70S6 kinase était véritablement un substrat de Drak2 in vitro et in vivo. Cette étude a découvert les fonctions importantes de Drak2 dans l’homéostasie des cellules T et le diabète. Nous avons prouvé que p70S6 kinase était un substrat de Drak2. Nos résultats ont approfondi nos connaissances de Drak2 à l’intérieur des systèmes immunitaire et endocrinien. Certaines de nos conclusions, comme les rôles de Drak2 dans le développement des cellules mémoires T et la survie des cellules beta pourraient être explorées pour des applications cliniques dans les domaines de la transplantation et du diabète.

Investigations On The Development Of An Ann Model & Visual Manipulation Approach For 2-D Dft Computation In Image Processing

This thesis is an outcome of the investigations carried out on the development of an Artificial Neural Network (ANN) model to implement 2-D DFT at high speed. A new definition of 2-D DFT relation is presented. This new definition enables DFT computation organized in stages involving only real addition except at the final stage of computation. The number of stages is always fixed at 4. Two different strategies are proposed. 1) A visual representation of 2-D DFT coefficients. 2) A neural network approach. The visual representation scheme can be used to compute, analyze and manipulate 2D signals such as images in the frequency domain in terms of symbols derived from 2x2 DFT. This, in turn, can be represented in terms of real data. This approach can help analyze signals in the frequency domain even without computing the DFT coefficients. A hierarchical neural network model is developed to implement 2-D DFT. Presently, this model is capable of implementing 2-D DFT for a particular order N such that ((N))4 = 2. The model can be developed into one that can implement the 2-D DFT for any order N upto a set maximum limited by the hardware constraints. The reported method shows a potential in implementing the 2-D DF T in hardware as a VLSI / ASIC

Comprehensive evaluation of the WaterGAP3 model across climatic, physiographic, and anthropogenic gradients

In den letzten Jahrzehnten haben sich makroskalige hydrologische Modelle als wichtige Werkzeuge etabliert um den Zustand der globalen erneuerbaren Süßwasserressourcen flächendeckend bewerten können. Sie werden heutzutage eingesetzt um eine große Bandbreite wissenschaftlicher Fragestellungen zu beantworten, insbesondere hinsichtlich der Auswirkungen anthropogener Einflüsse auf das natürliche Abflussregime oder der Auswirkungen des globalen Wandels und Klimawandels auf die Ressource Wasser. Diese Auswirkungen lassen sich durch verschiedenste wasserbezogene Kenngrößen abschätzen, wie z.B. erneuerbare (Grund-)Wasserressourcen, Hochwasserrisiko, Dürren, Wasserstress und Wasserknappheit. Die Weiterentwicklung makroskaliger hydrologischer Modelle wurde insbesondere durch stetig steigende Rechenkapazitäten begünstigt, aber auch durch die zunehmende Verfügbarkeit von Fernerkundungsdaten und abgeleiteten Datenprodukten, die genutzt werden können, um die Modelle anzutreiben und zu verbessern. Wie alle makro- bis globalskaligen Modellierungsansätze unterliegen makroskalige hydrologische Simulationen erheblichen Unsicherheiten, die (i) auf räumliche Eingabedatensätze, wie z.B. meteorologische Größen oder Landoberflächenparameter, und (ii) im Besonderen auf die (oftmals) vereinfachte Abbildung physikalischer Prozesse im Modell zurückzuführen sind. Angesichts dieser Unsicherheiten ist es unabdingbar, die tatsächliche Anwendbarkeit und Prognosefähigkeit der Modelle unter diversen klimatischen und physiographischen Bedingungen zu überprüfen. Bisher wurden die meisten Evaluierungsstudien jedoch lediglich in wenigen, großen Flusseinzugsgebieten durchgeführt oder fokussierten auf kontinentalen Wasserflüssen. Dies steht im Kontrast zu vielen Anwendungsstudien, deren Analysen und Aussagen auf simulierten Zustandsgrößen und Flüssen in deutlich feinerer räumlicher Auflösung (Gridzelle) basieren. Den Kern der Dissertation bildet eine umfangreiche Evaluierung der generellen Anwendbarkeit des globalen hydrologischen Modells WaterGAP3 für die Simulation von monatlichen Abflussregimen und Niedrig- und Hochwasserabflüssen auf Basis von mehr als 2400 Durchflussmessreihen für den Zeitraum 1958-2010. Die betrachteten Flusseinzugsgebiete repräsentieren ein breites Spektrum klimatischer und physiographischer Bedingungen, die Einzugsgebietsgröße reicht von 3000 bis zu mehreren Millionen Quadratkilometern. Die Modellevaluierung hat dabei zwei Zielsetzungen: Erstens soll die erzielte Modellgüte als Bezugswert dienen gegen den jegliche weiteren Modellverbesserungen verglichen werden können. Zweitens soll eine Methode zur diagnostischen Modellevaluierung entwickelt und getestet werden, die eindeutige Ansatzpunkte zur Modellverbesserung aufzeigen soll, falls die Modellgüte unzureichend ist. Hierzu werden komplementäre Modellgütemaße mit neun Gebietsparametern verknüpft, welche die klimatischen und physiographischen Bedingungen sowie den Grad anthropogener Beeinflussung in den einzelnen Einzugsgebieten quantifizieren. WaterGAP3 erzielt eine mittlere bis hohe Modellgüte für die Simulation von sowohl monatlichen Abflussregimen als auch Niedrig- und Hochwasserabflüssen, jedoch sind für alle betrachteten Modellgütemaße deutliche räumliche Muster erkennbar. Von den neun betrachteten Gebietseigenschaften weisen insbesondere der Ariditätsgrad und die mittlere Gebietsneigung einen starken Einfluss auf die Modellgüte auf. Das Modell tendiert zur Überschätzung des jährlichen Abflussvolumens mit steigender Aridität. Dieses Verhalten ist charakteristisch für makroskalige hydrologische Modelle und ist auf die unzureichende Abbildung von Prozessen der Abflussbildung und –konzentration in wasserlimitierten Gebieten zurückzuführen. In steilen Einzugsgebieten wird eine geringe Modellgüte hinsichtlich der Abbildung von monatlicher Abflussvariabilität und zeitlicher Dynamik festgestellt, die sich auch in der Güte der Niedrig- und Hochwassersimulation widerspiegelt. Diese Beobachtung weist auf notwendige Modellverbesserungen in Bezug auf (i) die Aufteilung des Gesamtabflusses in schnelle und verzögerte Abflusskomponente und (ii) die Berechnung der Fließgeschwindigkeit im Gerinne hin. Die im Rahmen der Dissertation entwickelte Methode zur diagnostischen Modellevaluierung durch Verknüpfung von komplementären Modellgütemaßen und Einzugsgebietseigenschaften wurde exemplarisch am Beispiel des WaterGAP3 Modells erprobt. Die Methode hat sich als effizientes Werkzeug erwiesen, um räumliche Muster in der Modellgüte zu erklären und Defizite in der Modellstruktur zu identifizieren. Die entwickelte Methode ist generell für jedes hydrologische Modell anwendbar. Sie ist jedoch insbesondere für makroskalige Modelle und multi-basin Studien relevant, da sie das Fehlen von feldspezifischen Kenntnissen und gezielten Messkampagnen, auf die üblicherweise in der Einzugsgebietsmodellierung zurückgegriffen wird, teilweise ausgleichen kann.

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model.

1. There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6. Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

The role of satellite image-processing for national-scale estimates of gene flow from genetically modified crops: rapeseed in the UK as a model

1.There is concern over the possibility of unwanted environmental change following transgene movement from genetically modified (GM) rapeseed Brassica napus to its wild and weedy relatives. 2. The aim of this research was to develop a remote sensing-assisted methodology to help quantify gene flow from crops to their wild relatives over wide areas. Emphasis was placed on locating sites of sympatry, where the frequency of gene flow is likely to be highest, and on measuring the size of rapeseed fields to allow spatially explicit modelling of wind-mediated pollen-dispersal patterns. 3. Remote sensing was used as a tool to locate rapeseed fields, and a variety of image-processing techniques was adopted to facilitate the compilation of a spatially explicit profile of sympatry between the crop and Brassica rapa. 4. Classified satellite images containing rapeseed fields were first used to infer the spatial relationship between donor rapeseed fields and recipient riverside B. rapa populations. Such images also have utility for improving the efficiency of ground surveys by identifying probable sites of sympatry. The same data were then also used for the calculation of mean field size. 5. This paper forms a companion paper to Wilkinson et al. (2003), in which these elements were combined to produce a spatially explicit profile of hybrid formation over the UK. The current paper demonstrates the value of remote sensing and image processing for large-scale studies of gene flow, and describes a generic method that could be applied to a variety of crops in many countries. 6.Synthesis and applications. The decision to approve or prevent the release of a GM cultivar is made at a national rather than regional level. It is highly desirable that data relating to the decision-making process are collected at the same scale, rather than relying on extrapolation from smaller experiments designed at the plot, field or even regional scale. It would be extremely difficult and labour intensive to attempt to carry out such large-scale investigations without the use of remote-sensing technology. This study used rapeseed in the UK as a model to demonstrate the value of remote sensing in assembling empirical information at a national level.

Development and experimental identification of a biomechanical model of the trunk for functional electrical stimulation control in paraplegia

Objectives. Theoretic modeling and experimental studies suggest that functional electrical stimulation (FES) can improve trunk balance in spinal cord injured subjects. This can have a positive impact on daily life, increasing the volume of bimanual workspace, improving sitting posture, and wheelchair propulsion. A closed loop controller for the stimulation is desirable, as it can potentially decrease muscle fatigue and offer better rejection to disturbances. This paper proposes a biomechanical model of the human trunk, and a procedure for its identification, to be used for the future development of FES controllers. The advantage over previous models resides in the simplicity of the solution proposed, which makes it possible to identify the model just before a stimulation session ( taking into account the variability of the muscle response to the FES). Materials and Methods. The structure of the model is based on previous research on FES and muscle physiology. Some details could not be inferred from previous studies, and were determined from experimental data. Experiments with a paraplegic volunteer were conducted in order to measure the moments exerted by the trunk-passive tissues and artificially stimulated muscles. Data for model identification and validation also were collected. Results. Using the proposed structure and identification procedure, the model could adequately reproduce the moments exerted during the experiments. The study reveals that the stimulated trunk extensors can exert maximal moment when the trunk is in the upright position. In contrast, previous studies show that able-bodied subjects can exert maximal trunk extension when flexed forward. Conclusions. The proposed model and identification procedure are a successful first step toward the development of a model-based controller for trunk FES. The model also gives information on the trunk in unique conditions, normally not observable in able-bodied subjects (ie, subject only to extensor muscles contraction).

The vertical structure of oceanic Rossby waves: a comparison of high-resolution model data to theoretical vertical structures

Tests of the new Rossby wave theories that have been developed over the past decade to account for discrepancies between theoretical wave speeds and those observed by satellite altimeters have focused primarily on the surface signature of such waves. It appears, however, that the surface signature of the waves acts only as a rather weak constraint, and that information on the vertical structure of the waves is required to better discriminate between competing theories. Due to the lack of 3-D observations, this paper uses high-resolution model data to construct realistic vertical structures of Rossby waves and compares these to structures predicted by theory. The meridional velocity of a section at 24° S in the Atlantic Ocean is pre-processed using the Radon transform to select the dominant westward signal. Normalized profiles are then constructed using three complementary methods based respectively on: (1) averaging vertical profiles of velocity, (2) diagnosing the amplitude of the Radon transform of the westward propagating signal at different depths, and (3) EOF analysis. These profiles are compared to profiles calculated using four different Rossby wave theories: standard linear theory (SLT), SLT plus mean flow, SLT plus topographic effects, and theory including mean flow and topographic effects. Our results support the classical theoretical assumption that westward propagating signals have a well-defined vertical modal structure associated with a phase speed independent of depth, in contrast with the conclusions of a recent study using the same model but for different locations in the North Atlantic. The model structures are in general surface intensified, with a sign reversal at depth in some regions, notably occurring at shallower depths in the East Atlantic. SLT provides a good fit to the model structures in the top 300 m, but grossly overestimates the sign reversal at depth. The addition of mean flow slightly improves the latter issue, but is too surface intensified. SLT plus topography rectifies the overestimation of the sign reversal, but overestimates the amplitude of the structure for much of the layer above the sign reversal. Combining the effects of mean flow and topography provided the best fit for the mean model profiles, although small errors at the surface and mid-depths are carried over from the individual effects of mean flow and topography respectively. Across the section the best fitting theory varies between SLT plus topography and topography with mean flow, with, in general, SLT plus topography performing better in the east where the sign reversal is less pronounced. None of the theories could accurately reproduce the deeper sign reversals in the west. All theories performed badly at the boundaries. The generalization of this method to other latitudes, oceans, models and baroclinic modes would provide greater insight into the variability in the ocean, while better observational data would allow verification of the model findings.