Mixed Methods Case Study of Generational Patterns in Responses to Shame and Guilt

ERIC Educational Resources Information Center

Ng, Tony

2013-01-01

Moral socialization and moral learning are antecedents of moral motivation. As many as 4 generations interact in workplace and education settings; hence, a deeper understanding of the moral motivation of members of those generations is needed. The purpose of this convergent mixed methods case study was to understand the moral motivation of 5…

Using mixed methods research in medical education: basic guidelines for researchers.

PubMed

Schifferdecker, Karen E; Reed, Virginia A

2009-07-01

Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available. The purpose of this paper is to remedy that situation by providing an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research. Mixed methods may prove superior in increasing the integrity and applicability of findings when studying new or complex initiatives and interactions in medical education research. They deserve an increased presence and recognition in medical education research.

Purists need not apply: the case for pragmatism in mixed methods research.

PubMed

Florczak, Kristine L

2014-10-01

The purpose of this column is to describe several different ways of conducting mixed method research. The paradigms that underpin both qualitative and quantitative research are also considered along with a cursory review of classical pragmatism as it relates conducting mixed methods studies. Finally, the idea of loosely coupled systems as a means to support mixed methods studies is proposed along with several caveats to researchers who desire to use this new way of obtaining knowledge. © The Author(s) 2014.

General practice performance in referral for suspected cancer: influence of number of cases and case-mix on publicly reported data.

PubMed

Murchie, P; Chowdhury, A; Smith, S; Campbell, N C; Lee, A J; Linden, D; Burton, C D

2015-05-26

Publicly available data show variation in GPs' use of urgent suspected cancer (USC) referral pathways. We investigated whether this could be due to small numbers of cancer cases and random case-mix, rather than due to true variation in performance. We analysed individual GP practice USC referral detection rates (proportion of the practice's cancer cases that are detected via USC) and conversion rates (proportion of the practice's USC referrals that prove to be cancer) in routinely collected data from GP practices in all of England (over 4 years) and northeast Scotland (over 7 years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47). Much apparent variation in GPs' use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP-suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used, and more appropriate and robust methods should be developed.

Using Case-Mix Adjustment Methods To Measure the Effectiveness of Substance Abuse Treatment: Three Examples Using Client Employment Outcomes.

ERIC Educational Resources Information Center

Koenig, Lane; Fields, Errol L.; Dall, Timothy M.; Ameen, Ansari Z.; Harwood, Henrick J.

This report demonstrates three applications of case-mix methods using regression analysis. The results are used to assess the relative effectiveness of substance abuse treatment providers. The report also examines the ability of providers to improve client employment outcomes, an outcome domain relatively unexamined in the assessment of provider…

Meaning Makers: A Mixed-Methods Case Study of Exemplary University Presidents and the Behaviors They Use to Create Personal and Organizational Meaning

ERIC Educational Resources Information Center

Bartels, Barbara E.

2017-01-01

The purpose of this thematic, mixed method case study was to identify and describe the behaviors that exemplary university presidents use to create personal and organizational meaning for themselves and their followers through character, vision, relationships, wisdom, and inspiration. Further, this study surveyed followers to assess the degree of…

Is Flipping Worth the Fuss: A Mixed Methods Case Study of Screencasting in the Social Studies Classroom Authors

ERIC Educational Resources Information Center

Snyder, Catherine; Besozzi, David; Paska, Lawrence; Oppenlander, Jane

2016-01-01

This action research case study evaluates the effectiveness of using "flipped" instruction in a secondary social studies classroom. The researchers used mixed methods data to determine if flipping the instruction in a social studies class through the use of screencasting increased student learning as measured by pre- and post-unit…

Reconciling incongruous qualitative and quantitative findings in mixed methods research: exemplars from research with drug using populations.

PubMed

Wagner, Karla D; Davidson, Peter J; Pollini, Robin A; Strathdee, Steffanie A; Washburn, Rachel; Palinkas, Lawrence A

2012-01-01

Mixed methods research is increasingly being promoted in the health sciences as a way to gain more comprehensive understandings of how social processes and individual behaviours shape human health. Mixed methods research most commonly combines qualitative and quantitative data collection and analysis strategies. Often, integrating findings from multiple methods is assumed to confirm or validate the findings from one method with the findings from another, seeking convergence or agreement between methods. Cases in which findings from different methods are congruous are generally thought of as ideal, whilst conflicting findings may, at first glance, appear problematic. However, the latter situation provides the opportunity for a process through which apparently discordant results are reconciled, potentially leading to new emergent understandings of complex social phenomena. This paper presents three case studies drawn from the authors' research on HIV risk amongst injection drug users in which mixed methods studies yielded apparently discrepant results. We use these case studies (involving injection drug users [IDUs] using a Needle/Syringe Exchange Program in Los Angeles, CA, USA; IDUs seeking to purchase needle/syringes at pharmacies in Tijuana, Mexico; and young street-based IDUs in San Francisco, CA, USA) to identify challenges associated with integrating findings from mixed methods projects, summarize lessons learned, and make recommendations for how to more successfully anticipate and manage the integration of findings. Despite the challenges inherent in reconciling apparently conflicting findings from qualitative and quantitative approaches, in keeping with others who have argued in favour of integrating mixed methods findings, we contend that such an undertaking has the potential to yield benefits that emerge only through the struggle to reconcile discrepant results and may provide a sum that is greater than the individual qualitative and quantitative parts. Copyright © 2011 Elsevier B.V. All rights reserved.

Reconciling incongruous qualitative and quantitative findings in mixed methods research: exemplars from research with drug using populations

PubMed Central

Wagner, Karla D.; Davidson, Peter J.; Pollini, Robin A.; Strathdee, Steffanie A.; Washburn, Rachel; Palinkas, Lawrence A.

2011-01-01

Mixed methods research is increasingly being promoted in the health sciences as a way to gain more comprehensive understandings of how social processes and individual behaviours shape human health. Mixed methods research most commonly combines qualitative and quantitative data collection and analysis strategies. Often, integrating findings from multiple methods is assumed to confirm or validate the findings from one method with the findings from another, seeking convergence or agreement between methods. Cases in which findings from different methods are congruous are generally thought of as ideal, while conflicting findings may, at first glance, appear problematic. However, the latter situation provides the opportunity for a process through which apparently discordant results are reconciled, potentially leading to new emergent understandings of complex social phenomena. This paper presents three case studies drawn from the authors’ research on HIV risk among injection drug users in which mixed methods studies yielded apparently discrepant results. We use these case studies (involving injection drug users [IDUs] using a needle/syringe exchange program in Los Angeles, California, USA; IDUs seeking to purchase needle/syringes at pharmacies in Tijuana, Mexico; and young street-based IDUs in San Francisco, CA, USA) to identify challenges associated with integrating findings from mixed methods projects, summarize lessons learned, and make recommendations for how to more successfully anticipate and manage the integration of findings. Despite the challenges inherent in reconciling apparently conflicting findings from qualitative and quantitative approaches, in keeping with others who have argued in favour of integrating mixed methods findings, we contend that such an undertaking has the potential to yield benefits that emerge only through the struggle to reconcile discrepant results and may provide a sum that is greater than the individual qualitative and quantitative parts. PMID:21680168

Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

PubMed

Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

2018-05-13

Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

Using existing case-mix methods to fund trauma cases.

PubMed

Monakova, Julia; Blais, Irene; Botz, Charles; Chechulin, Yuriy; Picciano, Gino; Basinski, Antoni

2010-01-01

Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases. The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.

Thai Perspectives on the Internationalization of Higher Education in Thailand: A Mixed Methods Analysis and Three Mini-Case Studies

ERIC Educational Resources Information Center

McBride, Karen Anne

2012-01-01

This study is a sequential mixed methods study that also includes three mini-case studies for the purpose of portraying contemporary Thai views on the internationalization of higher education in Thailand and reflections on its status as an international education hub in the Southeast Asian region. An inductive analysis technique is used whereby…

Quantification of chaotic strength and mixing in a micro fluidic system

NASA Astrophysics Data System (ADS)

Kim, Ho Jun; Beskok, Ali

2007-11-01

Comparative studies of five different techniques commonly employed to identify the chaotic strength and mixing efficiency in micro fluidic systems are presented to demonstrate the competitive advantages and shortcomings of each method. The 'chaotic electroosmotic stirrer' of Qian and Bau (2002 Anal. Chem. 74 3616-25) is utilized as the benchmark case due to its well-defined flow kinematics. Lagrangian particle tracking methods are utilized to study particle dispersion in the conceptual device using spectral element and fourth-order Runge-Kutta discretizations in space and time, respectively. Stirring efficiency is predicted using the stirring index based on the box counting method, and Poincaré sections are utilized to identify the chaotic and regular regions under various actuation conditions. Finite time Lyapunov exponents are calculated to quantify the chaotic strength, while the probability density function of the stretching field is utilized as an alternative method to demonstrate the statistical analysis of chaotic and partially chaotic cases. Mixing index inverse, based on the standard deviation of scalar species distribution, is utilized as a metric to quantify the mixing efficiency. Series of numerical simulations are performed by varying the Peclet number (Pe) at fixed kinematic conditions. The mixing time (tm) is characterized as a function of the Pe number, and tm ~ ln(Pe) scaling is demonstrated for fully chaotic cases, while tm ~ Peα scaling with α ≈ 0.33 and α = 0.5 are observed for partially chaotic and regular cases, respectively. Employing the aforementioned techniques, optimum kinematic conditions and the actuation frequency of the stirrer that result in the highest mixing/stirring efficiency are identified.

Explaining resource consumption among non-normal neonates

PubMed Central

Schwartz, Rachel M.; Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S.

1991-01-01

The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID:10122360

Rural and Urban Differences in Vocational Rehabilitation Case Mix, Delivery Practices, and Employment Outcomes

ERIC Educational Resources Information Center

Ipsen, Catherine; Swicegood, Grant

2015-01-01

Purpose: To examine rural and urban differences in Vocational Rehabilitation (VR) case mix, delivery practices, and employment outcomes. Methods: Rehabilitation Services Administration 911 (RSA-911) case data do not include location indicators that allow for rural analyses. We compiled RSA-911 data with county and ZIP code information from 47 VR…

Quantifying spatial distribution of spurious mixing in ocean models.

PubMed

Ilıcak, Mehmet

2016-12-01

Numerical mixing is inevitable for ocean models due to tracer advection schemes. Until now, there is no robust way to identify the regions of spurious mixing in ocean models. We propose a new method to compute the spatial distribution of the spurious diapycnic mixing in an ocean model. This new method is an extension of available potential energy density method proposed by Winters and Barkan (2013). We test the new method in lock-exchange and baroclinic eddies test cases. We can quantify the amount and the location of numerical mixing. We find high-shear areas are the main regions which are susceptible to numerical truncation errors. We also test the new method to quantify the numerical mixing in different horizontal momentum closures. We conclude that Smagorinsky viscosity has less numerical mixing than the Leith viscosity using the same non-dimensional constant.

The operating room case-mix problem under uncertainty and nurses capacity constraints.

PubMed

Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

2016-12-01

Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

A Mixed Methods Case Study: Understanding the Experience of Nebraska 4-H Participants Relative to Their Transition and Adaptation to College

ERIC Educational Resources Information Center

Walahoski, Jill

2013-01-01

This mixed methods case study was designed to assess the preparedness of former Nebraska 4-H participants to successfully transition and adjust to college. The study also sought to understand the way that students' experiences in Nebraska 4-H may have influenced their readiness to transition to college. The initial quantitative stage of this case…

[A new methodological approach for leptospira persistence studies in case of mixed leptospirosis].

PubMed

Samsonova, A P; Petrov, E M; Vyshivkina, N V; Anan'ina, Iu V

2003-01-01

A new methodical approach for Leptospira persistence studies in case of mixed leptospirosis, based on the use of PCR test systems with different taxonomic specificity for the indication and identification of leptospires, was developed. Two PCR test systems (G and B) were used in experiments on BALB/c white mice to study patterns of the development of mixed infection caused by leptospires of serovar poi (genomospecies L. borgpeterseni) and grippotyphosa (genomospecies L. kirschneri). The conclusion was made of good prospects of this method application in studies on symbiotic relationships of leptospires both in vivo and in vitro.

Mixed Model Association with Family-Biased Case-Control Ascertainment.

PubMed

Hayeck, Tristan J; Loh, Po-Ru; Pollack, Samuela; Gusev, Alexander; Patterson, Nick; Zaitlen, Noah A; Price, Alkes L

2017-01-05

Mixed models have become the tool of choice for genetic association studies; however, standard mixed model methods may be poorly calibrated or underpowered under family sampling bias and/or case-control ascertainment. Previously, we introduced a liability threshold-based mixed model association statistic (LTMLM) to address case-control ascertainment in unrelated samples. Here, we consider family-biased case-control ascertainment, where case and control subjects are ascertained non-randomly with respect to family relatedness. Previous work has shown that this type of ascertainment can severely bias heritability estimates; we show here that it also impacts mixed model association statistics. We introduce a family-based association statistic (LT-Fam) that is robust to this problem. Similar to LTMLM, LT-Fam is computed from posterior mean liabilities (PML) under a liability threshold model; however, LT-Fam uses published narrow-sense heritability estimates to avoid the problem of biased heritability estimation, enabling correct calibration. In simulations with family-biased case-control ascertainment, LT-Fam was correctly calibrated (average χ 2 = 1.00-1.02 for null SNPs), whereas the Armitage trend test (ATT), standard mixed model association (MLM), and case-control retrospective association test (CARAT) were mis-calibrated (e.g., average χ 2 = 0.50-1.22 for MLM, 0.89-2.65 for CARAT). LT-Fam also attained higher power than other methods in some settings. In 1,259 type 2 diabetes-affected case subjects and 5,765 control subjects from the CARe cohort, downsampled to induce family-biased ascertainment, LT-Fam was correctly calibrated whereas ATT, MLM, and CARAT were again mis-calibrated. Our results highlight the importance of modeling family sampling bias in case-control datasets with related samples. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Case-mix reimbursement for nursing home services: Simulation approach

PubMed Central

Adams, E. Kathleen; Schlenker, Robert E.

1986-01-01

Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

Case-mix reimbursement for nursing home services: simulation approach.

PubMed

Adams, E K; Schlenker, R E

1986-01-01

Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2013-12-25

Background: Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. Methods: In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Results: Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Conclusions: Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Inter-provider comparison of patient-reported outcomes: developing an adjustment to account for differences in patient case mix.

PubMed

Nuttall, David; Parkin, David; Devlin, Nancy

2015-01-01

This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed. © 2013 Crown copyright.

The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident Acuity

PubMed Central

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

2006-01-01

Objective To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. PMID:16899009

Finite elements and finite differences for transonic flow calculations

NASA Technical Reports Server (NTRS)

Hafez, M. M.; Murman, E. M.; Wellford, L. C.

1978-01-01

The paper reviews the chief finite difference and finite element techniques used for numerical solution of nonlinear mixed elliptic-hyperbolic equations governing transonic flow. The forms of the governing equations for unsteady two-dimensional transonic flow considered are the Euler equation, the full potential equation in both conservative and nonconservative form, the transonic small-disturbance equation in both conservative and nonconservative form, and the hodograph equations for the small-disturbance case and the full-potential case. Finite difference methods considered include time-dependent methods, relaxation methods, semidirect methods, and hybrid methods. Finite element methods include finite element Lax-Wendroff schemes, implicit Galerkin method, mixed variational principles, dual iterative procedures, optimal control methods and least squares.

Assessing and evaluating multidisciplinary translational teams: a mixed methods approach.

PubMed

Wooten, Kevin C; Rose, Robert M; Ostir, Glenn V; Calhoun, William J; Ameredes, Bill T; Brasier, Allan R

2014-03-01

A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed-methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed-methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team-type taxonomy. Based on team maturation and scientific progress, teams were designated as (a) early in development, (b) traditional, (c) process focused, or (d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored.

Unexpected but Most Welcome: Mixed Methods for the Validation and Revision of the Participatory Evaluation Measurement Instrument

ERIC Educational Resources Information Center

Daigneault, Pierre-Marc; Jacob, Steve

2014-01-01

Although combining methods is nothing new, more contributions about why and how to mix methods for validation purposes are needed. This article presents a case of validating the inferences drawn from the Participatory Evaluation Measurement Instrument, an instrument that purports to measure stakeholder participation in evaluation. Although the…

Analysis of messy data with heteroscedastic in mean models

NASA Astrophysics Data System (ADS)

Trianasari, Nurvita; Sumarni, Cucu

2016-02-01

In the analysis of the data, we often faced with the problem of data where the data did not meet some assumptions. In conditions of such data is often called data messy. This problem is a consequence of the data that generates outliers that bias or error estimation. To analyze the data messy, there are three approaches, namely standard analysis, transform data and data analysis methods rather than a standard. Simulations conducted to determine the performance of a third comparative test procedure on average often the model variance is not homogeneous. Data simulation of each scenario is raised as much as 500 times. Next, we do the analysis of the average comparison test using three methods, Welch test, mixed models and Welch-r test. Data generation is done through software R version 3.1.2. Based on simulation results, these three methods can be used for both normal and abnormal case (homoscedastic). The third method works very well on data balanced or unbalanced when there is no violation in the homogenity's assumptions variance. For balanced data, the three methods still showed an excellent performance despite the violation of the assumption of homogeneity of variance, with the requisite degree of heterogeneity is high. It can be shown from the level of power test above 90 percent, and the best to Welch method (98.4%) and the Welch-r method (97.8%). For unbalanced data, Welch method will be very good moderate at in case of heterogeneity positive pair with a 98.2% power. Mixed models method will be very good at case of highly heterogeneity was negative negative pairs with power. Welch-r method works very well in both cases. However, if the level of heterogeneity of variance is very high, the power of all method will decrease especially for mixed models methods. The method which still works well enough (power more than 50%) is Welch-r method (62.6%), and the method of Welch (58.6%) in the case of balanced data. If the data are unbalanced, Welch-r method works well enough in the case of highly heterogeneous positive positive or negative negative pairs, there power are 68.8% and 51% consequencly. Welch method perform well enough only in the case of highly heterogeneous variety of positive positive pairs with it is power of 64.8%. While mixed models method is good in the case of a very heterogeneous variety of negative partner with 54.6% power. So in general, when there is a variance is not homogeneous case, Welch method is applied to the data rank (Welch-r) has a better performance than the other methods.

Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database

PubMed Central

2005-01-01

Introduction The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). Methods The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. Results The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. Conclusions The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases.

Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database

PubMed Central

Harrison, David A; Brady, Anthony R; Rowan, Kathy

2004-01-01

Introduction The present paper describes the methods of data collection and validation employed in the Intensive Care National Audit & Research Centre Case Mix Programme (CMP), a national comparative audit of outcome for adult, critical care admissions. The paper also describes the case mix, outcome and activity of the admissions in the Case Mix Programme Database (CMPD). Methods The CMP collects data on consecutive admissions to adult, general critical care units in England, Wales and Northern Ireland. Explicit steps are taken to ensure the accuracy of the data, including use of a dataset specification, of initial and refresher training courses, and of local and central validation of submitted data for incomplete, illogical and inconsistent values. Criteria for evaluating clinical databases developed by the Directory of Clinical Databases were applied to the CMPD. The case mix, outcome and activity for all admissions were briefly summarised. Results The mean quality level achieved by the CMPD for the 10 Directory of Clinical Databases criteria was 3.4 (on a scale of 1 = worst to 4 = best). The CMPD contained validated data on 129,647 admissions to 128 units. The median age was 63 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. Mortality was 20.3% in the CMP unit and was 30.8% at ultimate discharge from hospital. Nonsurvivors stayed longer in intensive care than did survivors (median 2.0 days versus 1.7 days in the CMP unit) but had a shorter total hospital length of stay (9 days versus 16 days). Results for the CMPD were comparable with results from other published reports of UK critical care admissions. Conclusions The CMP uses rigorous methods to ensure data are complete, valid and reliable. The CMP scores well against published criteria for high-quality clinical databases. PMID:15025784

Target space pseudoduality in supersymmetric sigma models on symmetric spaces

NASA Astrophysics Data System (ADS)

Sarisaman, Mustafa

We discuss the target space pseudoduality in supersymmetric sigma models on symmetric spaces. We first consider the case where sigma models based on real compact connected Lie groups of the same dimensionality and give examples using three dimensional models on target spaces. We show explicit construction of nonlocal conserved currents on the pseudodual manifold. We then switch the Lie group valued pseudoduality equations to Lie algebra valued ones, which leads to an infinite number of pseudoduality equations. We obtain an infinite number of conserved currents on the tangent bundle of the pseudo-dual manifold. Since pseudoduality imposes the condition that sigma models pseudodual to each other are based on symmetric spaces with opposite curvatures (i.e. dual symmetric spaces), we investigate pseudoduality transformation on the symmetric space sigma models in the third chapter. We see that there can be mixing of decomposed spaces with each other, which leads to mixings of the following expressions. We obtain the pseudodual conserved currents which are viewed as the orthonormal frame on the pullback bundle of the tangent space of G˜ which is the Lie group on which the pseudodual model based. Hence we obtain the mixing forms of curvature relations and one loop renormalization group beta function by means of these currents. In chapter four, we generalize the classical construction of pseudoduality transformation to supersymmetric case. We perform this both by component expansion method on manifold M and by orthonormal coframe method on manifold SO( M). The component method produces the result that pseudoduality transformation is not invertible at all points and occurs from all points on one manifold to only one point where riemann normal coordinates valid on the second manifold. Torsion of the sigma model on M must vanish while it is nonvanishing on M˜, and curvatures of the manifolds must be constant and the same because of anticommuting grassmann numbers. We obtain the similar results with the classical case in orthonormal coframe method. In case of super WZW sigma models pseudoduality equations result in three different pseudoduality conditions; flat space, chiral and antichiral pseudoduality. Finally we study the pseudoduality transformations on symmetric spaces using two different methods again. These two methods yield similar results to the classical cases with the exception that commuting bracket relations in classical case turns out to be anticommuting ones because of the appearance of grassmann numbers. It is understood that constraint relations in case of non-mixing pseudoduality are the remnants of mixing pseudoduality. Once mixing terms are included in the pseudoduality the constraint relations disappear.

Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care.

PubMed

Damman, Olga C; Stubbe, Janine H; Hendriks, Michelle; Arah, Onyebuchi A; Spreeuwenberg, Peter; Delnoij, Diana M J; Groenewegen, Peter P

2009-04-01

Ratings on the quality of healthcare from the consumer's perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for analyzing healthcare performance data, it has rarely been used to assess case-mix adjustment of such data. The purpose of this article is to investigate whether multilevel regression analysis is a useful tool to detect case-mix adjusters in consumer assessment of healthcare. We used data on 11,539 consumers from 27 Dutch health plans, which were collected using the Dutch Consumer Quality Index health plan instrument. We conducted multilevel regression analyses of consumers' responses nested within health plans to assess the effects of consumer characteristics on consumer experience. We compared our findings to the results of another methodology: the impact factor approach, which combines the predictive effect of each case-mix variable with its heterogeneity across health plans. Both multilevel regression and impact factor analyses showed that age and education were the most important case-mix adjusters for consumer experience and ratings of health plans. With the exception of age, case-mix adjustment had little impact on the ranking of health plans. On both theoretical and practical grounds, multilevel modeling is useful for adequate case-mix adjustment and analysis of performance ratings.

Child Geopolitical Agency: A Mixed Methods Case Study

ERIC Educational Resources Information Center

Habashi, Janette; Worley, Jody

2009-01-01

This study examines the geopolitical agency of Palestinian children. Mixed methodology was used to identify the etiologies contributing to processes of political socialization. Both qualitative and qualitative methods are equally distributed throughout this research. Focus groups and interviews with 12 Palestinian children, aged 10 to 13 years,…

Detection of Mixed Infection from Bacterial Whole Genome Sequence Data Allows Assessment of Its Role in Clostridium difficile Transmission

PubMed Central

Eyre, David W.; Cule, Madeleine L.; Griffiths, David; Crook, Derrick W.; Peto, Tim E. A.

2013-01-01

Bacterial whole genome sequencing offers the prospect of rapid and high precision investigation of infectious disease outbreaks. Close genetic relationships between microorganisms isolated from different infected cases suggest transmission is a strong possibility, whereas transmission between cases with genetically distinct bacterial isolates can be excluded. However, undetected mixed infections—infection with ≥2 unrelated strains of the same species where only one is sequenced—potentially impairs exclusion of transmission with certainty, and may therefore limit the utility of this technique. We investigated the problem by developing a computationally efficient method for detecting mixed infection without the need for resource-intensive independent sequencing of multiple bacterial colonies. Given the relatively low density of single nucleotide polymorphisms within bacterial sequence data, direct reconstruction of mixed infection haplotypes from current short-read sequence data is not consistently possible. We therefore use a two-step maximum likelihood-based approach, assuming each sample contains up to two infecting strains. We jointly estimate the proportion of the infection arising from the dominant and minor strains, and the sequence divergence between these strains. In cases where mixed infection is confirmed, the dominant and minor haplotypes are then matched to a database of previously sequenced local isolates. We demonstrate the performance of our algorithm with in silico and in vitro mixed infection experiments, and apply it to transmission of an important healthcare-associated pathogen, Clostridium difficile. Using hospital ward movement data in a previously described stochastic transmission model, 15 pairs of cases enriched for likely transmission events associated with mixed infection were selected. Our method identified four previously undetected mixed infections, and a previously undetected transmission event, but no direct transmission between the pairs of cases under investigation. These results demonstrate that mixed infections can be detected without additional sequencing effort, and this will be important in assessing the extent of cryptic transmission in our hospitals. PMID:23658511

Assessing and Evaluating Multidisciplinary Translational Teams: A Mixed Methods Approach

PubMed Central

Wooten, Kevin C.; Rose, Robert M.; Ostir, Glenn V.; Calhoun, William J.; Ameredes, Bill T.; Brasier, Allan R.

2014-01-01

A case report illustrates how multidisciplinary translational teams can be assessed using outcome, process, and developmental types of evaluation using a mixed methods approach. Types of evaluation appropriate for teams are considered in relation to relevant research questions and assessment methods. Logic models are applied to scientific projects and team development to inform choices between methods within a mixed methods design. Use of an expert panel is reviewed, culminating in consensus ratings of 11 multidisciplinary teams and a final evaluation within a team type taxonomy. Based on team maturation and scientific progress, teams were designated as: a) early in development, b) traditional, c) process focused, or d) exemplary. Lessons learned from data reduction, use of mixed methods, and use of expert panels are explored. PMID:24064432

Applying the Mixed Methods Instrument Development and Construct Validation Process: the Transformative Experience Questionnaire

ERIC Educational Resources Information Center

Koskey, Kristin L. K.; Sondergeld, Toni A.; Stewart, Victoria C.; Pugh, Kevin J.

2018-01-01

Onwuegbuzie and colleagues proposed the Instrument Development and Construct Validation (IDCV) process as a mixed methods framework for creating and validating measures. Examples applying IDCV are lacking. We provide an illustrative case integrating the Rasch model and cognitive interviews applied to the development of the Transformative…

An Observational Analysis of Coaching Behaviors for Career Development Event Teams: A Mixed Methods Study

ERIC Educational Resources Information Center

Ball, Anna L.; Bowling, Amanda M.; Sharpless, Justin D.

2016-01-01

School Based Agricultural Education (SBAE) teachers can use coaching behaviors, along with their agricultural content knowledge to help their Career Development Event (CDE) teams succeed. This mixed methods, collective case study observed three SBAE teachers preparing multiple CDEs throughout the CDE season. The teachers observed had a previous…

Perceptions of Organizational Culture of a Multi-Campus Community College District: Mixed Methods in Concert

ERIC Educational Resources Information Center

Kuster Dale, Kimberly

2012-01-01

This concurrent, mixed-methods case study analyzed perceptions of current and preferred organizational culture within a rural, multi-campus community college district. This phenomenon was examined by analyzing and comparing data collected by surveying all full-time employees utilizing the Organizational Culture Assessment Instrument (OCAI) and…

Female Leadership at High-Poverty, High-Performing Schools: Four Case Studies

ERIC Educational Resources Information Center

Reynolds, Shirley Ann

2009-01-01

This mixed methods study examined the leadership abilities of four African American female principals in an urban setting. The purpose of the mixed methods study was to observe, describe and analyze how the principals have been effective leaders in their respective high-poverty, high-performing elementary schools (K-5). The qualitative methodology…

How to Construct a Mixed Methods Research Design.

PubMed

Schoonenboom, Judith; Johnson, R Burke

2017-01-01

This article provides researchers with knowledge of how to design a high quality mixed methods research study. To design a mixed study, researchers must understand and carefully consider each of the dimensions of mixed methods design, and always keep an eye on the issue of validity. We explain the seven major design dimensions: purpose, theoretical drive, timing (simultaneity and dependency), point of integration, typological versus interactive design approaches, planned versus emergent design, and design complexity. There also are multiple secondary dimensions that need to be considered during the design process. We explain ten secondary dimensions of design to be considered for each research study. We also provide two case studies showing how the mixed designs were constructed.

Numerical simulation of a plane turbulent mixing layer, with applications to isothermal, rapid reactions

NASA Technical Reports Server (NTRS)

Lin, P.; Pratt, D. T.

1987-01-01

A hybrid method has been developed for the numerical prediction of turbulent mixing in a spatially-developing, free shear layer. Most significantly, the computation incorporates the effects of large-scale structures, Schmidt number and Reynolds number on mixing, which have been overlooked in the past. In flow field prediction, large-eddy simulation was conducted by a modified 2-D vortex method with subgrid-scale modeling. The predicted mean velocities, shear layer growth rates, Reynolds stresses, and the RMS of longitudinal velocity fluctuations were found to be in good agreement with experiments, although the lateral velocity fluctuations were overpredicted. In scalar transport, the Monte Carlo method was extended to the simulation of the time-dependent pdf transport equation. For the first time, the mixing frequency in Curl's coalescence/dispersion model was estimated by using Broadwell and Breidenthal's theory of micromixing, which involves Schmidt number, Reynolds number and the local vorticity. Numerical tests were performed for a gaseous case and an aqueous case. Evidence that pure freestream fluids are entrained into the layer by large-scale motions was found in the predicted pdf. Mean concentration profiles were found to be insensitive to Schmidt number, while the unmixedness was higher for higher Schmidt number. Applications were made to mixing layers with isothermal, fast reactions. The predicted difference in product thickness of the two cases was in reasonable quantitative agreement with experimental measurements.

Reclassification of Mixed Oligoastrocytic Tumors Using a Genetically Integrated Diagnostic Approach

PubMed Central

Kim, Seong-Ik; Lee, Yujin; Won, Jae-Kyung; Park, Chul-Kee; Choi, Seung Hong; Park, Sung-Hye

2018-01-01

Background Mixed gliomas, such as oligoastrocytomas (OA), anaplastic oligoastrocytomas, and glioblastomas (GBMs) with an oligodendroglial component (GBMO) are defined as tumors composed of a mixture of two distinct neoplastic cell types, astrocytic and oligodendroglial. Recently, mutations ATRX and TP53, and codeletion of 1p/19q are shown to be genetic hallmarks of astrocytic and oligodendroglial tumors, respectively. Subsequent molecular analyses of mixed gliomas preferred the reclassification to either oligodendroglioma or astrocytoma. This study was designed to apply genetically integrated diagnostic criteria to mixed gliomas and determine usefulness and prognostic value of new classification in Korean patients. Methods Fifty-eight cases of mixed OAs and GBMOs were retrieved from the pathology archives of Seoul National University Hospital from 2004 to 2015. Reclassification was performed according to genetic and immunohistochemical properties. Clinicopathological characteristics of each subgroup were evaluated. Overall survival was assessed and compared between subgroups. Results We could reclassify all mixed OAs and GBMOs into either astrocytic or oligodendroglial tumors. Notably, 29 GBMOs could be reclassified into 11 cases of GBM, IDH-mutant, 16 cases of GBM, IDH-wildtype, and two cases of anaplastic oligodendroglioma, IDH mutant. Overall survival was significantly different among these new groups (p<.001). Overall survival and progression-free survival were statistically better in gliomas with IDH mutation, ATRX mutation, no microscopic necrosis, and young patient age (cut off, 45 years old). Conclusions Our results strongly suggest that a genetically integrated diagnosis of glioma better reflects prognosis than former morphology-based methods. PMID:28958143

A multidimensional approach to case mix for home health services

PubMed Central

Manton, Kenneth G.; Hausner, Tony

1987-01-01

Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services. PMID:10312187

A multidimensional approach to case mix for home health services.

PubMed

Manton, K G; Hausner, T

1987-01-01

Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services.

Feminist Approaches to Triangulation: Uncovering Subjugated Knowledge and Fostering Social Change in Mixed Methods Research

ERIC Educational Resources Information Center

Hesse-Biber, Sharlene

2012-01-01

This article explores the deployment of triangulation in the service of uncovering subjugated knowledge and promoting social change for women and other oppressed groups. Feminist approaches to mixed methods praxis create a tight link between the research problem and the research design. An analysis of selected case studies of feminist praxis…

Community-Involved Learning to Expand Possibilities for Vulnerable Children: A Critical Communicative, Sen's Capability, and Action Research Approach

ERIC Educational Resources Information Center

Kim, Kyung Hi

2014-01-01

This research, based on a case study of vulnerable children in Korea, used a mixed methods transformative approach to explore strategies to support and help disadvantaged children. The methodological approach includes three phases: a mixed methods contextual analysis, a qualitative dominant analysis based on Sen's capability approach and critical…

A Mixed-Methods Case Study of Parent Involvement in an Urban High School Serving Minority Students

ERIC Educational Resources Information Center

Reynolds, Andrew D.; Crea, Thomas M.; Medina, Jose; Degnan, Elizabeth; McRoy, Ruth

2015-01-01

Parental involvement in education has been associated with a number of positive outcomes for students. Using a mixed-methods approach, the authors examine how role construction and self-efficacy (psychological motivators), invitations (contextual motivators), and life contexts influence a parent's decision to become involved within the context of…

Using Mixed Methods from a Communicative Orientation: Researching with Grassroots Roma

ERIC Educational Resources Information Center

Flecha, Ramon

2014-01-01

Over a decade ago, researchers in Roma studies shifted their approach, from an exclusionary stance to a more communicative one. Despite major positive changes since then, researchers still do not adequately reflect the voices of the majority of the world's Roma. In this article, we draw on a communicative mixed methods case study, conducted within…

Do Zoo Visitors Come to Learn? An Internationally Comparative, Mixed-Methods Study

ERIC Educational Resources Information Center

Roe, Katie; McConney, Andrew

2015-01-01

Zoo visitors go to see animals, but are they there to learn? This mixed-methods study examines visitor learning from both zoos' and visitors' perspectives using qualitative and quantitative data. Five hundred and forty zoo visitor interviews from nine case studies provide insight into visitor intentions, which indicate that the majority of…

Learning and Study Strategies of Students with Traumatic Brain Injury: A Mixed Method Study

ERIC Educational Resources Information Center

Bush, Erin; Hux, Karen; Zickefoose, Samantha; Simanek, Gina; Holmberg, Michelle; Henderson, Ambyr

2011-01-01

The purpose of this research was to explore the perceptions of four college students with severe traumatic brain injury and people associated with them regarding the use of learning skills and study strategies. The researchers employed a concurrent mixed method design using descriptive quantitative data as well as qualitative multiple case study…

Assessing Discriminative Performance at External Validation of Clinical Prediction Models

PubMed Central

Nieboer, Daan; van der Ploeg, Tjeerd; Steyerberg, Ewout W.

2016-01-01

Introduction External validation studies are essential to study the generalizability of prediction models. Recently a permutation test, focusing on discrimination as quantified by the c-statistic, was proposed to judge whether a prediction model is transportable to a new setting. We aimed to evaluate this test and compare it to previously proposed procedures to judge any changes in c-statistic from development to external validation setting. Methods We compared the use of the permutation test to the use of benchmark values of the c-statistic following from a previously proposed framework to judge transportability of a prediction model. In a simulation study we developed a prediction model with logistic regression on a development set and validated them in the validation set. We concentrated on two scenarios: 1) the case-mix was more heterogeneous and predictor effects were weaker in the validation set compared to the development set, and 2) the case-mix was less heterogeneous in the validation set and predictor effects were identical in the validation and development set. Furthermore we illustrated the methods in a case study using 15 datasets of patients suffering from traumatic brain injury. Results The permutation test indicated that the validation and development set were homogenous in scenario 1 (in almost all simulated samples) and heterogeneous in scenario 2 (in 17%-39% of simulated samples). Previously proposed benchmark values of the c-statistic and the standard deviation of the linear predictors correctly pointed at the more heterogeneous case-mix in scenario 1 and the less heterogeneous case-mix in scenario 2. Conclusion The recently proposed permutation test may provide misleading results when externally validating prediction models in the presence of case-mix differences between the development and validation population. To correctly interpret the c-statistic found at external validation it is crucial to disentangle case-mix differences from incorrect regression coefficients. PMID:26881753

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

PubMed

Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing patient survey data would be timely, and could improve rigour and comparability across the NHS. Performance comparisons need to be perceived as fair and scientifically robust to maintain confidence in publicly reported data, and to support their use by both the public and the NHS. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Achieving Integration in Mixed Methods Designs—Principles and Practices

PubMed Central

Fetters, Michael D; Curry, Leslie A; Creswell, John W

2013-01-01

Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs—exploratory sequential, explanatory sequential, and convergent—and through four advanced frameworks—multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods. PMID:24279835

Achieving integration in mixed methods designs-principles and practices.

PubMed

Fetters, Michael D; Curry, Leslie A; Creswell, John W

2013-12-01

Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods. © Health Research and Educational Trust.

Customer-Focused Business Practice Adoption: A Comparison of Private and Public Sector Implementations

DTIC Science & Technology

2004-03-01

Narratives Phenomenologies Ethnographies Grounded Theory Case Studies Mixed Methods Sequential Concurrent Transformative Creswell... ethnographies , grounded theory studies and case studies (Creswell, 2003:18). The methods used in qualitative study provide the framework for...Definition Grounded theory provides a structured

Advanced scatter search approach and its application in a sequencing problem of mixed-model assembly lines in a case company

NASA Astrophysics Data System (ADS)

Liu, Qiong; Wang, Wen-xi; Zhu, Ke-ren; Zhang, Chao-yong; Rao, Yun-qing

2014-11-01

Mixed-model assembly line sequencing is significant in reducing the production time and overall cost of production. To improve production efficiency, a mathematical model aiming simultaneously to minimize overtime, idle time and total set-up costs is developed. To obtain high-quality and stable solutions, an advanced scatter search approach is proposed. In the proposed algorithm, a new diversification generation method based on a genetic algorithm is presented to generate a set of potentially diverse and high-quality initial solutions. Many methods, including reference set update, subset generation, solution combination and improvement methods, are designed to maintain the diversification of populations and to obtain high-quality ideal solutions. The proposed model and algorithm are applied and validated in a case company. The results indicate that the proposed advanced scatter search approach is significant for mixed-model assembly line sequencing in this company.

[Case-mix index and length of hospitalization].

PubMed

D'Andrea, V; Catania, A; Di Matteo, F M; Savino, G; Greco, R; Di Marco, C; De Antoni, E

2010-05-01

The ACG (Adjusted Clinical Groups) case-mix system is a classification method of diseases of patients, focused on the person. Depending on the pattern of these morbid conditions, the ACG system assigns each patient to a single group (an ACG group), which allows to capture the effects of a group of diseases in estimates of resource use. Diseases are classified into a diagnostic group (ADG) according to 5 clinical dimensions: duration (acute, recurrent or chronic), severity (minor/major vs stable/unstable), diagnostic assessment (symptoms vs diseases), etiology (infectious, traumatic or other), specialty (medical, surgical, obstetric, ...). All diseases can be classified into these dimensions and into one of 32 groups. The ACG case-mix system uses an algorithm to classify each patient into one of 93 ACG categories. Each person is assigned to an ACG according to his ADG combination, his age and his gender. With the repayment system "case-mix", surgery has become central for all great hospitals in virtue of its great productive potential. The case-mix index is one of the factors which influence the duration of hospitalization. The case-mix system has emphasized the importance of the duration of hospitalization, encouraging the planning of programs in order to discharge patients early after surgical operations. It has also stimulated the surgical activity in operating units with "budget" forecasts in which resources are provided according to an expected level of specialist surgery.

Discontinuous dual-primal mixed finite elements for elliptic problems

NASA Technical Reports Server (NTRS)

Bottasso, Carlo L.; Micheletti, Stefano; Sacco, Riccardo

2000-01-01

We propose a novel discontinuous mixed finite element formulation for the solution of second-order elliptic problems. Fully discontinuous piecewise polynomial finite element spaces are used for the trial and test functions. The discontinuous nature of the test functions at the element interfaces allows to introduce new boundary unknowns that, on the one hand enforce the weak continuity of the trial functions, and on the other avoid the need to define a priori algorithmic fluxes as in standard discontinuous Galerkin methods. Static condensation is performed at the element level, leading to a solution procedure based on the sole interface unknowns. The resulting family of discontinuous dual-primal mixed finite element methods is presented in the one and two-dimensional cases. In the one-dimensional case, we show the equivalence of the method with implicit Runge-Kutta schemes of the collocation type exhibiting optimal behavior. Numerical experiments in one and two dimensions demonstrate the order accuracy of the new method, confirming the results of the analysis.

Hawks, doves, and mixed-symmetry games.

PubMed

Crowley, P H

2000-06-21

The hawk-dove game has proved to be an important tool for understanding the role of aggression in social interactions. Here, the game is presented in a more general form (GHD) to facilitate analyses of interactions between individuals that may differ in "size", where size is interpreted as a surrogate for resource holding power. Three different situations are considered, based on the availability and use of information that interacting individuals have about their sizes: the classical symmetric case, in which no information about sizes is used, the asymmetric case, in which the individuals know their relative sizes and thus their chances of prevailing in combat, and a mixed-symmetry case, in which each individual only knows its own size (or only knows its opponent's size). I describe and use some recently developed methods for multitype games-evolutionary games involving two or more categories of players. With these methods and others, the evolutionarily stable strategies (ESSs) that emerge for the three different cases are identified and compared. A proof of the form and uniqueness of the ESS for the mixed-symmetry case is presented. In this situation, one size category at most can play a mixed strategy; larger individuals are aggressive and smaller individuals are not. As the number of size categories approaches infinity and the size distribution becomes continuous, there is a threshold size, above which all individuals are aggressive, and below which they are not. Copyright 2000 Academic Press.

Computation of flow in radial- and mixed-flow cascades by an inviscid-viscous interaction method

NASA Technical Reports Server (NTRS)

Serovy, G. K.; Hansen, E. C.

1980-01-01

The use of inviscid-viscous interaction methods for the case of radial or mixed-flow cascade diffusers is discussed. A literature review of investigations considering cascade flow-field prediction by inviscid-viscous iterative computation is given. Cascade aerodynamics in the third blade row of a multiple-row radial cascade diffuser are specifically investigated.

A Mixed-Method Study of Princeville's Rebuilding from the Flood of 1999: Lessons on the Importance of Invisible Community Assets

ERIC Educational Resources Information Center

Yoon, Intae

2009-01-01

Guided by previous studies and the community assets perspective, a concurrent mixed-method case study was conducted five years after a devastating flood to investigate how invisible community assets played a role in Princeville's rebuilding process from the flood of 1999. The independent variables in this study included retrospectively assessed…

The Assessment of Math Learning Difficulties in a Primary Grade-4 Child with High Support Needs: Mixed Methods Approach

ERIC Educational Resources Information Center

Mundia, Lawrence

2012-01-01

This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child's major presenting difficulties. These included: inability to use the four…

Case-Mix for Performance Management: A Risk Algorithm Based on ICD-10-CM.

PubMed

Gao, Jian; Moran, Eileen; Almenoff, Peter L

2018-06-01

Accurate risk adjustment is the key to a reliable comparison of cost and quality performance among providers and hospitals. However, the existing case-mix algorithms based on age, sex, and diagnoses can only explain up to 50% of the cost variation. More accurate risk adjustment is desired for provider performance assessment and improvement. To develop a case-mix algorithm that hospitals and payers can use to measure and compare cost and quality performance of their providers. All 6,048,895 patients with valid diagnoses and cost recorded in the US Veterans health care system in fiscal year 2016 were included in this study. The dependent variable was total cost at the patient level, and the explanatory variables were age, sex, and comorbidities represented by 762 clinically homogeneous groups, which were created by expanding the 283 categories from Clinical Classifications Software based on ICD-10-CM codes. The split-sample method was used to assess model overfitting and coefficient stability. The predictive power of the algorithms was ascertained by comparing the R, mean absolute percentage error, root mean square error, predictive ratios, and c-statistics. The expansion of the Clinical Classifications Software categories resulted in higher predictive power. The R reached 0.72 and 0.52 for the transformed and raw scale cost, respectively. The case-mix algorithm we developed based on age, sex, and diagnoses outperformed the existing case-mix models reported in the literature. The method developed in this study can be used by other health systems to produce tailored risk models for their specific purpose.

Functional mapping of hospitals by diagnosis-dominant case-mix analysis

PubMed Central

Fushimi, Kiyohide; Hashimoto, Hideki; Imanaka, Yuichi; Kuwabara, Kazuaki; Horiguchi, Hiromasa; Ishikawa, Kohichi B; Matsuda, Shinya

2007-01-01

Background Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC), and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations. Methods By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups. Results On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals. Conclusion We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers. PMID:17425788

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

PubMed Central

Khanassov, Vladimir; Vedel, Isabelle; Pluye, Pierre

2014-01-01

PURPOSE Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODS We conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool. RESULTS Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers. CONCLUSIONS Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services. PMID:25354410

Analysis of Academic and Non-Academic Outcomes from a Bottom-up Comprehensive School Reform in the Absence of Student Level Data through Simulation Methods: A Mixed Methods Case Study

ERIC Educational Resources Information Center

Sondergeld, Toni A.

2009-01-01

This dissertation examines the efficacy of a bottom-up comprehensive school reform (CSR) program by evaluating its impact on student achievement, attendance, and behavior outcomes through an explanatory mixed methods design. The CSR program (Gear Up) was implemented in an urban junior high school over the course of seven years allowing for…

Connecting the Dots and Merging Meaning: Using Mixed Methods to Study Primary Care Delivery Transformation

PubMed Central

Scammon, Debra L; Tomoaia-Cotisel, Andrada; Day, Rachel L; Day, Julie; Kim, Jaewhan; Waitzman, Norman J; Farrell, Timothy W; Magill, Michael K

2013-01-01

Objective. To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. Data Source/Study Setting. An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. Study Design. Convergent case study mixed methods design. Data Collection/Extraction Methods. Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. Principal Findings. Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Conclusions. Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence. PMID:24279836

Quantification of mixing in vesicle suspensions using numerical simulations in two dimensions.

PubMed

Kabacaoğlu, G; Quaife, B; Biros, G

2017-02-01

We study mixing in Stokesian vesicle suspensions in two dimensions on a cylindrical Couette apparatus using numerical simulations. The vesicle flow simulation is done using a boundary integral method, and the advection-diffusion equation for the mixing of the solute is solved using a pseudo-spectral scheme. We study the effect of the area fraction, the viscosity contrast between the inside (the vesicles) and the outside (the bulk) fluid, the initial condition of the solute, and the mixing metric. We compare mixing in the suspension with mixing in the Couette apparatus without vesicles. On the one hand, the presence of vesicles in most cases slightly suppresses mixing. This is because the solute can be only diffused across the vesicle interface and not advected. On the other hand, there exist spatial distributions of the solute for which the unperturbed Couette flow completely fails to mix whereas the presence of vesicles enables mixing. We derive a simple condition that relates the velocity and solute and can be used to characterize the cases in which the presence of vesicles promotes mixing.

Quantification of mixing in vesicle suspensions using numerical simulations in two dimensions

PubMed Central

Quaife, B.; Biros, G.

2017-01-01

We study mixing in Stokesian vesicle suspensions in two dimensions on a cylindrical Couette apparatus using numerical simulations. The vesicle flow simulation is done using a boundary integral method, and the advection-diffusion equation for the mixing of the solute is solved using a pseudo-spectral scheme. We study the effect of the area fraction, the viscosity contrast between the inside (the vesicles) and the outside (the bulk) fluid, the initial condition of the solute, and the mixing metric. We compare mixing in the suspension with mixing in the Couette apparatus without vesicles. On the one hand, the presence of vesicles in most cases slightly suppresses mixing. This is because the solute can be only diffused across the vesicle interface and not advected. On the other hand, there exist spatial distributions of the solute for which the unperturbed Couette flow completely fails to mix whereas the presence of vesicles enables mixing. We derive a simple condition that relates the velocity and solute and can be used to characterize the cases in which the presence of vesicles promotes mixing. PMID:28344432

A Mixed-Method Analysis of Reports on 100 Cases of Improper Prescribing of Controlled Substances

PubMed Central

DuBois, James M.; Chibnall, John T.; Anderson, Emily E.; Eggers, Michelle; Baldwin, Kari; Vasher, Meghan

2017-01-01

Improper prescribing of controlled substances contributes to opioid addictions and deaths by overdose. Studies conducted to-date have largely lacked a theoretical framework and ignored the interaction of individual with environmental factors. We conducted a mixed-method analysis of published reports on 100 cases that occurred in the United States. An average of 17 reports (e.g., from medical boards) per case were coded for 38 dichotomous variables describing the physician, setting, patients, and investigation. A theory on how the case occurred was developed for each case. Explanatory typologies were developed and then validated through hierarchical cluster analysis. Most cases involved physicians who were male (88%), >40 years old (90%), non-board certified (63%), and in small private practices (97%); 54% of cases reported facts about the physician indicative of self-centered personality traits. Three explanatory typologies were validated. Increasing oversight provided by peers and trainees may help prevent improper prescribing of controlled substances. PMID:28663601

A Mixed Methods Study of the Effects of a Modified High School Calendar on Student Achievement and Teacher Perceptions

ERIC Educational Resources Information Center

Watrous, Lorena Harper

2011-01-01

The purpose of this mixed-methods explanatory case study was to determine the impact of a reduced school calendar on student achievement for students in grades 9 through 12 in two rural school districts in Virginia and to explore meanings associated with this change. The study focused on two research questions: how does student performance during…

Exploring Teachers' Technological Pedagogical Content Knowledge (TPACK) in an Online Course: A Mixed Methods Study

ERIC Educational Resources Information Center

Varguez, Ricardo

2012-01-01

The constant expansion of Web 2.0 applications available on the World Wide Web and expansion of technology resources has prompted the need to better prepare current and future educators to make more effective use of such resources in their classrooms. The purpose of this embedded mixed methods case study was to describe the experiences and changes…

Productivity growth in outpatient child and adolescent mental health services: the impact of case-mix adjustment.

PubMed

Halsteinli, Vidar; Kittelsen, Sverre A; Magnussen, Jon

2010-02-01

The performance of health service providers may be monitored by measuring productivity. However, the policy value of such measures may depend crucially on the accuracy of input and output measures. In particular, an important question is how to adjust adequately for case-mix in the production of health care. In this study, we assess productivity growth in Norwegian outpatient child and adolescent mental health service units (CAMHS) over a period characterized by governmental utilization of simple productivity indices, a substantial increase in capacity and a concurrent change in case-mix. We analyze the sensitivity of the productivity growth estimates using different specifications of output to adjust for case-mix differences. Case-mix adjustment is achieved by distributing patients into eight groups depending on reason for referral, age and gender, as well as correcting for the number of consultations. We utilize the nonparametric Data Envelopment Analysis (DEA) method to implicitly calculate weights that maximize each unit's efficiency. Malmquist indices of technical productivity growth are estimated and bootstrap procedures are performed to calculate confidence intervals and to test alternative specifications of outputs. The dataset consist of an unbalanced panel of 48-60 CAMHS in the period 1998-2006. The mean productivity growth estimate from a simple unadjusted patient model (one single output) is 35%; adjusting for case-mix (eight outputs) reduces the growth estimate to 15%. Adding consultations increases the estimate to 28%. The latter reflects an increase in number of consultations per patient. We find that the governmental productivity indices strongly tend to overestimate productivity growth. Case-mix adjustment is of major importance and governmental utilization of performance indicators necessitates careful considerations of output specifications. Copyright 2009 Elsevier Ltd. All rights reserved.

Large-Eddy Simulation (LES) of a Compressible Mixing Layer and the Significance of Inflow Turbulence

NASA Technical Reports Server (NTRS)

Mankbadi, Mina Reda; Georgiadis, Nicholas J.; Debonis, James R.

2017-01-01

In the context of Large Eddy Simulations (LES), the effects of inflow turbulence are investigated through the Synthetic Eddy Method (SEM). The growth rate of a turbulent compressible mixing layer corresponding to operating conditions of GeobelDutton Case 2 is investigated herein. The effects of spanwise width on the growth rate of the mixing layer is investigated such that spanwise width independence is reached. The error in neglecting inflow turbulence effects is quantified by comparing two methodologies: (1) Hybrid-RANS-LES methodology and (2) SEM-LES methodology. Best practices learned from Case 2 are developed herein and then applied to a higher convective mach number corresponding to Case 4 experiments of GeobelDutton.

Applications of mixed-methods methodology in clinical pharmacy research.

PubMed

Hadi, Muhammad Abdul; Closs, S José

2016-06-01

Introduction Mixed-methods methodology, as the name suggests refers to mixing of elements of both qualitative and quantitative methodologies in a single study. In the past decade, mixed-methods methodology has gained popularity among healthcare researchers as it promises to bring together the strengths of both qualitative and quantitative approaches. Methodology A number of mixed-methods designs are available in the literature and the four most commonly used designs in healthcare research are: the convergent parallel design, the embedded design, the exploratory design, and the explanatory design. Each has its own unique advantages, challenges and procedures and selection of a particular design should be guided by the research question. Guidance on designing, conducting and reporting mixed-methods research is available in the literature, so it is advisable to adhere to this to ensure methodological rigour. When to use it is best suited when the research questions require: triangulating findings from different methodologies to explain a single phenomenon; clarifying the results of one method using another method; informing the design of one method based on the findings of another method, development of a scale/questionnaire and answering different research questions within a single study. Two case studies have been presented to illustrate possible applications of mixed-methods methodology. Limitations Possessing the necessary knowledge and skills to undertake qualitative and quantitative data collection, analysis, interpretation and integration remains the biggest challenge for researchers conducting mixed-methods studies. Sequential study designs are often time consuming, being in two (or more) phases whereas concurrent study designs may require more than one data collector to collect both qualitative and quantitative data at the same time.

The Effects of Instructional Implementation on Learning with Interactive Multimedia Case-Based Instruction

ERIC Educational Resources Information Center

Mitchem, Katherine; Koury, Kevin; Fitzgerald, Gail; Hollingsead, Candice; Miller, Kevin; Tsai, Hui-Hsien; Zha, Shenghua

2009-01-01

Interactive, multimedia cases with technology supports present new ways of teaching and learning in teacher education. In this mixed-methods, naturalistic study, the authors investigate how and what participants learn from multimedia cases and, in particular, how instructional implementation affects learning outcomes from multimedia cases.…

The Influence of Alternative Pedagogical Methods in Postsecondary Biology Education: How Do Students Experience a Multimedia Case-Study Environment?

ERIC Educational Resources Information Center

Wolter, Bjorn Hugo Karl

2010-01-01

The purpose of this study was to better understand how an online, multimedia case study method influenced students' motivation, performance, and perceptions of science in collegiate level biology classes. It utilized a mix-methods design including data from pre- and post-test, student surveys, and focus group interviews to answer one primary…

Connecting the dots and merging meaning: using mixed methods to study primary care delivery transformation.

PubMed

Scammon, Debra L; Tomoaia-Cotisel, Andrada; Day, Rachel L; Day, Julie; Kim, Jaewhan; Waitzman, Norman J; Farrell, Timothy W; Magill, Michael K

2013-12-01

To demonstrate the value of mixed methods in the study of practice transformation and illustrate procedures for connecting methods and for merging findings to enhance the meaning derived. An integrated network of university-owned, primary care practices at the University of Utah (Community Clinics or CCs). CC has adopted Care by Design, its version of the Patient Centered Medical Home. Convergent case study mixed methods design. Analysis of archival documents, internal operational reports, in-clinic observations, chart audits, surveys, semistructured interviews, focus groups, Centers for Medicare and Medicaid Services database, and the Utah All Payer Claims Database. Each data source enriched our understanding of the change process and understanding of reasons that certain changes were more difficult than others both in general and for particular clinics. Mixed methods enabled generation and testing of hypotheses about change and led to a comprehensive understanding of practice change. Mixed methods are useful in studying practice transformation. Challenges exist but can be overcome with careful planning and persistence. © Health Research and Educational Trust.

Case Series: Mental Health Needs and Perspectives of Rural Children Reared by Parents Who Abuse Methamphetamine

ERIC Educational Resources Information Center

Ostler, Teresa; Haight, Wendy; Black, James; Choi, Ga-Young; Kingery, Linda; Sheridan, Kathryn

2007-01-01

Objective: This case-based, mixed-methods study was undertaken to understand the perspectives and mental health needs of rural children exposed to parental methamphetamine abuse. Method: Participants were 23 children involved with a state child protective agency because of parental methamphetamine abuse. A semistructured interview provided…

Teaching with the Case Method Online: Pure versus Hybrid Approaches

ERIC Educational Resources Information Center

Webb, Harold W.; Gill, Grandon; Poe, Gary

2005-01-01

The impact of hybrid classroom/distance education approaches is examined in the context of the case method. Four distinct semester-long treatments, which varied mixes of classroom and online discussion, were used to teach a graduate MIS survey course. Specific findings suggest that by using Web technology, college instructors may offer students…

Does the average cost of home health care vary with case mix?

PubMed

Nyman, J A; Svetlik, M A

1989-01-01

The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using 1983 data from Wisconsin's home health care agencies. In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. The methods used in the previous work are evaluated, and differences between the earlier study and the present study are discussed to explain the divergent results. Also, average costs are shown to decrease with output, to increase with the proportion of private patients served by the agency, and to be higher if the home health agency is located in an urban area or if it has a proprietary charter. The implications of this research for the design of an appropriate home health reimbursement policy are discussed. Primarily, it is argued that, although future research might confirm the relationship between average costs and case mix for home health agencies, we cannot necessarily conclude that reimbursement rates must be adjusted to account for differences in case mix as many States are now doing for nursing home reimbursement. Policies must take into account the fundamental differences between home health agencies and nursing homes, and their respective markets, in order to be effective.

Does the average cost of home health care vary with case mix?

PubMed Central

Nyman, J A; Svetlik, M A

1989-01-01

The relationship between the average cost of home health care and the case mix of patients served by the home health agency is investigated using 1983 data from Wisconsin's home health care agencies. In contrast to previous work, case mix is shown to have a significant effect on the home health agency's average costs. The methods used in the previous work are evaluated, and differences between the earlier study and the present study are discussed to explain the divergent results. Also, average costs are shown to decrease with output, to increase with the proportion of private patients served by the agency, and to be higher if the home health agency is located in an urban area or if it has a proprietary charter. The implications of this research for the design of an appropriate home health reimbursement policy are discussed. Primarily, it is argued that, although future research might confirm the relationship between average costs and case mix for home health agencies, we cannot necessarily conclude that reimbursement rates must be adjusted to account for differences in case mix as many States are now doing for nursing home reimbursement. Policies must take into account the fundamental differences between home health agencies and nursing homes, and their respective markets, in order to be effective. PMID:2502804

The influence of different black carbon and sulfate mixing methods on their optical and radiative properties

NASA Astrophysics Data System (ADS)

Zhang, Hua; Zhou, Chen; Wang, Zhili; Zhao, Shuyun; Li, Jiangnan

2015-08-01

Three different internal mixing methods (Core-Shell, Maxwell-Garnett, and Bruggeman) and one external mixing method are used to study the impact of mixing methods of black carbon (BC) with sulfate aerosol on their optical properties, radiative flux, and heating rate. The optical properties of a mixture of BC and sulfate aerosol particles are considered for three typical bands. The results show that mixing methods, the volume ratio of BC to sulfate, and relative humidity have a strong influence on the optical properties of mixed aerosols. Compared to internal mixing, external mixing underestimates the particle mass absorption coefficient by 20-70% and the particle mass scattering coefficient by up to 50%, whereas it overestimates the particle single scattering albedo by 20-50% in most cases. However, the asymmetry parameter is strongly sensitive to the equivalent particle radius, but is only weakly sensitive to the different mixing methods. Of the internal methods, there is less than 2% difference in all optical properties between the Maxwell-Garnett and Bruggeman methods in all bands; however, the differences between the Core-Shell and Maxwell-Garnett/Bruggeman methods are usually larger than 15% in the ultraviolet and visible bands. A sensitivity test is conducted with the Beijing Climate Center Radiation transfer model (BCC-RAD) using a simulated BC concentration that is typical of east-central China and a sulfate volume ratio of 75%. The results show that the internal mixing methods could reduce the radiative flux more effectively because they produce a higher absorption. The annual mean instantaneous radiative force due to BC-sulfate aerosol is about -3.18 W/m2 for the external method and -6.91 W/m2 for the internal methods at the surface, and -3.03/-1.56/-1.85 W/m2 for the external/Core-Shell/(Maxwell-Garnett/Bruggeman) methods, respectively, at the tropopause.

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

PubMed Central

Pluye, Pierre; Grad, Roland M.; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

PURPOSE We wanted to describe family physicians’ use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008–2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported. PMID:24218380

Mixing a Grounded Theory Approach with a Randomized Controlled Trial Related to Intimate Partner Violence: What Challenges Arise for Mixed Methods Research?

PubMed Central

Catallo, Cristina; Jack, Susan M.; Ciliska, Donna; MacMillan, Harriet L.

2013-01-01

Little is known about how to systematically integrate complex qualitative studies within the context of randomized controlled trials. A two-phase sequential explanatory mixed methods study was conducted in Canada to understand how women decide to disclose intimate partner violence in emergency department settings. Mixing a RCT (with a subanalysis of data) with a grounded theory approach required methodological modifications to maintain the overall rigour of this mixed methods study. Modifications were made to the following areas of the grounded theory approach to support the overall integrity of the mixed methods study design: recruitment of participants, maximum variation and negative case sampling, data collection, and analysis methods. Recommendations for future studies include: (1) planning at the outset to incorporate a qualitative approach with a RCT and to determine logical points during the RCT to integrate the qualitative component and (2) consideration for the time needed to carry out a RCT and a grounded theory approach, especially to support recruitment, data collection, and analysis. Data mixing strategies should be considered during early stages of the study, so that appropriate measures can be developed and used in the RCT to support initial coding structures and data analysis needs of the grounded theory phase. PMID:23577245

The Role of Leadership and Culture in Creating Meaningful Assessment: A Mixed Methods Case Study

ERIC Educational Resources Information Center

Guetterman, Timothy C.; Mitchell, Nancy

2016-01-01

With increased demands for institutional accountability and improved student learning, involvement in assessment has become a fundamental role of higher education faculty (Rhodes, 2010). However, faculty members and administrators often question whether assessment efforts do indeed improve student learning (Hutchings, 2010). This mixed methods…

Case-Based Reasoning in Mixed Paradigm Settings and with Learning

DTIC Science & Technology

1994-04-30

Learning Prototypical Cases OFF-BROADWAY, MCI and RMHC -* are three CBR-ML systems that learn case prototypes. We feel that methods that enable the...at Irvine Machine Learning Repository, including heart disease and breast cancer databases. OFF-BROADWAY, MCI and RMHC -* made the following notable

Breast cancer risk factor associations differ for pure versus invasive carcinoma with an in situ component in case-control and case-case analyses

PubMed Central

Ruszczyk, Melanie; Zirpoli, Gary; Kumar, Shicha; Bandera, Elisa V.; Bovbjerg, Dana H.; Jandorf, Lina; Khoury, Thaer; Hwang, Helena; Ciupak, Gregory; Pawlish, Karen; Schedin, Pepper; Masso-Welch, Patricia; Ambrosone, Christine B.; Hong, Chi-Chen

2015-01-01

Purpose Invasive ductal carcinoma (IDC) is diagnosed with or without a ductal carcinoma in situ (DCIS) component. Previous analyses have found significant differences in tumor characteristics between pure IDC lacking DCIS and mixed IDC with DCIS. We will test our hypothesis that pure IDC represents a form of breast cancer with etiology and risk factors distinct from mixed IDC/DCIS. Methods We compared reproductive risk factors for breast cancer risk, as well as family and smoking history between 831 women with mixed IDC/DCIS (n=650) or pure IDC (n=181), and 1,620 controls, in the context of the Women's Circle of Health Study (WCHS), a case-control study of breast cancer in African-American and European-American women. Data on reproductive and lifestyle factors were collected during interviews, and tumor characteristics were abstracted from pathology reports. Case-control and case-case analyses were conducted using unconditional logistic regression. Results Most risk factors were similarly associated with pure IDC and mixed IDC/DCIS. However, among postmenopausal women, risk for pure IDC was lower in women with body mass index (BMI) 25 to <30 kg/m2 (Odds Ratio (OR)=0.66; 95% confidence interval (CI), 0.35-1.23) and BMI≥30 kg/m2 (OR=0.33; 95% CI, 0.18-0.67) compared to women with BMI<25 kg/m2, with no associations with mixed IDC/DCIS. In case-case analyses, women who breastfed up to 12 months (OR=0.55; 95% CI, 0.32-0.94) or longer (OR=0.47; 95% CI, 0.26-0.87) showed decreased odds of pure IDC than mixed IDC/DCIS compared to those who did not breastfeed. Conclusions Associations with some breast cancer risk factors differed between mixed IDC/DCIS and pure IDC, potentially suggesting differential developmental pathways. These findings, if confirmed in a larger study, will provide a better understanding of the development patterns of breast cancer and the influence of modifiable risk factors, which in turn could lead to better preventive measures for pure IDC, which have worse disease prognosis compared to mixed IDC/DCIS. PMID:26621543

Characterization of mixing of suspension in a mechanically stirred precipitation system

NASA Astrophysics Data System (ADS)

Farkas, B.; Blickle, T.; Ulbert, Zs.; Hasznos-Nezdei, M.

1996-09-01

In the case of precipitational crystallization, the particle size distribution of the resulting product is greatly influenced by the mixing rate of the system. We have worked out a method of characterizing the mixing of precipitated suspensions by applying a function of mean residence time and particle size distribution. For the experiments a precipitated suspension of β-lactam-type antibiotic has been used in a mechanically stirred tank.

Interhospital differences and case-mix in a nationwide prevalence survey.

PubMed

Kanerva, M; Ollgren, J; Lyytikäinen, O

2010-10-01

A prevalence survey is a time-saving and useful tool for obtaining an overview of healthcare-associated infection (HCAI) either in a single hospital or nationally. Direct comparison of prevalence rates is difficult. We evaluated the impact of case-mix adjustment on hospital-specific prevalences. All five tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals took part in the first national prevalence survey in Finland in 2005. US Centers for Disease Control and Prevention criteria served to define HCAI. The information collected included demographic characteristics, severity of the underlying disease, use of catheters and a respirator, and previous surgery. Patients with HCAI related to another hospital were excluded. Case-mix-adjusted HCAI prevalences were calculated by using a multivariate logistic regression model for HCAI risk and an indirect standardisation method. Altogether, 587 (7.2%) of 8118 adult patients had at least one infection; hospital-specific prevalences ranged between 1.9% and 12.6%. Risk factors for HCAI that were previously known or identified by univariate analysis (age, male gender, intensive care, high Charlson comorbidity and McCabe indices, respirator, central venous or urinary catheters, and surgery during stay) were included in the multivariate analysis for standardisation. Case-mix-adjusted prevalences varied between 2.6% and 17.0%, and ranked the hospitals differently from the observed rates. In 11 (38%) hospitals, the observed prevalence rank was lower than predicted by the case-mix-adjusted figure. Case-mix should be taken into consideration in the interhospital comparison of prevalence rates. Copyright 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

PubMed

Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

2011-11-01

It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

Teaching the Properties of Chromium's Oxidation States with a Case Study Method

ERIC Educational Resources Information Center

Ozdilek, Zehra

2015-01-01

The purpose of this study was to investigate how a mixed-method case study affects pre-service science teachers' awareness of hexavalent chromium pollution and content knowledge about the properties of chromium's different oxidation states. The study was conducted in Turkey with 55 sophomores during the fall semester of 2013-2014. The students…

Unlearning of Mixed States in the Hopfield Model —Extensive Loading Case—

NASA Astrophysics Data System (ADS)

Hayashi, Kao; Hashimoto, Chinami; Kimoto, Tomoyuki; Uezu, Tatsuya

2018-05-01

We study the unlearning of mixed states in the Hopfield model for the extensive loading case. Firstly, we focus on case I, where several embedded patterns are correlated with each other, whereas the rest are uncorrelated. Secondly, we study case II, where patterns are divided into clusters in such a way that patterns in any cluster are correlated but those in two different clusters are not correlated. By using the replica method, we derive the saddle point equations for order parameters under the ansatz of replica symmetry. The same equations are also derived by self-consistent signal-to-noise analysis in case I. In both cases I and II, we find that when the correlation between patterns is large, the network loses its ability to retrieve the embedded patterns and, depending on the parameters, a confused memory, which is a mixed state and/or spin glass state, emerges. By unlearning the mixed state, the network acquires the ability to retrieve the embedded patterns again in some parameter regions. We find that to delete the mixed state and to retrieve the embedded patterns, the coefficient of unlearning should be chosen appropriately. We perform Markov chain Monte Carlo simulations and find that the simulation and theoretical results agree reasonably well, except for the spin glass solution in a parameter region due to the replica symmetry breaking. Furthermore, we find that the existence of many correlated clusters reduces the stabilities of both embedded patterns and mixed states.

A Mixed Methods Study of Shared Leadership in a K-12 School District Enhanced by a Case Study of the Former Superintendent's Role

ERIC Educational Resources Information Center

Miller, Ronald

2008-01-01

The purpose of this mixed methods study was to identify what practical applications of shared leadership have been applied and which initiatives will further the building of trust and vision in a small town school district in an eastern region of a western state. A quantitative assessment survey was conducted in the fall of 2004 by the school…

Case-Based Instruction in Different Delivery Contexts: The Impact of Time in Cases

ERIC Educational Resources Information Center

Koury, Kevin; Hollingsead, Candice; Fitzgerald, Gail; Miller, Kevin; Mitchem, Katherine; Tsai, Hui-Hsien; Zha, Shenghua

2009-01-01

The focus of this article is a mixed methods naturalistic research project investigating the relationship between learners' time working within multimedia cases and learners' outcomes. Research was conducted across multiple delivery contexts in four universities. Participants were undergraduate and graduate teacher education students completing…

Using a mixed-methods design to examine nurse practitioner integration in British Columbia.

PubMed

Sangster-Gormley, Esther; Griffith, Janessa; Schreiber, Rita; Borycki, Elizabeth

2015-07-01

To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. Data were collected using surveys, focus groups, participant interviews and case studies over three years. Data sources and methods were triangulated to determine how the findings addressed the research questions. The challenges and benefits of using the multiphase design are highlighted in the paper. The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process.

Nursing home reimbursement and the allocation of rehabilitation therapy resources.

PubMed

Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

1988-10-01

Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

A survey of quantum Lyapunov control methods.

PubMed

Cong, Shuang; Meng, Fangfang

2013-01-01

The condition of a quantum Lyapunov-based control which can be well used in a closed quantum system is that the method can make the system convergent but not just stable. In the convergence study of the quantum Lyapunov control, two situations are classified: nondegenerate cases and degenerate cases. For these two situations, respectively, in this paper the target state is divided into four categories: the eigenstate, the mixed state which commutes with the internal Hamiltonian, the superposition state, and the mixed state which does not commute with the internal Hamiltonian. For these four categories, the quantum Lyapunov control methods for the closed quantum systems are summarized and analyzed. Particularly, the convergence of the control system to the different target states is reviewed, and how to make the convergence conditions be satisfied is summarized and analyzed.

Numerical simulation and comparison of two ventilation methods for a restaurant - displacement vs mixed flow ventilation

NASA Astrophysics Data System (ADS)

Chitaru, George; Berville, Charles; Dogeanu, Angel

2018-02-01

This paper presents a comparison between a displacement ventilation method and a mixed flow ventilation method using computational fluid dynamics (CFD) approach. The paper analyses different aspects of the two systems, like the draft effect in certain areas, the air temperatureand velocity distribution in the occupied zone. The results highlighted that the displacement ventilation system presents an advantage for the current scenario, due to the increased buoyancy driven flows caused by the interior heat sources. For the displacement ventilation case the draft effect was less prone to appear in the occupied zone but the high heat emissions from the interior sources have increased the temperature gradient in the occupied zone. Both systems have been studied in similar conditions, concentrating only on the flow patterns for each case.

Toward a general mixed quantum/classical method for the calculation of the vibronic ECD of a flexible dye molecule with different stable conformers: Revisiting the case of 2,2,2-trifluoro-anthrylethanol.

PubMed

Cerezo, Javier; Aranda, Daniel; Avila Ferrer, Francisco J; Prampolini, Giacomo; Mazzeo, Giuseppe; Longhi, Giovanna; Abbate, Sergio; Santoro, Fabrizio

2018-06-01

We extend a recently proposed mixed quantum/classical method for computing the vibronic electronic circular dichroism (ECD) spectrum of molecules with different conformers, to cases where more than one hindered rotation is present. The method generalizes the standard procedure, based on the simple Boltzmann average of the vibronic spectra of the stable conformers, and includes the contribution of structures that sample all the accessible conformational space. It is applied to the simulation of the ECD spectrum of (S)-2,2,2-trifluoroanthrylethanol, a molecule with easily interconvertible conformers, whose spectrum exhibits a pattern of alternating positive and negative vibronic peaks. Results are in very good agreement with experiment and show that spectra averaged over all the sampled conformational space can deviate significantly from the simple average of the contributions of the stable conformers. The present mixed quantum/classical method is able to capture the effect of the nonlinear dependence of the rotatory strength on the molecular structure and of the anharmonic couplings among the modes responsible for molecular flexibility. Despite its computational cost, the procedure is still affordable and promises to be useful in all cases where the ECD shape arises from a subtle balance between vibronic effects and conformational variety. © 2018 Wiley Periodicals, Inc.

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PubMed

Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

2013-01-01

We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

Study of effects of injector geometry on fuel-air mixing and combustion

NASA Technical Reports Server (NTRS)

Bangert, L. H.; Roach, R. L.

1977-01-01

An implicit finite-difference method has been developed for computing the flow in the near field of a fuel injector as part of a broader study of the effects of fuel injector geometry on fuel-air mixing and combustion. Detailed numerical results have been obtained for cases of laminar and turbulent flow without base injection, corresponding to the supersonic base flow problem. These numerical results indicated that the method is stable and convergent, and that significant savings in computer time can be achieved, compared with explicit methods.

Barriers to implementation of case management for patients with dementia: a systematic mixed studies review.

PubMed

Khanassov, Vladimir; Vedel, Isabelle; Pluye, Pierre

2014-01-01

Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. We conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool. Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that high-intensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers. Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services. © 2014 Annals of Family Medicine, Inc.

Periodic trim solutions with hp-version finite elements in time

NASA Technical Reports Server (NTRS)

Peters, David A.; Hou, Lin-Jun

1990-01-01

Finite elements in time as an alternative strategy for rotorcraft trim problems are studied. The research treats linear flap and linearized flap-lag response both for quasi-trim and trim cases. The connection between Fourier series analysis and hp-finite elements for periodic a problem is also examined. It is proved that Fourier series is a special case of space-time finite elements in which one element is used with a strong displacement formulation. Comparisons are made with respect to accuracy among Fourier analysis, displacement methods, and mixed methods over a variety parameters. The hp trade-off is studied for the periodic trim problem to provide an optimum step size and order of polynomial for a given error criteria. It is found that finite elements in time can outperform Fourier analysis for periodic problems, and for some given error criteria. The mixed method provides better results than does the displacement method.

A mixed methods approach to assess animal vaccination programmes: The case of rabies control in Bamako, Mali.

PubMed

Mosimann, Laura; Traoré, Abdallah; Mauti, Stephanie; Léchenne, Monique; Obrist, Brigit; Véron, René; Hattendorf, Jan; Zinsstag, Jakob

2017-01-01

In the framework of the research network on integrated control of zoonoses in Africa (ICONZ) a dog rabies mass vaccination campaign was carried out in two communes of Bamako (Mali) in September 2014. A mixed method approach, combining quantitative and qualitative tools, was developed to evaluate the effectiveness of the intervention towards optimization for future scale-up. Actions to control rabies occur on one level in households when individuals take the decision to vaccinate their dogs. However, control also depends on provision of vaccination services and community participation at the intermediate level of social resilience. Mixed methods seem necessary as the problem-driven transdisciplinary project includes epidemiological components in addition to social dynamics and cultural, political and institutional issues. Adapting earlier effectiveness models for health intervention to rabies control, we propose a mixed method assessment of individual effectiveness parameters like availability, affordability, accessibility, adequacy or acceptability. Triangulation of quantitative methods (household survey, empirical coverage estimation and spatial analysis) with qualitative findings (participant observation, focus group discussions) facilitate a better understanding of the weight of each effectiveness determinant, and the underlying reasons embedded in the local understandings, cultural practices, and social and political realities of the setting. Using this method, a final effectiveness of 33% for commune Five and 28% for commune Six was estimated, with vaccination coverage of 27% and 20%, respectively. Availability was identified as the most sensitive effectiveness parameter, attributed to lack of information about the campaign. We propose a mixed methods approach to optimize intervention design, using an "intervention effectiveness optimization cycle" with the aim of maximizing effectiveness. Empirical vaccination coverage estimation is compared to the effectiveness model with its determinants. In addition, qualitative data provide an explanatory framework for deeper insight, validation and interpretation of results which should improve the intervention design while involving all stakeholders and increasing community participation. This work contributes vital information for the optimization and scale-up of future vaccination campaigns in Bamako, Mali. The proposed mixed method, although incompletely applied in this case study, should be applicable to similar rabies interventions targeting elimination in other settings. Copyright © 2016 Elsevier B.V. All rights reserved.

US Interpretation of International Space Policies Regarding Commercial Resource Acquisitions

DTIC Science & Technology

2015-06-12

examining research . These include narrative research , phenomenology , grounded theory , ethnography , and case studies . The first four of these......within a case study strategy a methodology of research must be selected. Possible choices in methods used include quantitative, qualitative , or mixed

[Script crossing in scanning electron microscopy].

PubMed

Oehmichen, M; von Kortzfleisch, D; Hegner, B

1989-01-01

A case of mixed script in which ball point-pen ink was contaminated with typewriting prompted a survey of the literature and a systematic SEM study of mixed script with various writing instruments or inks. Mixed scripts produced with the following instruments or inks were investigated: pencil, ink/India ink, ball-pint pen, felt-tip pen, copied script and typewriter. This investigation showed SEM to be the method of choice for visualizing overlying scripts produced by different writing instruments or inks.

A Survey of Quantum Lyapunov Control Methods

PubMed Central

2013-01-01

The condition of a quantum Lyapunov-based control which can be well used in a closed quantum system is that the method can make the system convergent but not just stable. In the convergence study of the quantum Lyapunov control, two situations are classified: nondegenerate cases and degenerate cases. For these two situations, respectively, in this paper the target state is divided into four categories: the eigenstate, the mixed state which commutes with the internal Hamiltonian, the superposition state, and the mixed state which does not commute with the internal Hamiltonian. For these four categories, the quantum Lyapunov control methods for the closed quantum systems are summarized and analyzed. Particularly, the convergence of the control system to the different target states is reviewed, and how to make the convergence conditions be satisfied is summarized and analyzed. PMID:23766732

A comparative study of the costliness of Manitoba hospitals.

PubMed

Shanahan, M; Loyd, M; Roos, N P; Brownell, M

1999-06-01

In light of ongoing discussions about health care policy, this study offered a method of calculating costs at Manitoba hospitals that compared relative costliness of inpatient care provided in each hospital. This methodology also allowed comparisons across types of hospitals-teaching, community, major rural, intermediate and small rural, as well as northern isolated facilities. Data used in this project include basic hospital information, both financial and statistical, for each of the Manitoba hospitals, hospital charge information by case from the State of Maryland, and hospital discharge abstract information for Manitoba. The data from Maryland were used to create relative cost weights (RCWs) for refined diagnostic related groups (RDRGs) and were subsequently adjusted for Manitoba length of stay. These case weights were then applied to cases in Manitoba hospitals, and several other adjustments were made for nontypical cases. This case mix system allows cost comparisons across hospitals. In general, hospital case mix costing demonstrated variability in hospital costliness, not only across types of hospitals but also within hospitals of the same type and size. Costs at the teaching hospitals were found to be considerably higher than the average, even after accounting for acuity and case mix.

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

29 CFR 1614.302 - Mixed case complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Mixed case complaints. 1614.302 Section 1614.302 Labor... EMPLOYMENT OPPORTUNITY Related Processes § 1614.302 Mixed case complaints. (a) Definitions—(1) Mixed case complaint. A mixed case complaint is a complaint of employment discrimination filed with a federal agency...

Functional mapping of hospitals by diagnosis-dominant case-mix analysis.

PubMed

Fushimi, Kiyohide; Hashimoto, Hideki; Imanaka, Yuichi; Kuwabara, Kazuaki; Horiguchi, Hiromasa; Ishikawa, Kohichi B; Matsuda, Shinya

2007-04-10

Principles and methods for the allocation of healthcare resources among healthcare providers have long been health policy research issues in many countries. Healthcare reforms including the development of a new case-mix system, Diagnosis Procedure Combination (DPC), and the introduction of a DPC-based payment system are currently underway in Japan, and a methodology for adequately assessing the functions of healthcare providers is needed to determine healthcare resource allocations. By two-dimensional mapping of the rarity and complexity of diagnoses for patients receiving treatment, we were able to quantitatively demonstrate differences in the functions of different healthcare service provider groups. On average, inpatients had diseases that were 3.6-times rarer than those seen in outpatients, while major teaching hospitals treated inpatients with diseases 3.0-times rarer on average than those seen at small hospitals. We created and evaluated a new indicator for DPC, the diagnosis-dominant case-mix system developed in Japan, whereby the system was used to assess the functions of healthcare service providers. The results suggest that it is possible to apply the case-mix system to the integrated evaluation of outpatient and inpatient healthcare services and to the appropriate allocation of healthcare resources among health service providers.

Paradigms, pragmatism and possibilities: mixed-methods research in speech and language therapy.

PubMed

Glogowska, Margaret

2011-01-01

After the decades of the so-called 'paradigm wars' in social science research methodology and the controversy about the relative place and value of quantitative and qualitative research methodologies, 'paradigm peace' appears to have now been declared. This has come about as many researchers have begun to take a 'pragmatic' approach in the selection of research methodology, choosing the methodology best suited to answering the research question rather than conforming to a methodological orthodoxy. With the differences in the philosophical underpinnings of the two traditions set to one side, an increasing awareness, and valuing, of the 'mixed-methods' approach to research is now present in the fields of social, educational and health research. To explore what is meant by mixed-methods research and the ways in which quantitative and qualitative methodologies and methods can be combined and integrated, particularly in the broad field of health services research and the narrower one of speech and language therapy. The paper discusses the ways in which methodological approaches have already been combined and integrated in health services research and speech and language therapy, highlighting the suitability of mixed-methods research for answering the typically multifaceted questions arising from the provision of complex interventions. The challenges of combining and integrating quantitative and qualitative methods and the barriers to the adoption of mixed-methods approaches are also considered. The questions about healthcare, as it is being provided in the 21st century, calls for a range of methodological approaches. This is particularly the case for human communication and its disorders, where mixed-methods research offers a wealth of possibilities. In turn, speech and language therapy research should be able to contribute substantively to the future development of mixed-methods research. © 2010 Royal College of Speech & Language Therapists.

Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents

PubMed Central

Wodchis, Walter P.; Hirth, Richard A.; Fries, Brant E.

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents. PMID:17645160

Effect of Medicaid payment on rehabilitation care for nursing home residents.

PubMed

Wodchis, Walter P; Hirth, Richard A; Fries, Brant E

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents.

A preliminary case-mix classification system for Medicare home health clients.

PubMed

Branch, L G; Goldberg, H B

1993-04-01

In this study, a hierarchical case-mix model was developed for grouping Medicare home health beneficiaries homogeneously, based on the allowed charges for their home care. Based on information from a two-page form from 2,830 clients from ten states and using the classification and regression trees method, a four-component model was developed that yielded 11 case-mix groups and explained 22% of the variance for the test sample of 1,929 clients. The four components are rehabilitation, special care, skilled-nurse monitoring, and paralysis; each are categorized as present or absent. The range of mean-allowed charges for the 11 groups in the total sample was $473 to $2,562 with a mean of $847. Of the six groups with mean charges above $1,000, none exceeded 5.2% of clients; thus, the high-cost groups are relatively rare.

Multidisciplinary Approaches to Educational Research: Case Studies from Europe and the Developing World. Routledge Research in Education

ERIC Educational Resources Information Center

Rizvi, Sadaf, Ed.

2011-01-01

This book provides an original perspective on a range of controversial issues in educational and social research through case studies of multi-disciplinary and mixed-method research involving children, teachers, schools and communities in Europe and the developing world. These case studies from researchers "across continents" and…

Contemporary Instructor-Librarian Collaboration: A Case Study of an Online Embedded Librarian Implementation

ERIC Educational Resources Information Center

Edwards, Mary E.; Black, Erik W.

2012-01-01

This paper reports the results of a case study evaluation of an embedded librarian project at a large, land-grant, research institution. The case is comprised of learners who are full-time academic health care professionals enrolled in an online graduate educational technology program. The mixed methods methodology focused on assessing the…

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 4 2014-01-01 2014-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 4 2013-01-01 2013-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 4 2012-01-01 2012-01-01 false Mixed case complaints. 268.302 Section 268.302... (CONTINUED) RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case... discrimination or it may contain additional allegations that the MSPB has jurisdiction to address. A mixed case...

Thermal stratification potential in rocket engine coolant channels

NASA Technical Reports Server (NTRS)

Kacynski, Kenneth J.

1992-01-01

The potential for rocket engine coolant channel flow stratification was computationally studied. A conjugate, 3-D, conduction/advection analysis code (SINDA/FLUINT) was used. Core fluid temperatures were predicted to vary by over 360 K across the coolant channel, at the throat section, indicating that the conventional assumption of a fully mixed fluid may be extremely inaccurate. Because of the thermal stratification of the fluid, the walls exposed to the rocket engine exhaust gases will be hotter than an assumption of full mixing would imply. In this analysis, wall temperatures were 160 K hotter in the turbulent mixing case than in the full mixing case. The discrepancy between the full mixing and turbulent mixing analyses increased with increasing heat transfer. Both analysis methods predicted identical channel resistances at the coolant inlet, but in the stratified analysis the thermal resistance was negligible. The implications are significant. Neglect of thermal stratification could lead to underpredictions in nozzle wall temperatures. Even worse, testing at subscale conditions may be inadequate for modeling conditions that would exist in a full scale engine.

Effect on Non-Newtonian Rheology on Mixing in Taylor-Couette Flow

NASA Astrophysics Data System (ADS)

Cagney, Neil; Balabani, Stavroula

2017-11-01

Mixing processes within many industry applications are strongly affected by the rheology of the working fluid. This is particularly relevant for pharmaceutical, food and waste treatment industries, where the working fluids are often strongly non-Newtonian, and significant variations in rheology between batches may occur. We approach the question of how rheology affects mixing by focussing on a the classical case of Taylor-Couette flow, which exhibits a number of instabilities and flow regimes as a function of Reynolds number. We examine Taylor-Couette flow generated for a range of aqueous solutions of xantham gum or corn starch, such that the rheology varies from shear-thinning to shear-thickening. For each case, we measure the power consumption using a torque meter and the flow field using high speed, time-resolved Particle-Image Velocimetry. The mixing characteristics are quantified using a number of Lagrangian and Eulerian approaches, including the coarse grained density method and vortex strength. By comparing these metrics to the power number, we discuss how the mixing efficiency (ratio of mixing effectiveness to power input) varies with the flow index of the fluid.

A Novel Approach to Enhance the Mechanical Strength and Electrical and Thermal Conductivity of Cu-GNP Nanocomposites

NASA Astrophysics Data System (ADS)

Saboori, Abdollah; Pavese, Matteo; Badini, Claudio; Fino, Paolo

2018-01-01

Copper/graphene nanoplatelet (GNP) nanocomposites were produced by a wet mixing method followed by a classical powder metallurgy technique. A qualitative evaluation of the structure of graphene after mixing indicated that wet mixing is an appropriate dispersion method. Thereafter, the effects of two post-processing techniques such as repressing-annealing and hot isostatic pressing (HIP) on density, interfacial bonding, hardness, and thermal and electrical conductivity of the nanocomposites were analyzed. Density evaluations showed that the relative density of specimens increased after the post-processing steps so that after HIPing almost full densification was achieved. The Vickers hardness of specimens increased considerably after the post-processing techniques. The thermal conductivity of pure copper was very low in the case of the as-sintered samples containing 2 to 3 pct porosity and increased considerably to a maximum value in the case of HIPed samples which contained only 0.1 to 0.2 pct porosity. Electrical conductivity measurements showed that by increasing the graphene content electrical conductivity decreased.

Assessing Discriminative Performance at External Validation of Clinical Prediction Models.

PubMed

Nieboer, Daan; van der Ploeg, Tjeerd; Steyerberg, Ewout W

2016-01-01

External validation studies are essential to study the generalizability of prediction models. Recently a permutation test, focusing on discrimination as quantified by the c-statistic, was proposed to judge whether a prediction model is transportable to a new setting. We aimed to evaluate this test and compare it to previously proposed procedures to judge any changes in c-statistic from development to external validation setting. We compared the use of the permutation test to the use of benchmark values of the c-statistic following from a previously proposed framework to judge transportability of a prediction model. In a simulation study we developed a prediction model with logistic regression on a development set and validated them in the validation set. We concentrated on two scenarios: 1) the case-mix was more heterogeneous and predictor effects were weaker in the validation set compared to the development set, and 2) the case-mix was less heterogeneous in the validation set and predictor effects were identical in the validation and development set. Furthermore we illustrated the methods in a case study using 15 datasets of patients suffering from traumatic brain injury. The permutation test indicated that the validation and development set were homogenous in scenario 1 (in almost all simulated samples) and heterogeneous in scenario 2 (in 17%-39% of simulated samples). Previously proposed benchmark values of the c-statistic and the standard deviation of the linear predictors correctly pointed at the more heterogeneous case-mix in scenario 1 and the less heterogeneous case-mix in scenario 2. The recently proposed permutation test may provide misleading results when externally validating prediction models in the presence of case-mix differences between the development and validation population. To correctly interpret the c-statistic found at external validation it is crucial to disentangle case-mix differences from incorrect regression coefficients.

Clinical Experience Using the Mann Assessment of Swallowing Ability for Identification of Patients at Risk for Aspiration in a Mixed-Disease Population

ERIC Educational Resources Information Center

Gonzalez-Fernandez, Marlis; Sein, Michael T.; Palmer, Jeffrey B.

2011-01-01

Purpose: To determine the clinical performance characteristics of the Mann Assessment of Swallowing Ability (MASA) for predicting aspiration (determined by videofluoroscopic swallowing study [VFSS]) in a mixed population. Method: We selected 133 cases clinically evaluated using MASA and VFSS from January through June 2007. Ordinal risk rating…

Teaching Addition and Subtraction Operations with Schematic Place-Value Learning Aids & the Impact on Arithmetic Competency

ERIC Educational Resources Information Center

Kyriakidou-Christofidou, Athina

2016-01-01

The present mixed-methods quasi-experimental study (embedding a case study and a mixed factorial within-between ANOVA test), conducted in a private English school in Limassol, Cyprus, investigated how the use of the schematic learning aids (researcher-made color-coded flash-cards and grids) influence year-2 children's ability to read, write and…

A new approach to the solution of the linear mixing model for a single isotope: application to the case of an opportunistic predator.

PubMed

Hall-Aspland, S A; Hall, A P; Rogers, T L

2005-03-01

Mixing models are used to determine diets where the number of prey items are greater than one, however, the limitation of the linear mixing method is the lack of a unique solution when the number of potential sources is greater than the number (n) of isotopic signatures +1. Using the IsoSource program all possible combinations of each source contribution (0-100%) in preselected small increments can be examined and a range of values produced for each sample analysed. We propose the use of a Moore Penrose (M-P) pseudoinverse, which involves the inverse of a 2x2 matrix. This is easily generalized to the case of a single isotope with (p) prey sources and produces a specific solution. The Antarctic leopard seal (Hydrurga leptonyx) was used as a model species to test this method. This seal is an opportunistic predator, which preys on a wide range of species including seals, penguins, fish and krill. The M-P method was used to determine the contribution to diet from each of the four prey types based on blood and fur samples collected over three consecutive austral summers. The advantage of the M-P method was the production of a vector of fractions f for each predator isotopic value, allowing us to identify the relative variation in dietary proportions. Comparison of the calculated fractions from this method with 'means' from IsoSource allowed confidence in the new approach for the case of a single isotope, N.

A Hybrid Numerical Method for Turbulent Mixing Layers. Degree awarded by Case Western Reserve Univ.

NASA Technical Reports Server (NTRS)

Georgiadis, Nicholas J.

2001-01-01

A hybrid method has been developed for simulations of compressible turbulent mixing layers. Such mixing layers dominate the flows in exhaust systems of modern day aircraft and also those of hypersonic vehicles currently under development. The method configurations in which a dominant structural feature provides an unsteady mechanism to drive the turbulent development in the mixing layer. The hybrid method uses a Reynolds-averaged Navier-Stokes (RANS) procedure to calculate wall bounded regions entering a mixing section, and a Large Eddy Simulation (LES) procedure to calculate the mixing dominated regions. A numerical technique was developed to enable the use of the hybrid RANS-LES method on stretched, non-Cartesian grids. Closure for the RANS equations was obtained using the Cebeci-Smith algebraic turbulence model in conjunction with the wall-function approach of Ota and Goldberg. The wall-function approach enabled a continuous computational grid from the RANS regions to the LES region. The LES equations were closed using the Smagorinsky subgrid scale model. The hybrid RANS-LES method is applied to a benchmark compressible mixing layer experiment. Preliminary two dimensional calculations are used to investigate the effects of axial grid density and boundary conditions. Vortex shedding from the base region of a splitter plate separating the upstream flows was observed to eventually transition to turbulence. The location of the transition, however, was much further downstream than indicated by experiments. Actual LES calculations, performed in three spatial directions, also indicated vortex shedding, but the transition to turbulence was found to occur much closer to the beginning of the mixing section. which is in agreement with experimental observations. These calculations demonstrated that LES simulations must be performed in three dimensions. Comparisons of time-averaged axial velocities and turbulence intensities indicated reasonable agreement with experimental data.

Surface immunoglobulins on blood lymphocytes of normal and immunodeficient persons studied by the mixed antiglobulin method

PubMed Central

Litwin, S. D.; Ochs, H.; Pollara, B.

1973-01-01

Surface immunoglobulins on human peripheral blood lymphocytes were investigated by the mixed antiglobulin technique—using the single layer mixed antiglobulin method as originally described (SLMA), and a modification employing a double layer of antibody (DLMA). Lymphocytes isolated from the blood of normal individuals had a mean of 7.8 and 18.4 per cent Ig + cells by the SLMA and DLMA techniques respectively. The DLMA data are similar to results obtained by other methods of detecting membrane Igs indicating that the mixed antiglobulin method is comparable in sensitivity. When the total numbers of Ig + cells, obtained by separate κ and λ testing, were compared with results obtained using single anti-light chain antisera, there was no significant difference, suggesting that most positive lymphocytes carry a single variety of light chain. Lymphocytes from the blood of seventeen patients with primary immunodeficiency were analysed. Four patients with variable immunodeficiency and four others with absent serum IgA all had normal surface Igs including α chains. All members of a family having an X-linked immunodeficiency had normal surface Igs including the affected members and a presumed carrier. Four cases of immunodeficiency associated with thymoma proved to have disparate findings. One patient exhibited a selective absence of μ antigens on the membranes of blood lymphocytes of over 2800 tested cells. Two other cases had normal surface Igs while a fourth patient, previously reported, lacked all surface Igs. PMID:4796276

Nursing home case-mix reimbursement in Mississippi and South Dakota.

PubMed

Arling, Greg; Daneman, Barry

2002-04-01

To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.

Direct simulation of groundwater age

USGS Publications Warehouse

Goode, Daniel J.

1996-01-01

A new method is proposed to simulate groundwater age directly, by use of an advection-dispersion transport equation with a distributed zero-order source of unit (1) strength, corresponding to the rate of aging. The dependent variable in the governing equation is the mean age, a mass-weighted average age. The governing equation is derived from residence-time-distribution concepts for the case of steady flow. For the more general case of transient flow, a transient governing equation for age is derived from mass-conservation principles applied to conceptual “age mass.” The age mass is the product of the water mass and its age, and age mass is assumed to be conserved during mixing. Boundary conditions include zero age mass flux across all noflow and inflow boundaries and no age mass dispersive flux across outflow boundaries. For transient-flow conditions, the initial distribution of age must be known. The solution of the governing transport equation yields the spatial distribution of the mean groundwater age and includes diffusion, dispersion, mixing, and exchange processes that typically are considered only through tracer-specific solute transport simulation. Traditional methods have relied on advective transport to predict point values of groundwater travel time and age. The proposed method retains the simplicity and tracer-independence of advection-only models, but incorporates the effects of dispersion and mixing on volume-averaged age. Example simulations of age in two idealized regional aquifer systems, one homogeneous and the other layered, demonstrate the agreement between the proposed method and traditional particle-tracking approaches and illustrate use of the proposed method to determine the effects of diffusion, dispersion, and mixing on groundwater age.

Application of the Fokker-Planck molecular mixing model to turbulent scalar mixing using moment methods

NASA Astrophysics Data System (ADS)

Madadi-Kandjani, E.; Fox, R. O.; Passalacqua, A.

2017-06-01

An extended quadrature method of moments using the β kernel density function (β -EQMOM) is used to approximate solutions to the evolution equation for univariate and bivariate composition probability distribution functions (PDFs) of a passive scalar for binary and ternary mixing. The key element of interest is the molecular mixing term, which is described using the Fokker-Planck (FP) molecular mixing model. The direct numerical simulations (DNSs) of Eswaran and Pope ["Direct numerical simulations of the turbulent mixing of a passive scalar," Phys. Fluids 31, 506 (1988)] and the amplitude mapping closure (AMC) of Pope ["Mapping closures for turbulent mixing and reaction," Theor. Comput. Fluid Dyn. 2, 255 (1991)] are taken as reference solutions to establish the accuracy of the FP model in the case of binary mixing. The DNSs of Juneja and Pope ["A DNS study of turbulent mixing of two passive scalars," Phys. Fluids 8, 2161 (1996)] are used to validate the results obtained for ternary mixing. Simulations are performed with both the conditional scalar dissipation rate (CSDR) proposed by Fox [Computational Methods for Turbulent Reacting Flows (Cambridge University Press, 2003)] and the CSDR from AMC, with the scalar dissipation rate provided as input and obtained from the DNS. Using scalar moments up to fourth order, the ability of the FP model to capture the evolution of the shape of the PDF, important in turbulent mixing problems, is demonstrated. Compared to the widely used assumed β -PDF model [S. S. Girimaji, "Assumed β-pdf model for turbulent mixing: Validation and extension to multiple scalar mixing," Combust. Sci. Technol. 78, 177 (1991)], the β -EQMOM solution to the FP model more accurately describes the initial mixing process with a relatively small increase in computational cost.

The Role of Emotional Intelligence in Community College Leadership

ERIC Educational Resources Information Center

Freed, Curt Alan

2016-01-01

The study explores the role of emotional intelligence in community college leaders using a case study design with mixed-methods, including quantitative and qualitative data. Twenty-one leaders among three cases participated in the study, each completing the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and participating in…

Assessing the role of case mix in cesarean delivery rates.

PubMed

Lieberman, E; Lang, J M; Heffner, L J; Cohen, A

1998-07-01

Implicit in comparisons of unadjusted cesarean rates for hospitals and providers is the assumption that differences result from management practices rather than differences in case mix. This study proposes a method for comparison of cesarean rates that takes the effect of case mix into account. All women delivered of infants at our institution from December 1, 1994, through July 31, 1995, were classified according to whether they received care from community-based practitioners (N=3913) or from the hospital-based practice that serves a higher-risk population (N=1556). Women were categorized according to both obstetric history (nulliparas, multiparas without a previous cesarean, multiparas with a previous cesarean) and the presence of obstetric conditions influencing the risk of cesarean delivery (multiple birth, breech presentation or transverse lie, preterm, no trial of labor for a medical indication). We determined the percent of women in each parity-obstetric condition subgroup and calculated a standardized cesarean rate for the hospital-based practice using the case mix of the community-based practitioners as the standard. The crude cesarean rate was higher for the hospital-based practice (24.4%) than for the community-based practitioners (21.5%), a rate difference of 2.9% (95% confidence interval=0.4%, 5.4%; P=.02). However, the proportion of women falling into categories conferring a high risk of cesarean delivery (multiple pregnancy, breech presentation or transverse lie, preterm, no trial of labor permitted) was twice as high for the hospital-based practice (24.4% hospital, 12.1% community). The standardization indicates that if the hospital-based practitioners had the same case mix as community-based practitioners, their overall cesarean rate would be 20.1%, similar to the 21.5% rate of community providers (rate difference=-1.4%, 95% confidence interval =-3.1%, 0.3%; P=.11). Standardization for case mix provides a mechanism for distinguishing differences in cesarean rates resulting from case mix from those relating to differences in practice. The methodology is not complex and could be applied to facilitate fairer comparisons of rates among providers and across institutions.

Contemplating case mix: A primer on case mix classification and management.

PubMed

Costa, Andrew P; Poss, Jeffery W; McKillop, Ian

2015-01-01

Case mix classifications are the frameworks that underlie many healthcare funding schemes, including the so-called activity-based funding. Now more than ever, Canadian healthcare administrators are evaluating case mix-based funding and deciphering how they will influence their organization. Case mix is a topic fraught with technical jargon and largely relegated to government agencies or private industries. This article provides an abridged review of case mix classification as well as its implications for management in healthcare. © 2015 The Canadian College of Health Leaders.

Clinical characteristics and prognostic significance of 92 cases of patients with primary mixed-histology lung cancer.

PubMed

Deng, Pengbo; Hu, Chengping; Zhou, Lihua; Li, Yuanyuan; Huang, Li

2013-09-01

Mixed-histology primary lung cancer is a rare type of lung cancer, where data regarding epidemiology, clinical features and prognosis of survival are limited. The aim of this study was to analyze the clinical characteristics of patients with mixed-histology lung tumors, and to investigate the association between clinical characteristics, treatment and prognosis. Between January, 1999 and September, 2008, 1,842 patients were diagnosed with primary lung tumors. Of these, 92 presented a mixed histological pattern. Patient clinical characteristics, clinical tumor-node-metastasis (TNM) staging, diagnostic methods, treatment and survival data were collected in order to be retrospectively analyzed. Differences between the frequencies were examined using the χ 2 test and survival rates using the Kaplan-Meier method. The log-rank test was used to compare the survival curves and a probability value <5% (P<0.05) was considered to indicate a statistically significant difference. Of the 92 lung cancer patients (4.99%) with a mixed histological pattern, most were adenosquamous carcinomas. Patients included 75 men and 17 women with a mean age of 56 years. Most cases were in late stage and 64 patients had metastasis. The 1-, 2- and 3-year survival of 52 mixed-histology and 54 non-small cell lung cancer (NSCLC) patients with resection who were successfully followed up, was 63.5, 23.1, 9.6 and 81.5, 48.1, 27.7% (P=0.013). The median survival time of mixed-histology lung cancer patients treated with surgery plus adjuvant therapy and surgery alone was 22 and 12 months, respectively (P=0.002). Mixed-histology lung cancer is characterized by higher malignancy and poor prognosis. However, surgery plus adjuvant therapy is able to prolong survival, compared to surgery alone.

Frequency and distribution of mixed Plasmodium falciparum-vivax infections in French Guiana between 2000 and 2008.

PubMed

Ginouves, Marine; Veron, Vincent; Musset, Lise; Legrand, Eric; Stefani, Aurélia; Prevot, Ghislaine; Demar, Magalie; Djossou, Félix; Brousse, Paul; Nacher, Mathieu; Carme, Bernard

2015-11-10

The two main plasmodial species in French Guiana are Plasmodium vivax and Plasmodium falciparum whose respective prevalence influences the frequency of mixed plasmodial infections. The accuracy of their diagnosis is influenced by the sensitivity of the method used, whereas neither microscopy nor rapid diagnostic tests allow a satisfactory evaluation of mixed plasmodial infections. In the present study, the frequency of mixed infections in different part of French Guiana was determined using real time PCR, a sensitive and specific technique. From 400 cases of malaria initially diagnosed by microscopy, real time PCR showed that 10.75 % of the cases were mixed infections. Their prevalence varied considerably between geographical areas. The presence, in equivalent proportions, of the two plasmodial species in eastern French Guiana was associated with a much higher prevalence of mixed plasmodial infections than in western French Guiana, where the majority of the population was Duffy negative and thus resistant to vivax malaria. Clinicians must be more vigilant regarding mixed infections in co-endemic P. falciparum/P. vivax areas, in order to deliver optimal care for patients suffering from malaria. This may involve the use of rapid diagnostic tests capable of detecting mixed infections or low density single infections. This is important as French Guiana moves towards malaria elimination.

Use of Navier-Stokes methods for the calculation of high-speed nozzle flow fields

NASA Technical Reports Server (NTRS)

Georgiadis, Nicholas J.; Yoder, Dennis A.

1994-01-01

Flows through three reference nozzles have been calculated to determine the capabilities and limitations of the widely used Navier-Stokes solver, PARC. The nozzles examined have similar dominant flow characteristics as those considered for supersonic transport programs. Flows from an inverted velocity profile (IVP) nozzle, an under expanded nozzle, and an ejector nozzle were examined. PARC calculations were obtained with its standard algebraic turbulence model, Thomas, and the two-equation turbulence model, Chien k-epsilon. The Thomas model was run with the default coefficient of mixing set at both 0.09 and a larger value of 0.13 to improve the mixing prediction. Calculations using the default value substantially underpredicted the mixing for all three flows. The calculations obtained with the higher mixing coefficient better predicted mixing in the IVP and underexpanded nozzle flows but adversely affected PARC's convergence characteristics for the IVP nozzle case. The ejector nozzle case did not converge with the Thomas model and the higher mixing coefficient. The Chien k-epsilon results were in better agreement with the experimental data overall than were those of the Thomas run with the default mixing coefficient, but the default boundary conditions for k and epsilon underestimated the levels of mixing near the nozzle exits.

Nursing home costs, Medicaid rates, and profits under alternative Medicaid payment systems.

PubMed Central

Schlenker, R E

1991-01-01

This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems. PMID:1743972

Case mix, quality, and cost relationships in Colorado nursing homes.

PubMed

Schlenker, R E; Shaughessy, P W

1984-01-01

The analyses reported in this article assessed the cost, case mix, and quality interrelationships among Colorado nursing homes. A unique set of patient-level data was collected specifically to measure case mix and quality. Case mix was found to be strongly associated with cost, accounting for up to 45 percent of the variation in cost per patient day. The relationship between quality and cost was weaker; quality variables accounted for only about 10 percent of the cost per day variation. Case mix was also associated with several facility characteristics found to be significant in other cost studies, suggesting that such facility characteristics serve as partial proxy measures for case mix. The cost-case mix relationships appear to be strong enough to justify incorporating case mix directly in nursing home reimbursement systems. In contrast, the weaker cost-quality association implies that it may not (yet) be appropriate to incorporate quality directly in reimbursement.

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study.

PubMed

Seow, Hsien-Yeang; Sibley, Lyn M

2014-08-30

Health system planners aim to pursue the three goals of Triple Aim: 1) reduce health care costs; 2) improve population health; and 3) improve the care experience. Moreover, they also need measures that can reliably predict future health care needs in order to manage effectively the health system performance. Yet few measures exist to assess Triple Aim and predict future needs at a health system level. The purpose of this study is to explore the novel application of a case-mix adjustment method in order to measure and help improve the Triple Aim of health system performance. We applied a case-mix adjustment method to a population-based analysis to assess its usefulness as a measure of health system performance and Triple Aim. The study design was a retrospective, cohort study of adults from Ontario, Canada using administrative databases: individuals were assigned a predicted illness burden score using a case-mix adjustment system from diagnoses and health utilization data in 2008, and then followed forward to assess the actual health care utilization and costs in the following year (2009). We applied the Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix System to categorize individuals into 60 levels of healthcare need, called ACGs. The outcomes were: 1) Number of individuals per ACG; 2) Total system costs per ACG; and 3) Mean cost per person per ACG, which together formed a health system "dashboard". We identified 11.4 million adults. 16.1% were aged 65 or older, 3.2 million (28%) did not use health care services that year, and 45,000 (0.4%) were in the highest acuity ACG category using 12 times more than an average adult. The sickest 1%, 5% and 15% of the population use about 10%, 30% and 50% of total health system costs respectively. The dashboard measures 2 dimensions of Triple Aim: 1) reduced costs: when total system costs per ACG or when average costs per person is reduced; and 2) improved population health: when more people move into healthier rather than sicker ACGs. It can help to achieve the third aim, improved care experience, when ACG utilization predictions are reported to providers to proactively develop care plans. The dashboard, developed via case-mix methods, measures 2 of the Triple Aim goals and can help health system planners better manage their health delivery systems.

Numerical analysis of mixing enhancement for micro-electroosmotic flow

NASA Astrophysics Data System (ADS)

Tang, G. H.; He, Y. L.; Tao, W. Q.

2010-05-01

Micro-electroosmotic flow is usually slow with negligible inertial effects and diffusion-based mixing can be problematic. To gain an improved understanding of electroosmotic mixing in microchannels, a numerical study has been carried out for channels patterned with wall blocks, and channels patterned with heterogeneous surfaces. The lattice Boltzmann method has been employed to obtain the external electric field, electric potential distribution in the electrolyte, the flow field, and the species concentration distribution within the same framework. The simulation results show that wall blocks and heterogeneous surfaces can significantly disturb the streamlines by fluid folding and stretching leading to apparently substantial improvements in mixing. However, the results show that the introduction of such features can substantially reduce the mass flow rate and thus effectively prolongs the available mixing time when the flow passes through the channel. This is a non-negligible factor on the effectiveness of the observed improvements in mixing efficiency. Compared with the heterogeneous surface distribution, the wall block cases can achieve more effective enhancement in the same mixing time. In addition, the field synergy theory is extended to analyze the mixing enhancement in electroosmotic flow. The distribution of the local synergy angle in the channel aids to evaluate the effectiveness of enhancement method.

Why so many "rigorous" evaluations fail to identify unintended consequences of development programs: How mixed methods can contribute.

PubMed

Bamberger, Michael; Tarsilla, Michele; Hesse-Biber, Sharlene

2016-04-01

Many widely-used impact evaluation designs, including randomized control trials (RCTs) and quasi-experimental designs (QEDs), frequently fail to detect what are often quite serious unintended consequences of development programs. This seems surprising as experienced planners and evaluators are well aware that unintended consequences frequently occur. Most evaluation designs are intended to determine whether there is credible evidence (statistical, theory-based or narrative) that programs have achieved their intended objectives and the logic of many evaluation designs, even those that are considered the most "rigorous," does not permit the identification of outcomes that were not specified in the program design. We take the example of RCTs as they are considered by many to be the most rigorous evaluation designs. We present a numbers of cases to illustrate how infusing RCTs with a mixed-methods approach (sometimes called an "RCT+" design) can strengthen the credibility of these designs and can also capture important unintended consequences. We provide a Mixed Methods Evaluation Framework that identifies 9 ways in which UCs can occur, and we apply this framework to two of the case studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

An efficient mode-splitting method for a curvilinear nearshore circulation model

USGS Publications Warehouse

Shi, Fengyan; Kirby, James T.; Hanes, Daniel M.

2007-01-01

A mode-splitting method is applied to the quasi-3D nearshore circulation equations in generalized curvilinear coordinates. The gravity wave mode and the vorticity wave mode of the equations are derived using the two-step projection method. Using an implicit algorithm for the gravity mode and an explicit algorithm for the vorticity mode, we combine the two modes to derive a mixed difference–differential equation with respect to surface elevation. McKee et al.'s [McKee, S., Wall, D.P., and Wilson, S.K., 1996. An alternating direction implicit scheme for parabolic equations with mixed derivative and convective terms. J. Comput. Phys., 126, 64–76.] ADI scheme is then used to solve the parabolic-type equation in dealing with the mixed derivative and convective terms from the curvilinear coordinate transformation. Good convergence rates are found in two typical cases which represent respectively the motions dominated by the gravity mode and the vorticity mode. Time step limitations imposed by the vorticity convective Courant number in vorticity-mode-dominant cases are discussed. Model efficiency and accuracy are verified in model application to tidal current simulations in San Francisco Bight.

Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system.

PubMed

Hollenbeak, Christopher S; Rubin, Robert J; Tzivelekis, Spiros; Stephens, J Mark

2015-06-01

The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008. Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence. Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+. Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

Effect of Resin-modified Glass Ionomer Cement Dispensing/Mixing Methods on Mechanical Properties.

PubMed

Sulaiman, T A; Abdulmajeed, A A; Altitinchi, A; Ahmed, S N; Donovan, T E

2018-03-23

Resin-modified glass ionomer cements (RMGIs) are often used for luting indirect restorations. Hand-mixing traditional cements demands significant time and may be technique sensitive. Efforts have been made by manufacturers to introduce the same cement using different dispensing/mixing methods. It is not known what effects these changes may have on the mechanical properties of the dental cement. The purpose of this study was to evaluate the mechanical properties (diametral tensile strength [DTS], compressive strength [CS], and fracture toughness [FT]) of RMGIs with different dispensing/mixing systems. The RMGI specimens (n=14)-RelyX Luting (hand mix), RelyX Luting Plus (clicker-hand mix), RelyX Luting Plus (automix) (3M ESPE), GC Fuji PLUS (capsule-automix), and GC FujiCEM 2 (automix) (GC)-were prepared for each mechanical test and examined after thermocycling (n=7/subgroup) for 20,000 cycles to the following: DTS, CS (ISO 9917-1) and FT (ISO standard 6872; Single-edge V-notched beam method). Specimens were mounted and loaded with a universal testing machine until failure occurred. Two-/one-way analysis of variance followed by Tukey honestly significantly different post hoc test was used to analyze data for statistical significance ( p<0.05). The interaction effect of both dispensing/mixing method and thermocycling was significant only for the CS test of the GC group ( p<0.05). The different dispensing/mixing methods had no effect on the DTS of the tested cements. The CS of GC Fuji PLUS was significantly higher than that of the automix version ( p<0.05). The FT decreased significantly when switching from RelyX (hand mix) to RelyX Luting Plus (clicker-hand mix) and to RelyX Luting Plus (automix) ( p<0.05). Except in the case of the DTS of the GC group and the CS of GC Fuji PLUS, thermocycling had a significant effect reducing the mechanical properties of the RMGI cements ( p<0.05). Introducing alternative dispensing/mixing methods for mixing RMGIs to reduce time and technique sensitivity may affect mechanical properties and is brand dependent.

A velocity-pressure integrated, mixed interpolation, Galerkin finite element method for high Reynolds number laminar flows

NASA Technical Reports Server (NTRS)

Kim, Sang-Wook

1988-01-01

A velocity-pressure integrated, mixed interpolation, Galerkin finite element method for the Navier-Stokes equations is presented. In the method, the velocity variables were interpolated using complete quadratic shape functions and the pressure was interpolated using linear shape functions. For the two dimensional case, the pressure is defined on a triangular element which is contained inside the complete biquadratic element for velocity variables; and for the three dimensional case, the pressure is defined on a tetrahedral element which is again contained inside the complete tri-quadratic element. Thus the pressure is discontinuous across the element boundaries. Example problems considered include: a cavity flow for Reynolds number of 400 through 10,000; a laminar backward facing step flow; and a laminar flow in a square duct of strong curvature. The computational results compared favorable with those of the finite difference methods as well as experimental data available. A finite elememt computer program for incompressible, laminar flows is presented.

Approximating a retarded-advanced differential equation that models human phonation

NASA Astrophysics Data System (ADS)

Teodoro, M. Filomena

2017-11-01

In [1, 2, 3] we have got the numerical solution of a linear mixed type functional differential equation (MTFDE) introduced initially in [4], considering the autonomous and non-autonomous case by collocation, least squares and finite element methods considering B-splines basis set. The present work introduces a numerical scheme using least squares method (LSM) and Gaussian basis functions to solve numerically a nonlinear mixed type equation with symmetric delay and advance which models human phonation. The preliminary results are promising. We obtain an accuracy comparable with the previous results.

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

PubMed

Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

2018-05-04

To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Surface topography and ultrastructural changes of mucinous carcinoma breast cells.

PubMed

Voloudakis, G E; Baltatzis, G E; Agnantis, N J; Arnogianaki, N; Misitzis, J; Voloudakis-Baltatzis, I

2007-01-01

Mucinous carcinoma of the breast (MCB) is histologically classified into 2 groups: (1) pure MCB and (2) mixed MCB. Pure MCB carries a better diagnosis than mixed MCB. This research relates to the cell surface topography and ultrastructure of the cells in the above cases and aims to find the differences between them, by means of two methods: scanning electron microscopy (SEM) and transmission electron microscopy (TEM). For the SEM examination, it was necessary to initially culture the MCB tissues and then proceed with the usual SEM method. In contrast, for the TEM technique, MCB tissues were initially fixed followed by the classic TEM method. The authors found the topography of pure MCB cases to be without nodes. The cell membrane was smooth, with numerous pores and small ruffles that covered the entire cell. The ultrastructural appearance of the same cases was with a normal cell membrane containing abundant collagen fibers. They also had many small vesicles containing mucin as well as secretory droplets. In contrast the mixed MCB had a number of lymph nodes and their cell surface topography showed stronger changes such as microvilli, numerous blebs, ruffles and many long projections. Their ultrastructure showed very long microvilli with large cytoplasmic inclusions and extracellular mucin collections, electron-dense material vacuoles, and many important cytoplasmic organelles. An important fact is that mixed MCB also contains areas of infiltrating ductal carcinoma. These cells of the cytoplasmic organelles are clearly responsible for the synthesis, storage, and secretion of the characteristic mucin of this tumor type. Evidently, this abnormal mucin production and the abundance of secretory granules along with the long projections observed in the topographical structure might be responsible for transferring tumor cells to neighboring organs, thus being responsible for metastatic disease.

High Static Stability in the Mixed Layer Above the Extratropical Tropopause

NASA Astrophysics Data System (ADS)

Kunz, A.; Konopka, P.; Müller, R.; Schiller, C.

2008-12-01

A strong relationship between the static stability N2 and the strength of mixing in the mixed layer above the extratropical tropopause is evident from in-situ data observed during the SPURT aircraft campaigns. We present a method for quantifying the strength of mixing from O3/CO tracer correlations and we find that N2 is positively correlated with the strength of mixing. Age of air simulations with the CLaMS model reveal two different types of mixed regions. One type consisting of older airmasses with higher values of N2 which are created by radiative adjustment after a mixing event. These airmasses are within the TIL (Tropopause Inversion Layer), considering the TIL as part of the mixing layer. The second type comprises younger airmasses with somehow lower stratospheric N2 values within the mixing layer, because of recent intrusion processes due to the permeability or so-called mid-latitude-breaks associated with the jet stream. With the help of radiative transfer calculations we simulate the influence of trace gases such as O3 and H2O on the temperature gradient and thus on the static stability above the tropopause in the idealized case of non-mixing (L-shape) O3 and H2O profiles and in the reference case of mixed profiles. Within the altitude range of the SPURT campaigns the mean vertical SPURT profiles are used as reference, which are fitted to the HALOE climatological profiles above the UT/LS.

Using Mixed Methods to Evaluate a Community Intervention for Sexual Assault Survivors: A Methodological Tale.

PubMed

Campbell, Rebecca; Patterson, Debra; Bybee, Deborah

2011-03-01

This article reviews current epistemological and design issues in the mixed methods literature and then examines the application of one specific design, a sequential explanatory mixed methods design, in an evaluation of a community-based intervention to improve postassault care for sexual assault survivors. Guided by a pragmatist epistemological framework, this study collected quantitative and qualitative data to understand how the implementation of a Sexual Assault Nurse Examiner (SANE) program affected prosecution rates of adult sexual assault cases in a large midwestern community. Quantitative results indicated that the program was successful in affecting legal systems change and the qualitative data revealed the mediating mechanisms of the intervention's effectiveness. Challenges of implementing this design are discussed, including epistemological and practical difficulties that developed from blending methodologies into a single project. © The Author(s) 2011.

Interdisciplinary mixed methods research with structurally vulnerable populations: case studies of injection drug users in San Francisco.

PubMed

Lopez, Andrea M; Bourgois, Philippe; Wenger, Lynn D; Lorvick, Jennifer; Martinez, Alexis N; Kral, Alex H

2013-03-01

Research with injection drug users (IDUs) benefits from interdisciplinary theoretical and methodological innovation because drug use is illegal, socially sanctioned and often hidden. Despite the increasing visibility of interdisciplinary, mixed methods research projects with IDUs, qualitative components are often subordinated to quantitative approaches and page restrictions in top addiction journals limit detailed reports of complex data collection and analysis logistics, thus minimizing the fuller scientific potential of genuine mixed methods. We present the methodological logistics and conceptual approaches of four mixed-methods research projects that our interdisciplinary team conducted in San Francisco with IDUs over the past two decades. These projects include combinations of participant-observation ethnography, in-depth qualitative interviewing, epidemiological surveys, photo-documentation, and geographic mapping. We adapted Greene et al.'s framework for combining methods in a single research project through: data triangulation, methodological complementarity, methodological initiation, and methodological expansion. We argue that: (1) flexible and self-reflexive methodological procedures allowed us to seize strategic opportunities to document unexpected and sometimes contradictory findings as they emerged to generate new research questions, (2) iteratively mixing methods increased the scope, reliability, and generalizability of our data, and (3) interdisciplinary collaboration contributed to a scientific "value added" that allowed for more robust theoretical and practical findings about drug use and risk-taking. Copyright © 2013 Elsevier B.V. All rights reserved.

Interdisciplinary Mixed Methods Research with Structurally Vulnerable Populations: Case Studies of Injection Drug Users in San Francisco

PubMed Central

Lopez, Andrea; Bourgois, Philippe; Wenger, Lynn; Lorvick, Jennifer; Martinez, Alexis; Kral, Alex H.

2013-01-01

Research with injection drug users (IDUs) benefits from interdisciplinary theoretical and methodological innovation because drug use is illegal, socially sanctioned and often hidden. Despite the increasing visibility of interdisciplinary, mixed methods research projects with IDUs, qualitative components are often subordinated to quantitative approaches and page restrictions in top addiction journals limit detailed reports of complex data collection and analysis logistics, thus minimizing the fuller scientific potential of genuine mixed methods. We present the methodological logistics and conceptual approaches of four mixed-methods research projects that our interdisciplinary team conducted in San Francisco with IDUs over the past two decades. These projects include combinations of participant-observation ethnography, in-depth qualitative interviewing, epidemiological surveys, photo-documentation, and geographic mapping. We adapted Greene et al.’s framework for combining methods in a single research project through: data triangulation, methodological complementarity, methodological initiation, and methodological expansion. We argue that: (1) flexible and self-reflexive methodological procedures allowed us to seize strategic opportunities to document unexpected and sometimes contradictory findings as they emerged to generate new research questions, (2) iteratively mixing methods increased the scope, reliability, and generalizability of our data, and (3) interdisciplinary collaboration contributed to a scientific “value added” that allowed for more robust theoretical and practical findings about drug use and risk-taking. PMID:23312109

The role of mixed methods in improved cookstove research.

PubMed

Stanistreet, Debbi; Hyseni, Lirije; Bashin, Michelle; Sadumah, Ibrahim; Pope, Daniel; Sage, Michael; Bruce, Nigel

2015-01-01

The challenge of promoting access to clean and efficient household energy for cooking and heating is a critical issue facing low- and middle-income countries today. Along with clean fuels, improved cookstoves (ICSs) continue to play an important part in efforts to reduce the 4 million annual premature deaths attributed to household air pollution. Although a range of ICSs are available, there is little empirical evidence on appropriate behavior change approaches to inform adoption and sustained used at scale. Specifically, evaluations using either quantitative or qualitative methods provide an incomplete picture of the challenges in facilitating ICS adoption. This article examines how studies that use the strengths of both these approaches can offer important insights into behavior change in relation to ICS uptake and scale-up. Epistemological approaches, study design frameworks, methods of data collection, analytical approaches, and issues of validity and reliability in the context of mixed methods ICS research are examined, and the article presents an example study design from an evaluation study in Kenya incorporating a nested approach and a convergent case oriented design. The authors discuss the benefits and methodological challenges of mixed-methods approaches in the context of researching behavior change and ICS use recognizing that such methods represent relatively uncharted territory. The authors propose that more published examples are needed to provide frameworks for other researchers seeking to apply mixed methods in this context and suggest a comprehensive research agenda is required that incorporates integrated mixed-methods approaches, to provide best evidence for future scale-up.

Analysis of Arterial Blood Gas Report in Chronic Kidney Diseases - Comparison between Bedside and Multistep Systematic Method.

PubMed

Ghatak, Ishita; Dhat, Vaishali; Tilak, Mona A; Roy, Indranath

2016-08-01

Acid Base Disorders (ABDs) are commonly encountered in critically ill Chronic Kidney Disease (CKD) patients. Timely and correct analysis of Arterial Blood Gases (ABG) is critical for the diagnosis, treatment and prediction of outcome of the patients. The aim was to explore type and prevalence of ABDs in 31 critically ill CKD patients from a tertiary care hospital in Maharashtra, to compare two methods of analysis- bedside and systematic approaches and to clinically correlate the nature of ABDs in these patients. The initial ABG reports of 31 consecutive CKD patients were analysed by two methods. Medica Easy stat analyser was the equipment for analysis with Principle of potentiometry and ion selective electrode for pH and pCO2 and amperometry for pO2. Serum albumin was also measured by Bromocresol green dye binding method using liquixx albumin kit in Erba XL 300 autoanalyser. Chi-square test was used for statistical analysis using Epi Info version 3.5.4 and SPSS 14.0 softwares. The systematic method showed a significantly higher prevalence of mixed disorders (50%) compared to bedside method (12.9%). Most prevalent disorder by bedside method was metabolic acidosis in 15 cases (48.39%). By the systematic method, 3 reports were invalid. As a single category, most prevalent type was both simple respiratory alkalosis and mixed metabolic acidosis with respiratory alkalosis- 6 of 31 cases in each type (19.36% each). As a whole, metabolic acidosis (including both High Anion Gap Metabolic Acidosis or HAGMA and Non Anion Gap Metabolic Acidosis or NAGMA with 4 in each type) was most prevalent- 8 of 31(25.8%). Systematic approach was more effective in diagnosing mixed acid base disorders. By systematic method the findings of analysis in most cases could be correlated with the clinical condition and provisional diagnosis. Thus interpretation of ABDs by using stepwise approach could be useful to the clinicians in early diagnosis and management of the patients.

The value of automated gel column agglutination technology in the identification of true inherited D blood types in massively transfused patients.

PubMed

Summers, Thomas; Johnson, Viviana V; Stephan, John P; Johnson, Gloria J; Leonard, George

2009-08-01

Massive transfusion of D- trauma patients in the combat setting involves the use of D+ red blood cells (RBCs) or whole blood along with suboptimal pretransfusion test result documentation. This presents challenges to the transfusion service of tertiary care military hospitals who ultimately receive these casualties because initial D typing results may only reflect the transfused RBCs. After patients are stabilized, mixed-field reaction results on D typing indicate the patient's true inherited D phenotype. This case series illustrates the utility of automated gel column agglutination in detecting mixed-field reactions in these patients. The transfusion service test results, including the automated gel column agglutination D typing results, of four massively transfused D- patients transfused D+ RBCs is presented. To test the sensitivity of the automated gel column agglutination method in detecting mixed-field agglutination reactions, a comparative analysis of three automated technologies using predetermined mixtures of D+ and D- RBCs is also presented. The automated gel column agglutination method detected mixed-field agglutination in D typing in all four patients and in the three prepared control specimens. The automated microwell tube method identified one of the three prepared control specimens as indeterminate, which was subsequently manually confirmed as a mixed-field reaction. The automated solid-phase method was unable to detect any mixed fields. The automated gel column agglutination method provides a sensitive means for detecting mixed-field agglutination reactions in the determination of the true inherited D phenotype of combat casualties transfused massive amounts of D+ RBCs.

Exploring Barriers to Effective E-Learning: Case Study of DNPA

ERIC Educational Resources Information Center

Annansingh, Fenio; Bright, Ali

2010-01-01

Purpose: The purpose of this paper is to discuss a case study which examines and analyses a information communication technology training programme conducted using an e-learning platform at the Dartmoor National Park Authority, UK. Design/methodology/approach: The research adopted a mixed method approach which involved the use of questionnaires…

A Case Study of Computer Gaming for Math: Engaged Learning from Gameplay?

ERIC Educational Resources Information Center

Ke, Fengfeng

2008-01-01

Employing mixed-method approach, this case study examined the in situ use of educational computer games in a summer math program to facilitate 4th and 5th graders' cognitive math achievement, metacognitive awareness, and positive attitudes toward math learning. The results indicated that students developed more positive attitudes toward math…

Ensuring Healthy Youth Development through Community Schools: A Case Study

ERIC Educational Resources Information Center

Anderson-Butcher, Dawn; Paluta, Lauren; Sterling, Karen; Anderson, Carol

2018-01-01

Using mixed methods, this case study explored outcomes associated with the adoption and implementation of a community schools approach in four Title I schools using the Community Collaboration Model for School Improvement. Trends in school data demonstrate academic achievement improvements in three of the four schools. Absenteeism and the number…

Triggering Transformative Possibilities: A Case Study of Leaders' Quest in China

ERIC Educational Resources Information Center

Lau-Kwong, Kenzie

2012-01-01

This study explored the nature of transformative learning experiences among global executives who participated in Quest program, a learning journey program designed to facilitate shifting mind-sets and worldviews through 1-week intensives in countries such as China. A mixed methods, multiple case study approach was employed. First, a secondary…

Inspiration from the Classroom: A Mixed Method Case Study of Interdisciplinary Sustainability Learning in Higher Education

ERIC Educational Resources Information Center

Noy, Sue; Patrick, Rebecca; Capetola, Teresa; McBurnie, Janine

2017-01-01

Within higher education there is widespread support for developing students' interdisciplinary skills. Despite this, evidence for, and practice of, cross-faculty interdisciplinary sustainability learning remains in its infancy. Recent articles have shown that Australia is no exception. This article provides a case study of interdisciplinary…

Syrians' Acceptance of Digital Lectures: A Case Study

ERIC Educational Resources Information Center

Ramadan, Reem

2016-01-01

Technology-based learning modules are mostly challenged by their acceptance. A single-case study and mixed research method are used to explore a unique situation of applying digital lectures at the postgraduate Programmes at the Faculty of Tourism at Damascus University as a solution for brain drain in the Syrian higher education system. Results…

Changing Perceptions of Science in Undergraduate Students: A Mixed Methods Case Study

ERIC Educational Resources Information Center

Larson-Miller, Cindy S.

2011-01-01

The purpose of this bounded single-case study was to explore the understanding of the nature and process of science for undergraduate students at the University of Nebraska-Lincoln (UNL). The study investigated one professor's methodology to explicitly teach undergraduate students about the nature and process of science, and documented their…

Undergraduates' Perceptions of Conflict of Interest in Industry-Sponsored Research

ERIC Educational Resources Information Center

Perry, Heather Brodie

2018-01-01

The prevalence of industry-sponsored research has led to significant concerns about financial conflicts of interest and the impact on research findings. This case study sought to examine how students considered conflict of interest when establishing the cognitive authority of a journal article. The case study used a mixed methods pretest and…

Rethinking Workplace Learning in the Digital World: A Case Study of Open Badges

ERIC Educational Resources Information Center

Eaglen Bertrando, Sharen Linn

2017-01-01

The purpose of this collective case study was to explore digital badging in educational institutions as support for K-12 practitioners struggling to integrate technology into pedagogical practices. The researcher conducted a mixed-method study that captured perceptions about digital badges and follow-up interviews with selected badge users to…

Research misconduct oversight: defining case costs.

PubMed

Gammon, Elizabeth; Franzini, Luisa

2013-01-01

This study uses a sequential mixed method study design to define cost elements of research misconduct among faculty at academic medical centers. Using time driven activity based costing, the model estimates a per case cost for 17 cases of research misconduct reported by the Office of Research Integrity for the period of 2000-2005. Per case cost of research misconduct was found to range from $116,160 to $2,192,620. Research misconduct cost drivers are identified.

Subtelomeric multiplex ligation-dependent probe amplification as a supplement for rapid prenatal detection of fetal chromosomal aberrations.

PubMed

Chen, Xiangnan; Li, Huanzheng; Mao, Yijian; Xu, Xueqin; Lv, Jiaojiao; Zhou, Lili; Lin, Xiaoling; Tang, Shaohua

2014-01-01

Pregnant women with high-risk indications are highly suspected of fetal chromosomal aberrations. To determine whether Multiplex Ligation-dependent Probe Amplification (MLPA) using subtelomeric probe mixes (P036-E2 and P070-B2) is a reliable method for rapid detection of fetal chromosomal aberrations. The subtelomeric MLPA probe mixes were used to evaluate 50 blood samples from healthy individuals. 168 amniocytes and 182 umbilical cord blood samples from high-risk fetuses were analyzed using the same subtelomeric MLPA probe sets. Karyotyping was also performed in all cases of high-risk pregnancies, and single nucleotide polymorphism array analysis was used to confirm submicroscopic and ambiguous results from MLPA/karyotyping. Subtelomeric MLPA analysis of normal samples showed normal result in all cases by use of P036-E2 probe mix, while P070-B2 probe mix gave normal results for all but one case. In one normal control case P070-B2 produced a duplicated signal of probe for 13q34. In the high-risk group, totally 44 chromosomal abnormalities were found by karyotyping and MLPA, including 23 aneuploidies and 21 rearrangements or mosaics. MLPA detected all 23 aneuploidies, 12 rearrangements and 1 mosaic. Importantly, MLPA revealed 4 chromosomal translocations, 2 small supernumerary marker chromosomes (sSMCs), and 3 subtelomeric imbalances that were not well characterized or not detectable by karyotyping. However, MLPA showed negetive results for the remaining 8 rearrangements or mosaics, including 3 low mosaic aneuploidies, 1 inherited sSMC, and 4 paracentric inversions. Results suggest that combined use of subtelomeric MLPA and karyotyping may be an alternative method for using karyotype analyses alone in rapid detection of aneuploidies, rearrangements, and sSMCs.

Medicaid case-mix nursing home reimbursement in three states.

PubMed

Swan, James H; Pickard, Ruth B

2003-01-01

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

75 FR 28663 - Government-Owned Inventions, Available for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

... Crack Arresting Barrier. NASA Case No. MFS-32605-1-CIP: Neutron Guides and Methods of Fabrication. NASA...-32697-1: Friction Modifier Using Adherent Metallic Multilayered or Mixed Element Layer Conversion...

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals.

PubMed

Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca

2017-06-01

To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.

Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study.

PubMed

Doohan, Isabelle; Björnstig, Ulf; Östlund, Ulrika; Saveman, Britt-Inger

2017-04-01

The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four "core cases" of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.

The role of psychiatrists in diagnosing conversion disorder: a mixed-methods analysis.

PubMed

Kanaan, Richard A; Armstrong, David; Wessely, Simon

2016-01-01

Since DSM-5 removed the requirement for a psychosocial formulation, neurologists have been able to make the diagnosis of conversion disorder without psychiatric input. We sought to examine whether neurologists and specialist psychiatrists concurred with this approach. We used mixed methods, first surveying all the neurologists in the UK and then interviewing the neuropsychiatrists in a large UK region on the role of psychiatrists in diagnosing conversion disorder. Of the surveyed neurologists, 76% did not think that psychiatrists were essential for the diagnosis and 71% thought that psychiatrists did not even consider conversion disorder when referred a case. The neuropsychiatrists who were interviewed held complex models of conversion disorder. They believed all cases could be explained psychosocially in theory, but the nature of the diagnostic encounter often prevented it in practice; all felt that psychosocial formulation could be very helpful and some felt that it was essential to diagnosis. Although neurologists do not think psychiatrists are required for diagnosing conversion disorder, specialist psychiatrists disagree, at least in some cases.

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Mixed case complaints. 268.302 Section 268.302... RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case complaint is a complaint of employment discrimination filed with the Board based on race, color, religion...

12 CFR 268.302 - Mixed case complaints.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Mixed case complaints. 268.302 Section 268.302... RULES REGARDING EQUAL OPPORTUNITY Related Processes § 268.302 Mixed case complaints. A mixed case complaint is a complaint of employment discrimination filed with the Board based on race, color, religion...

WENO schemes on arbitrary mixed-element unstructured meshes in three space dimensions

NASA Astrophysics Data System (ADS)

Tsoutsanis, P.; Titarev, V. A.; Drikakis, D.

2011-02-01

The paper extends weighted essentially non-oscillatory (WENO) methods to three dimensional mixed-element unstructured meshes, comprising tetrahedral, hexahedral, prismatic and pyramidal elements. Numerical results illustrate the convergence rates and non-oscillatory properties of the schemes for various smooth and discontinuous solutions test cases and the compressible Euler equations on various types of grids. Schemes of up to fifth order of spatial accuracy are considered.

Leadership Styles of a Multigenerational Leader

ERIC Educational Resources Information Center

Welsh, Raymond John, Jr.

2010-01-01

The purpose of this concurrent, nested, mixed-methods case study was to trace the evolution of the multigenerational success of the winningest college football coach of all time, John Gagliardi, to identify potential leadership styles, characteristics, and coaching effectiveness methods that others in a multigenerational leadership role may use.…

Clustering "N" Objects into "K" Groups under Optimal Scaling of Variables.

ERIC Educational Resources Information Center

van Buuren, Stef; Heiser, Willem J.

1989-01-01

A method based on homogeneity analysis (multiple correspondence analysis or multiple scaling) is proposed to reduce many categorical variables to one variable with "k" categories. The method is a generalization of the sum of squared distances cluster analysis problem to the case of mixed measurement level variables. (SLD)

Nursing Admission Practices to Discern "Fit": A Case Study Exemplar

ERIC Educational Resources Information Center

Sinutko, Jaime M.

2014-01-01

Admission to a baccalaureate nursing school in the United States is currently a challenging proposition for a variety of reasons. This research explored a holistic nursing school admission process at a small, private, baccalaureate college using a retrospective, mixed-method, approach. The holistic method included multiple admission criteria, both…

A Framework for Mixing Methods in Quantitative Measurement Development, Validation, and Revision: A Case Study

ERIC Educational Resources Information Center

Luyt, Russell

2012-01-01

A framework for quantitative measurement development, validation, and revision that incorporates both qualitative and quantitative methods is introduced. It extends and adapts Adcock and Collier's work, and thus, facilitates understanding of quantitative measurement development, validation, and revision as an integrated and cyclical set of…

Exploring nursing expertise in residential care for older people: a mixed method study.

PubMed

Phelan, Amanda; McCormack, Brendan

2016-10-01

To explore the expertise of Registered Nurses in residential care for older people. As older people in residential care have many complex dependencies, nursing expertise is an essential component of care excellence. However, the work of these nurses can be invisible and, therefore, unrecognized. Thus, additional attention is required to illuminate such nursing expertise. A mixed method design was used in this study. The research took place in 2012 in the Republic of Ireland. Twenty-three case study nurses were recruited from nursing homes. Each case study nurse involved five data collection methods: shadowing, interview with a colleague, interview with a resident, a demographic profile and a director of nursing survey. The study was also informed by a modified focus group. Qualitative data were analysed using directed content analysis using a conceptual framework generated from the literature on nursing expertise. Quantitative data were analysed using SPSS and presented in descriptive statistics. The findings from the case studies and the modified focus group are presented in seven themes, which represent nursing expertise in residential care of older people: transitions, context of the nursing home, saliency, holistic practice knowledge, knowing the resident, moral agency and skilled know how. Nursing expertise in residential care of older people is a complex phenomenon which encompasses many aspects of care delivery in a person-centred framework. By rendering this expertise visible, the need for appropriate and adequate skill mix for a growing residential care population is presented. © 2016 John Wiley & Sons Ltd.

[Improvement of patient adherence by mixing oral itraconazole solution with a beverage (orange juice)].

PubMed

Adachi, Yoko; Sumikuma, Toshiya; Kagami, Ryogo; Nishio, Akira; Akasaka, Koji; Tsunemine, Hiroko; Kodaka, Taiichi; Hiramatsu, Yasushi; Tada, Hiroshi

2010-05-01

There have been some reports on the efficacy and tolerability of an oral itraconazole (ITCZ) solution as prophylaxis for fungal infection in patients with hematological malignancies. However, there are some cases where the bitter taste of oral ITCZ solution leads to an interruption of administration because the patient refuses to take this medicine. Therefore, we prospectively investigated the pharmacokinetics and promotion of treatment adherence in patients taking oral ITCZ solution mixed with a beverage. Compared with the responses of patients taking oral ITCZ solution with water, the taste of the agent was improved significantly when mixed with orange juice, although the plasma concentration of the agent did not differ between the two groups. Using this method, we can expect an improvement in treatment adherence and this method can easily be applied in clinical practice. This method is highly useful and should become common knowledge.

Study of thermodynamic properties of liquid binary alloys by a pseudopotential method

NASA Astrophysics Data System (ADS)

Vora, Aditya M.

2010-11-01

On the basis of the Percus-Yevick hard-sphere model as a reference system and the Gibbs-Bogoliubov inequality, a thermodynamic perturbation method is applied with the use of the well-known model potential. By applying a variational method, the hard-core diameters are found which correspond to a minimum free energy. With this procedure, the thermodynamic properties such as the internal energy, entropy, Helmholtz free energy, entropy of mixing, and heat of mixing are computed for liquid NaK binary systems. The influence of the local-field correction functions of Hartree, Taylor, Ichimaru-Utsumi, Farid-Heine-Engel-Robertson, and Sarkar-Sen-Haldar-Roy is also investigated. The computed excess entropy is in agreement with available experimental data in the case of liquid alloys, whereas the agreement for the heat of mixing is poor. This may be due to the sensitivity of the latter to the potential parameters and dielectric function.

A Fatal Case of Candida auris and Candida tropicalis Candidemia in Neutropenic Patient.

PubMed

Mohd Tap, Ratna; Lim, Teck Choon; Kamarudin, Nur Amalina; Ginsapu, Stephanie Jane; Abd Razak, Mohd Fuat; Ahmad, Norazah; Amran, Fairuz

2018-06-01

We report a fatal case of Candida auris that was involved in mixed candidemia with Candida tropicalis, isolated from the blood of a neutropenic patient. Identification of both isolates was confirmed by amplification and sequencing of internal transcribed spacer and D1/D2 domain of large subunit in rRNA gene. Antifungal susceptibility test by E-test method revealed that C. auris was resistant to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole and voriconazole. On the other hand, C. tropicalis was sensitive to all antifungal tested. The use of chromogenic agar as isolation media is vital in detecting mixed candidemia.

Reliability and Validity in Hospital Case-Mix Measurement

PubMed Central

Pettengill, Julian; Vertrees, James

1982-01-01

There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogenous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix. PMID:10309909

A Mixed Prioritization Operators Strategy Using A Single Measurement Criterion For AHP Application Development

NASA Astrophysics Data System (ADS)

Yuen, Kevin Kam Fung

2009-10-01

The most appropriate prioritization method is still one of the unsettled issues of the Analytic Hierarchy Process, although many studies have been made and applied. Interestingly, many AHP applications apply only Saaty's Eigenvector method as many studies have found that this method may produce rank reversals and have proposed various prioritization methods as alternatives. Some methods have been proved to be better than the Eigenvector method. However, these methods seem not to attract the attention of researchers. In this paper, eight important prioritization methods are reviewed. A Mixed Prioritization Operators Strategy (MPOS) is developed to select a vector which is prioritized by the most appropriate prioritization operator. To verify this new method, a case study of high school selection is revised using the proposed method. The contribution is that MPOS is useful for solving prioritization problems in the AHP.

Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer.

PubMed

Morgan, J; Richards, P; Ward, S; Francis, M; Lawrence, G; Collins, K; Reed, M; Wyld, L

2015-08-01

Non-surgical management of older women with oestrogen receptor (ER)-positive operable breast cancer is common in the UK, with up to 40 per cent of women aged over 70 years receiving primary endocrine therapy. Although this may be appropriate for frailer patients, for some it may result in treatment failure, contributing to the poor outcomes seen in this age group. Wide variation in the rates of non-operative management of breast cancer in older women exists across the UK. Case mix may explain some of this variation in practice. Data from two UK regional cancer registries were analysed to determine whether variation in treatment observed between 2002 and 2010 at hospital and clinician level persisted after adjustment for case mix. Expected case mix-adjusted surgery rates were derived by logistic regression using the variables age, proxy Charlson co-morbidity score, deprivation quintile, method of cancer detection, tumour size, stage, grade and node status. Data on 17,129 women aged 70 years or more with ER-positive operable breast cancer were analysed. There was considerable variation in rates of surgery at both hospital and clinician level. Despite adjusting for case mix, this variation persisted at hospital level, although not at clinician level. This study demonstrates variation in selection criteria for older women for operative treatment of early breast cancer, indicating that some older women may be undertreated or overtreated, and may partly explain the inferior disease outcomes in this age group. It emphasizes the urgent need for evidence-based guidelines for treatment selection criteria in older women with breast cancer. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Utilising a collective case study system theory mixed methods approach: a rural health example

PubMed Central

2014-01-01

Background Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. Method A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. Results 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. Conclusions The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research. PMID:25066241

Determining the turnover time of groundwater systems with the aid of environmental tracers. 1. Models and their applicability

NASA Astrophysics Data System (ADS)

Małoszewski, P.; Zuber, A.

1982-06-01

Three new lumped-parameter models have been developed for the interpretation of environmental radioisotope data in groundwater systems. Two of these models combine other simpler models, i.e. the piston flow model is combined either with the exponential model (exponential distribution of transit times) or with the linear model (linear distribution of transit times). The third model is based on a new solution to the dispersion equation which more adequately represents the real systems than the conventional solution generally applied so far. The applicability of models was tested by the reinterpretation of several known case studies (Modry Dul, Cheju Island, Rasche Spring and Grafendorf). It has been shown that two of these models, i.e. the exponential-piston flow model and the dispersive model give better fitting than other simpler models. Thus, the obtained values of turnover times are more reliable, whereas the additional fitting parameter gives some information about the structure of the system. In the examples considered, in spite of a lower number of fitting parameters, the new models gave practically the same fitting as the multiparameter finite state mixing-cell models. It has been shown that in the case of a constant tracer input a prior physical knowledge of the groundwater system is indispensable for determining the turnover time. The piston flow model commonly used for age determinations by the 14C method is an approximation applicable only in the cases of low dispersion. In some cases the stable-isotope method aids in the interpretation of systems containing mixed waters of different ages. However, when 14C method is used for mixed-water systems a serious mistake may arise by neglecting the different bicarbonate contents in particular water components.

Using Bronfenbrenner's Ecological Theory to Understand Community Partnerships: A Historical Case Study of One Urban High School

ERIC Educational Resources Information Center

Leonard, Jack

2011-01-01

Although the value of school-community partnerships is unquestioned, the reasons for success and failure are not sufficiently understood. This mixed-methods case study examines 60 years of partnering at one urban high school, using Bronfenbrenner's ecological systems theory to better understand the effect on student development as measured by…

A Comparative Case Study of Developing Leaders through a Doctoral Program: A Study of One Academic Institution

ERIC Educational Resources Information Center

Scanlon, Sheryl Lynne

2012-01-01

The purpose of this comparative case study was to determine how one academic institution could address the leadership gap facing organizations today, through a traditional, classroom doctoral program in Organizational Leadership. Data was gathered utilizing mixed methods methodology that included a survey questionnaire, focus group information,…

A Case Study of Student Assessment Programs in a College of Business Administration at a Southern HBCU

ERIC Educational Resources Information Center

Bell Haynes, Janel Elizabeth

2013-01-01

The purpose of this mixed method sequential explanatory case study was to describe the relationship of a student outcomes assessment program, as measured by the Peregrine Academic Leveling Course, (ALC), to the academic performance, determined by scores on the Peregrine Common Professional Component (CPC) examination, of students enrolled during…

Scaling up STEM Academies Statewide: Implementation, Network Supports, and Early Outcomes

ERIC Educational Resources Information Center

Young, Viki; House, Ann; Sherer, David; Singleton, Corinne; Wang, Haiwen; Klopfenstein, Kristin

2016-01-01

This chapter presents a case study of scaling up the T-STEM initiative in Texas. Data come from the four-year longitudinal evaluation of the Texas High School Project (THSP). The evaluation studied the implementation and impact of T-STEM and the other THSP reforms using a mixed-methods design, including qualitative case studies; principal,…

Circles of Support and Personalization: Exploring the Economic Case

ERIC Educational Resources Information Center

Wistow, Gerald; Perkins, Margaret; Knapp, Martin; Bauer, Annette; Bonin, Eva-Maria

2016-01-01

Circles of Support aim to enable people with learning disabilities (and others) to live full lives as part of their communities. As part of a wider study of the economic case for community capacity building conducted from 2012 to 2014, we conducted a mixed methods study of five Circles in North West England. Members of these Circles were…

Anticipated educational outcomes: a case study of the outdoor recreation consortium experience

Treesearch

Yasong Wang; Alan Graefe

2008-01-01

This paper reports on a case study of an outdoor experiential learning program and examines its meaning for program participants. The research was conducted with 56 university students who participated in the Outdoor Recreation Consortium held at the Great Smoky Mountain Institute in Tremont, TN. A mixed-method comparative research approach, using both quantitative and...

Contemplating a New Model for Air Force Aerospace Medical Technician Skills Sustainment Training

DTIC Science & Technology

2006-03-01

qualitative research designs. The major designs described by these researchers included: grounded theory , narrative research ... phenomenological research , ethnographies , content analysis, and case study . Because each of these designs can stand alone as an individual research ...exploratory, embedded, single case study . A mixed methods research approach will be applied in an effort to discover

Design Fixation and Cooperative Learning in Elementary Engineering Design Project: A Case Study

ERIC Educational Resources Information Center

Luo, Yi

2015-01-01

This paper presents a case study examining 3rd, 4th and 5th graders' design fixation and cooperative learning in an engineering design project. A mixed methods instrument, the Cooperative Learning Observation Protocol (CLOP), was adapted to record frequency and class observation on cooperative learning engagement through detailed field notes.…

Solvent tuning configurational conversion of lycopene aggregates in organic-aqueous mixing solvent

NASA Astrophysics Data System (ADS)

Dong, Jia; Zhang, Di; Wang, Xin-Yue; Wang, Peng

2018-06-01

In general cases, carotenoid aggregates are prepared in organic-water mixing solvent depending on its hydrophobic character. It is well-known that one of carotenoids, lycopene, is more likely to form typical H-aggregates. In this study, new type lycopene J-aggregates were prepared in DMSO-water mixing solvent with small amount of toluene, which was observed for the first time. We proposed a potential structure model combining with exciton model to interpret the mechanism of spectra changes. Our finding has provided new methods and novel ideas for controlling carotenoid aggregates formation.

Scheimpflug topographical changes after Femtosecond LASIK for mixed astigmatism - theoretical aspects and case study.

PubMed

Tabacaru, Bogdana; Stanca, Horia Tudor

2017-01-01

Objective: To evaluate the corneal topographical changes after Femtosecond-LASIK surgery in eyes with mixed astigmatism. Methods: We present the analysis of the corneal Scheimpflug topographies of a patient treated with Femtosecond-LASIK technique for bilateral mixed astigmatism. Results: Three-dimensional reconstruction maps and differential anterior curvature maps were used to demonstrate the ablation profile and its stability in time. Conclusions: Visual and refractive results were very good after surgery, being topographically confirmed by the corneal reshaping which was performed as planned, the achieved ablation being stable during the one-year follow-up period.

An algorithm for separation of mixed sparse and Gaussian sources

PubMed Central

Akkalkotkar, Ameya

2017-01-01

Independent component analysis (ICA) is a ubiquitous method for decomposing complex signal mixtures into a small set of statistically independent source signals. However, in cases in which the signal mixture consists of both nongaussian and Gaussian sources, the Gaussian sources will not be recoverable by ICA and will pollute estimates of the nongaussian sources. Therefore, it is desirable to have methods for mixed ICA/PCA which can separate mixtures of Gaussian and nongaussian sources. For mixtures of purely Gaussian sources, principal component analysis (PCA) can provide a basis for the Gaussian subspace. We introduce a new method for mixed ICA/PCA which we call Mixed ICA/PCA via Reproducibility Stability (MIPReSt). Our method uses a repeated estimations technique to rank sources by reproducibility, combined with decomposition of multiple subsamplings of the original data matrix. These multiple decompositions allow us to assess component stability as the size of the data matrix changes, which can be used to determinine the dimension of the nongaussian subspace in a mixture. We demonstrate the utility of MIPReSt for signal mixtures consisting of simulated sources and real-word (speech) sources, as well as mixture of unknown composition. PMID:28414814

An algorithm for separation of mixed sparse and Gaussian sources.

PubMed

Akkalkotkar, Ameya; Brown, Kevin Scott

2017-01-01

Independent component analysis (ICA) is a ubiquitous method for decomposing complex signal mixtures into a small set of statistically independent source signals. However, in cases in which the signal mixture consists of both nongaussian and Gaussian sources, the Gaussian sources will not be recoverable by ICA and will pollute estimates of the nongaussian sources. Therefore, it is desirable to have methods for mixed ICA/PCA which can separate mixtures of Gaussian and nongaussian sources. For mixtures of purely Gaussian sources, principal component analysis (PCA) can provide a basis for the Gaussian subspace. We introduce a new method for mixed ICA/PCA which we call Mixed ICA/PCA via Reproducibility Stability (MIPReSt). Our method uses a repeated estimations technique to rank sources by reproducibility, combined with decomposition of multiple subsamplings of the original data matrix. These multiple decompositions allow us to assess component stability as the size of the data matrix changes, which can be used to determinine the dimension of the nongaussian subspace in a mixture. We demonstrate the utility of MIPReSt for signal mixtures consisting of simulated sources and real-word (speech) sources, as well as mixture of unknown composition.

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

PubMed Central

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L

2012-01-01

Objectives Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Design/setting Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Main outcome measures Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Results Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. Conclusions While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio-demographic groups. PMID:22626735

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

PubMed

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L; Roland, Martin

2012-08-01

Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.

An electrohydrodynamic technique for rapid mixing in stationary droplets on digital microfluidic platforms.

PubMed

Samiei, Ehsan; de Leon Derby, Maria Diaz; den Berg, Andre Van; Hoorfar, Mina

2017-01-17

This paper presents an electrohydrodynamic technique for rapid mixing of droplets in open and closed digital microfluidic (DMF) platforms. Mixing is performed by applying a high frequency AC voltage to the coplanar or parallel electrodes, inducing circulation zones inside the droplet which results in rapid mixing of the content. The advantages of the proposed method in comparison to conventional mixing methods that operate based on transporting the droplet back and forth and side to side include 1) a shorter mixing time (as fast as 0.25 s), 2) the use of a fewer number of electrodes, reducing the size of the chip, and 3) the stationary nature of the technique which reduces the chance of cross-contamination and surface biofouling. Mixing using the proposed method is performed to create a uniform mixture after merging a water droplet with another droplet containing either particles or dye. The results show that increasing the frequency, and or the amplitude of the applied voltage, enhances the mixing process. However, actuation with a very high frequency and voltage may result in shedding pico-liter satellite droplets. Therefore, for each frequency there is an effective range of the amplitude which provides rapid mixing and avoids shedding satellite droplets. Also, the increase in the gap height between the two plates (for the closed DMF platforms) significantly enhances the mixing efficiency due to the lower viscous effects. Effects of the addition of salts and DNA to the samples were also studied. The electrothermal effect decreased for these cases, which was solved by increasing the frequency of the applied voltage. To assure the high frequency actuation does not increase the sample temperature excessively, the temperature change was monitored using a thermal imaging camera and it was found that the increase in temperature is negligible.

The Rivalry between Simulation and Problem-Based Learning: A Study of Learning Transfer in Physician Assistant Students

ERIC Educational Resources Information Center

Meyer, Kimberly E.

2010-01-01

The purpose of this dissertation was to evaluate learning transfer achieved by physician assistant students comparing two instructional methods, human patient simulation and electronic clinical case studies. This prospective, randomized, mixed-methods study utilized first and second-year physician assistant student volunteers taking a pretest and…

Giving Back: Exploring Service-Learning in an Online Learning Environment

ERIC Educational Resources Information Center

McWhorter, Rochell R.; Delello, Julie A.; Roberts, Paul B.

2016-01-01

Service-Learning (SL) as an instructional method is growing in popularity for giving back to the community while connecting the experience to course content. However, little has been published on using SL for online business students. This study highlights an exploratory mixed-methods, multiple case study of an online business leadership and…

Analytical Expressions for the Mixed-Order Kinetics Parameters of TL Glow Peaks Based on the two Heating Rates Method.

PubMed

Maghrabi, Mufeed; Al-Abdullah, Tariq; Khattari, Ziad

2018-03-24

The two heating rates method (originally developed for first-order glow peaks) was used for the first time to evaluate the activation energy (E) from glow peaks obeying mixed-order (MO) kinetics. The derived expression for E has an insignificant additional term (on the scale of a few meV) when compared with the first-order case. Hence, the original expression for E using the two heating rates method can be used with excellent accuracy in the case of MO glow peaks. In addition, we derived a simple analytical expression for the MO parameter. The present procedure has the advantage that the MO parameter can now be evaluated using analytical expression instead of using the graphical representation between the geometrical factor and the MO parameter as given by the existing peak shape methods. The applicability of the derived expressions for real samples was demonstrated for the glow curve of Li 2 B 4 O 7 :Mn single crystal. The obtained parameters compare very well with those obtained by glow curve fitting and with the available published data.

Numerical Analysis of an H 1-Galerkin Mixed Finite Element Method for Time Fractional Telegraph Equation

PubMed Central

Wang, Jinfeng; Zhao, Meng; Zhang, Min; Liu, Yang; Li, Hong

2014-01-01

We discuss and analyze an H 1-Galerkin mixed finite element (H 1-GMFE) method to look for the numerical solution of time fractional telegraph equation. We introduce an auxiliary variable to reduce the original equation into lower-order coupled equations and then formulate an H 1-GMFE scheme with two important variables. We discretize the Caputo time fractional derivatives using the finite difference methods and approximate the spatial direction by applying the H 1-GMFE method. Based on the discussion on the theoretical error analysis in L 2-norm for the scalar unknown and its gradient in one dimensional case, we obtain the optimal order of convergence in space-time direction. Further, we also derive the optimal error results for the scalar unknown in H 1-norm. Moreover, we derive and analyze the stability of H 1-GMFE scheme and give the results of a priori error estimates in two- or three-dimensional cases. In order to verify our theoretical analysis, we give some results of numerical calculation by using the Matlab procedure. PMID:25184148

Misconceptions about case-mix payments for nursing homes.

PubMed

Grimaldi, P L

1987-04-01

Despite the increasing use of case-mix payment systems for skilled and intermediate nursing home care (at least 10 state Medicaid programs have adopted or are considering adopting such a system), misconceptions about such systems still exist. Unless these inaccurate perceptions are corrected, a state may adopt a system that fails to realize its goals. Some of these misconceptions include the beliefs that case-mix payment systems: Apply to all nursing homes costs; Will benefit hospital-based facilities; Will resolve the access problems of heavy care public patients; Will result in higher statewide payment rates because patient characteristics are factored directly into the calculations. In fact, case-mix adjustments are applied only to costs that can be traced directly to patients' impairments. Nursing services and some ancillary services are dependent on case mix, while administrative and support services are largely independent of case mix. Capital costs usually can be ignored in formulating the case-mix adjustment. Although hospital-based facilities frequently have sicker patients than freestanding facilities, studies show that only a portion of the cost differential is explained by case-mix differences. In the case of heavy-care patients, some believe that case-mix payment systems will resolve access problems by paying higher rates in response to the higher treatment costs. Access may not improve, however, if the new rates are lower than those paid by comparable private patients. Perhaps a loosening in the certificate-of-need process will also be needed to resolve the access problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Multi-objective shape optimization of plate structure under stress criteria based on sub-structured mixed FEM and genetic algorithms

NASA Astrophysics Data System (ADS)

Garambois, Pierre; Besset, Sebastien; Jézéquel, Louis

2015-07-01

This paper presents a methodology for the multi-objective (MO) shape optimization of plate structure under stress criteria, based on a mixed Finite Element Model (FEM) enhanced with a sub-structuring method. The optimization is performed with a classical Genetic Algorithm (GA) method based on Pareto-optimal solutions and considers thickness distributions parameters and antagonist objectives among them stress criteria. We implement a displacement-stress Dynamic Mixed FEM (DM-FEM) for plate structure vibrations analysis. Such a model gives a privileged access to the stress within the plate structure compared to primal classical FEM, and features a linear dependence to the thickness parameters. A sub-structuring reduction method is also computed in order to reduce the size of the mixed FEM and split the given structure into smaller ones with their own thickness parameters. Those methods combined enable a fast and stress-wise efficient structure analysis, and improve the performance of the repetitive GA. A few cases of minimizing the mass and the maximum Von Mises stress within a plate structure under a dynamic load put forward the relevance of our method with promising results. It is able to satisfy multiple damage criteria with different thickness distributions, and use a smaller FEM.

Analyzing Association Mapping in Pedigree-Based GWAS Using a Penalized Multitrait Mixed Model

PubMed Central

Liu, Jin; Yang, Can; Shi, Xingjie; Li, Cong; Huang, Jian; Zhao, Hongyu; Ma, Shuangge

2017-01-01

Genome-wide association studies (GWAS) have led to the identification of many genetic variants associated with complex diseases in the past 10 years. Penalization methods, with significant numerical and statistical advantages, have been extensively adopted in analyzing GWAS. This study has been partly motivated by the analysis of Genetic Analysis Workshop (GAW) 18 data, which have two notable characteristics. First, the subjects are from a small number of pedigrees and hence related. Second, for each subject, multiple correlated traits have been measured. Most of the existing penalization methods assume independence between subjects and traits and can be suboptimal. There are a few methods in the literature based on mixed modeling that can accommodate correlations. However, they cannot fully accommodate the two types of correlations while conducting effective marker selection. In this study, we develop a penalized multitrait mixed modeling approach. It accommodates the two different types of correlations and includes several existing methods as special cases. Effective penalization is adopted for marker selection. Simulation demonstrates its satisfactory performance. The GAW 18 data are analyzed using the proposed method. PMID:27247027

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

A Case Study of a Turnaround High School: An Examination of the Maryland State Department of Education Breakthrough Center Intervention

ERIC Educational Resources Information Center

Galindo, Claudia; Stein, Kathleen; Schaffer, Eugene

2016-01-01

This study examined the Maryland State Department of Education Breakthrough Center (BTC) engagement in a Baltimore City turnaround high school. Utilizing a case-study design and mixed-methods research, data were collected through interviews, informal observations, and review of administrative and achievement documents. Beginning in the 2011-2012…

Fostering Interdisciplinary Research in Universities: A Case Study of Leadership, Alignment and Support

ERIC Educational Resources Information Center

Townsend, Tony; Pisapia, John; Razzaq, Jamila

2015-01-01

The aim of this paper is to describe actions designed to foster interdisciplinary research efforts at a major university in the UK. The study employed a descriptive mixed method case study approach to collecting and analysing the data used to draw its conclusions. One hundred and twenty-seven academic staff responded to the survey. The results of…

Identifying the Local Impacts of National ATE Centers on Their Host Institutions: An Exploratory Study

ERIC Educational Resources Information Center

Henderson, Charles; Fynewever, Herb; Petcovic, Heather; Bierema, Andrea

2012-01-01

The purpose of this study is to identify the local impacts of national advanced technological education (ATE) centers on their host institutions. A sample of three mature, national ATE centers are chosen, with each center serving as a case for a mixed-methods, collective case study research design. Results, drawn from interviews and surveys,…

A Multiple Case Study: The Effect of Professional Development on Teachers' Perceived Ability to Foster Resilience

ERIC Educational Resources Information Center

Klinger, Mary A.

2012-01-01

The purpose of this mixed methods study was to determine the effect of professional development on teachers' perceptions of their ability to foster resilience. Secondary questions investigated the effects of school level and socioeconomic status. An exploratory multi-site case study was designed to compare the perceptions of educators from…

Naturally-Emerging Technology-Based Leadership Roles in Three Independent Schools: A Social Network-Based Case Study Using Fuzzy Set Qualitative Comparative Analysis

ERIC Educational Resources Information Center

Velastegui, Pamela J.

2013-01-01

This hypothesis-generating case study investigates the naturally emerging roles of technology brokers and technology leaders in three independent schools in New York involving 92 school educators. A multiple and mixed method design utilizing Social Network Analysis (SNA) and fuzzy set Qualitative Comparative Analysis (FSQCA) involved gathering…

Young Workers and Their Dispositions towards Mathematics: Tensions of a Mathematical Habitus in the Retail Industry

ERIC Educational Resources Information Center

Jorgensen Zebenbergen, Robyn

2011-01-01

This paper presents a case study of contemporary retail industry and the ways in which young workers participate in that field. Public perceptions of low numeracy among young people provided the catalyst for the study. Drawing on a mixed-method approach involving survey, case studies, stimulated recall, observations, and interviews, it was found…

Case-Based Learning as Pedagogy for Teaching Information Ethics Based on the Dervin Sense-Making Methodology

ERIC Educational Resources Information Center

Dow, Mirah J.; Boettcher, Carrie A.; Diego, Juana F.; Karch, Marziah E.; Todd-Diaz, Ashley; Woods, Kristine M.

2015-01-01

The purpose of this mixed methods study is to determine the effectiveness of case-based pedagogy in teaching basic principles of information ethics and ethical decision making. Study reports results of pre- and post-assessment completed by 49 library and information science (LIS) graduate students at a Midwestern university. Using Creswell's…

Pathways for Success in Developing a Nature Trail at a Zoo: A Mixed-Methods Evaluative Case Study

ERIC Educational Resources Information Center

Hendrickson, Carol F.

2010-01-01

Modern zoos serve as tourist attractions and recreational facilities, while providing educational outreach programs in ecology, conservation, and animal needs. However, in the 21st century, there has been a negative backlash of people associating zoos with animals being shut away in cages or pits. This case study included an examination of the…

An open source Bayesian Monte Carlo isotope mixing model with applications in Earth surface processes

NASA Astrophysics Data System (ADS)

Arendt, Carli A.; Aciego, Sarah M.; Hetland, Eric A.

2015-05-01

The implementation of isotopic tracers as constraints on source contributions has become increasingly relevant to understanding Earth surface processes. Interpretation of these isotopic tracers has become more accessible with the development of Bayesian Monte Carlo (BMC) mixing models, which allow uncertainty in mixing end-members and provide methodology for systems with multicomponent mixing. This study presents an open source multiple isotope BMC mixing model that is applicable to Earth surface environments with sources exhibiting distinct end-member isotopic signatures. Our model is first applied to new δ18O and δD measurements from the Athabasca Glacier, which showed expected seasonal melt evolution trends and vigorously assessed the statistical relevance of the resulting fraction estimations. To highlight the broad applicability of our model to a variety of Earth surface environments and relevant isotopic systems, we expand our model to two additional case studies: deriving melt sources from δ18O, δD, and 222Rn measurements of Greenland Ice Sheet bulk water samples and assessing nutrient sources from ɛNd and 87Sr/86Sr measurements of Hawaiian soil cores. The model produces results for the Greenland Ice Sheet and Hawaiian soil data sets that are consistent with the originally published fractional contribution estimates. The advantage of this method is that it quantifies the error induced by variability in the end-member compositions, unrealized by the models previously applied to the above case studies. Results from all three case studies demonstrate the broad applicability of this statistical BMC isotopic mixing model for estimating source contribution fractions in a variety of Earth surface systems.

Evaluating hospital design from an operations management perspective.

PubMed

Vos, Leti; Groothuis, Siebren; van Merode, Godefridus G

2007-12-01

This paper describes an evaluation method for the assessment of hospital building design from the viewpoint of operations management to assure that the building design supports the efficient and effective operating of care processes now and in the future. The different steps of the method are illustrated by a case study. In the case study an experimental design is applied to assess the effect of used logistical concepts, patient mix and technologies. The study shows that the evaluation method provides a valuable tool for the assessment of both functionality and the ability to meet future developments in operational control of a building design.

The effect of state medicaid case-mix payment on nursing home resident acuity.

PubMed

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

2006-08-01

To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

Considering New Paths for Success: An Examination of the Research and Methods on Urban School-University Partnerships Post-No Child Left Behind

ERIC Educational Resources Information Center

Flynn, Joseph E.; Hunt, Rebecca D.; Johnson, Laura Ruth; Wickman, Scott A.

2014-01-01

This article examines urban school-university partnership research after No Child Left Behind. Central to the review is an analysis in the trend of research methods utilized across studies. It was found that many studies are single-case studies or anecdotal. There are few quantitative, sustained qualitative, or mixed-methods studies represented in…

Logit-normal mixed model for Indian monsoon precipitation

NASA Astrophysics Data System (ADS)

Dietz, L. R.; Chatterjee, S.

2014-09-01

Describing the nature and variability of Indian monsoon precipitation is a topic of much debate in the current literature. We suggest the use of a generalized linear mixed model (GLMM), specifically, the logit-normal mixed model, to describe the underlying structure of this complex climatic event. Four GLMM algorithms are described and simulations are performed to vet these algorithms before applying them to the Indian precipitation data. The logit-normal model was applied to light, moderate, and extreme rainfall. Findings indicated that physical constructs were preserved by the models, and random effects were significant in many cases. We also found GLMM estimation methods were sensitive to tuning parameters and assumptions and therefore, recommend use of multiple methods in applications. This work provides a novel use of GLMM and promotes its addition to the gamut of tools for analysis in studying climate phenomena.

The role of psychiatrists in diagnosing conversion disorder: a mixed-methods analysis

PubMed Central

Kanaan, Richard A; Armstrong, David; Wessely, Simon

2016-01-01

Objective Since DSM-5 removed the requirement for a psychosocial formulation, neurologists have been able to make the diagnosis of conversion disorder without psychiatric input. We sought to examine whether neurologists and specialist psychiatrists concurred with this approach. Design We used mixed methods, first surveying all the neurologists in the UK and then interviewing the neuropsychiatrists in a large UK region on the role of psychiatrists in diagnosing conversion disorder. Results Of the surveyed neurologists, 76% did not think that psychiatrists were essential for the diagnosis and 71% thought that psychiatrists did not even consider conversion disorder when referred a case. The neuropsychiatrists who were interviewed held complex models of conversion disorder. They believed all cases could be explained psychosocially in theory, but the nature of the diagnostic encounter often prevented it in practice; all felt that psychosocial formulation could be very helpful and some felt that it was essential to diagnosis. Conclusion Although neurologists do not think psychiatrists are required for diagnosing conversion disorder, specialist psychiatrists disagree, at least in some cases. PMID:27274253

In Search of a Time Efficient Approach to Crack and Delamination Growth Predictions in Composites

NASA Technical Reports Server (NTRS)

Krueger, Ronald; Carvalho, Nelson

2016-01-01

Analysis benchmarking was used to assess the accuracy and time efficiency of algorithms suitable for automated delamination growth analysis. First, the Floating Node Method (FNM) was introduced and its combination with a simple exponential growth law (Paris Law) and Virtual Crack Closure technique (VCCT) was discussed. Implementation of the method into a user element (UEL) in Abaqus/Standard(Registered TradeMark) was also presented. For the assessment of growth prediction capabilities, an existing benchmark case based on the Double Cantilever Beam (DCB) specimen was briefly summarized. Additionally, the development of new benchmark cases based on the Mixed-Mode Bending (MMB) specimen to assess the growth prediction capabilities under mixed-mode I/II conditions was discussed in detail. A comparison was presented, in which the benchmark cases were used to assess the existing low-cycle fatigue analysis tool in Abaqus/Standard(Registered TradeMark) in comparison to the FNM-VCCT fatigue growth analysis implementation. The low-cycle fatigue analysis tool in Abaqus/Standard(Registered TradeMark) was able to yield results that were in good agreement with the DCB benchmark example. Results for the MMB benchmark cases, however, only captured the trend correctly. The user element (FNM-VCCT) always yielded results that were in excellent agreement with all benchmark cases, at a fraction of the analysis time. The ability to assess the implementation of two methods in one finite element code illustrated the value of establishing benchmark solutions.

Ensemble of trees approaches to risk adjustment for evaluating a hospital's performance.

PubMed

Liu, Yang; Traskin, Mikhail; Lorch, Scott A; George, Edward I; Small, Dylan

2015-03-01

A commonly used method for evaluating a hospital's performance on an outcome is to compare the hospital's observed outcome rate to the hospital's expected outcome rate given its patient (case) mix and service. The process of calculating the hospital's expected outcome rate given its patient mix and service is called risk adjustment (Iezzoni 1997). Risk adjustment is critical for accurately evaluating and comparing hospitals' performances since we would not want to unfairly penalize a hospital just because it treats sicker patients. The key to risk adjustment is accurately estimating the probability of an Outcome given patient characteristics. For cases with binary outcomes, the method that is commonly used in risk adjustment is logistic regression. In this paper, we consider ensemble of trees methods as alternatives for risk adjustment, including random forests and Bayesian additive regression trees (BART). Both random forests and BART are modern machine learning methods that have been shown recently to have excellent performance for prediction of outcomes in many settings. We apply these methods to carry out risk adjustment for the performance of neonatal intensive care units (NICU). We show that these ensemble of trees methods outperform logistic regression in predicting mortality among babies treated in NICU, and provide a superior method of risk adjustment compared to logistic regression.

Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

PubMed

Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

2008-05-01

To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

Validation of Skills, Knowledge and Experience in Lifelong Learning in Europe

ERIC Educational Resources Information Center

Ogunleye, James

2012-01-01

The paper examines systems of validation of skills and experience as well as the main methods/tools currently used for validating skills and knowledge in lifelong learning. The paper uses mixed methods--a case study research and content analysis of European Union policy documents and frameworks--as a basis for this research. The selection of the…

Belonging to and Exclusion from the Peer Group in Schools: Influences on Adolescents' Moral Choices

ERIC Educational Resources Information Center

Feigenberg, Luba Falk; King, Melissa Steel; Barr, Dennis J.; Selman, Robert L.

2008-01-01

This paper reports on a mixed methods study of adolescents' responses to case material about social exclusion. First, a qualitative coding method is presented that describes the way adolescents choose and justify strategies to negotiate such situations. The responses were then analysed quantitatively using chi square tests and multinomial logistic…

Moral Judgement Changes among Undergraduates in a Capstone Internship Experience

ERIC Educational Resources Information Center

Craig, Patricia J.; Oja, Sharon Nodie

2013-01-01

This mixed-methods study explored the moral growth of undergraduates in a recreation management internship experience. The quantitative phase reported moral judgement gains in Personal Interest and Post-conventional schema, and N-2 scores, as measured by the Defining Issues Test 2 (DIT-2), among 33 interns. The case-study method used a pattern…

Legal Outcomes of Sexually Abused Children Evaluated at the Philippine General Hospital Child Protection Unit

ERIC Educational Resources Information Center

Sugue-Castillo, Mariella

2009-01-01

Objectives: To describe the legal outcomes and factors associated with case reaching court and conviction for sexual abuse of children seen at the Philippine General Hospital Child Protection Unit (PGH-CPU) from 1997 to 2000. Methods: Mixed transdisciplinary research design combined longitudinal cohort with qualitative methods. Data were obtained…

Examining Current Beliefs, Practices and Barriers about Technology Integration: A Case Study

ERIC Educational Resources Information Center

Hsu, Pi-Sui

2016-01-01

The purpose of this mixed-methods study was to examine the current beliefs, practices and barriers concerning technology integration of Kindergarten through Grade Six teachers in the midwestern United States. The three data collection methods were online surveys with 152 teachers as well as interviews and observations with 8 teachers. The findings…

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China

PubMed Central

Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun

2016-01-01

Background: In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. Methods: This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. Results: We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. Conclusions: We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures. PMID:27064041

Solar neutrino masses and mixing from bilinear R-parity broken supersymmetry: Analytical versus numerical results

NASA Astrophysics Data System (ADS)

Díaz, M.; Hirsch, M.; Porod, W.; Romão, J.; Valle, J.

2003-07-01

We give an analytical calculation of solar neutrino masses and mixing at one-loop order within bilinear R-parity breaking supersymmetry, and compare our results to the exact numerical calculation. Our method is based on a systematic perturbative expansion of R-parity violating vertices to leading order. We find in general quite good agreement between the approximate and full numerical calculations, but the approximate expressions are much simpler to implement. Our formalism works especially well for the case of the large mixing angle Mikheyev-Smirnov-Wolfenstein solution, now strongly favored by the recent KamLAND reactor neutrino data.

Hospital branding in Italy: A pilot study based on the case method.

PubMed

Esposito, Annamaria

2017-01-01

The article investigates if, and in affirmative case how, Italian hospitals are managing corporate brand communication. Thanks to results of qualitative research, this article offers insights on Italian hospital branding. The pilot study based in the case method is to be considered a starting point for wider investigations on this topic, and it is useful for managers and practitioners who want to understand the role of corporate brand in hospital communication management and to connect health care professionals with the audience in a meaningful way in those countries in which the health care system is a mix of both public and private institutions.

Topology optimisation of micro fluidic mixers considering fluid-structure interactions with a coupled Lattice Boltzmann algorithm

NASA Astrophysics Data System (ADS)

Munk, David J.; Kipouros, Timoleon; Vio, Gareth A.; Steven, Grant P.; Parks, Geoffrey T.

2017-11-01

Recently, the study of micro fluidic devices has gained much interest in various fields from biology to engineering. In the constant development cycle, the need to optimise the topology of the interior of these devices, where there are two or more optimality criteria, is always present. In this work, twin physical situations, whereby optimal fluid mixing in the form of vorticity maximisation is accompanied by the requirement that the casing in which the mixing takes place has the best structural performance in terms of the greatest specific stiffness, are considered. In the steady state of mixing this also means that the stresses in the casing are as uniform as possible, thus giving a desired operating life with minimum weight. The ultimate aim of this research is to couple two key disciplines, fluids and structures, into a topology optimisation framework, which shows fast convergence for multidisciplinary optimisation problems. This is achieved by developing a bi-directional evolutionary structural optimisation algorithm that is directly coupled to the Lattice Boltzmann method, used for simulating the flow in the micro fluidic device, for the objectives of minimum compliance and maximum vorticity. The needs for the exploration of larger design spaces and to produce innovative designs make meta-heuristic algorithms, such as genetic algorithms, particle swarms and Tabu Searches, less efficient for this task. The multidisciplinary topology optimisation framework presented in this article is shown to increase the stiffness of the structure from the datum case and produce physically acceptable designs. Furthermore, the topology optimisation method outperforms a Tabu Search algorithm in designing the baffle to maximise the mixing of the two fluids.

External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

PubMed Central

Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

2016-01-01

Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

The Case for Case-Mix: A New Construct for Hospital Management

PubMed Central

Plomann, Marilyn Peacock; Garzino, Fred R.

1981-01-01

Case-mix is a useful methodology for health care management, planning and control. It provides managers with a powerful tool by providing a framework for relating resource consumption profiles with specific treatment patterns. In the long run, it will assist hospital planners in analyzing the demands which different classes of patients bring to the hospital. Decisions concerning capital financing, facilities planning, new services, and the medical and financial implications of physician activities are more efficiently analyzed within a case-mix framework. In the near term, inventory management, staffing policies and the on-going need for the astute management of cash flow will be postively and decisively affected by the use of case-mix measures. The benefits derived from a case-mix system are not limited to hospitals possessing sophisticated management information systems. The case-mix methodology also provides a useful tool for hospitals with less advanced data processing systems and management practices in applying a variety of management science techniques to their planning and control activities.

The Readiness of Lecturers in Embedding Soft Skills in the Bachelor's Degree Program in Malaysian Institutes of Teacher Education

ERIC Educational Resources Information Center

Hassan, Aminuddin; Maharoff, Marina; Abiddin, Norhasni Zainal

2014-01-01

This is a preliminary research to obtain information to formulate a problem statement for an overall study of the embedding of soft skills in the program courses in higher learning institutions. This research was conducted in the form of single case and multi-case studies. The research data was attained through mixed methods; the quantitative…

Preparing Teachers for Prison Schools: A Case Study of the Challenges, Attitudes, and Motivations of Correctional Educators

ERIC Educational Resources Information Center

Lawton, Lucile

2012-01-01

The purpose of this case study using a mixed method approach was to examine the role of that correctional educators in an Arizona state prison based on their challenges, attitudes, and motivations in order to learn how best to prepare people for that role. Although the research on public school teachers and teaching in adult education practices in…

Why Children Join and Stay in Sports Clubs: Case Studies in Australian, French and German Swimming Clubs

ERIC Educational Resources Information Center

Light, Richard L.; Harvey, Stephen; Memmert, Daniel

2013-01-01

This article builds upon research on youth sport clubs conducted from a socio-cultural perspective by reporting on a study that inquired into the reasons why children aged 9-12 joined swimming clubs in France, Germany and Australia. Comprising three case studies it employed a mixed method approach with results considered within the framework of…

A Case Study of Human Resource Development Professionals' Decision Making in Vendor Selection for Employee Development: A Degrees-of-Freedom Analysis

ERIC Educational Resources Information Center

Cathcart, Stephen Michael

2016-01-01

This mixed method study examines HRD professionals' decision-making processes when making an organizational purchase of training. The study uses a case approach with a degrees of freedom analysis. The data to analyze will examine how HRD professionals in manufacturing select outside vendors human resource development programs for training,…

Acceptance of routine or case-based inquiry for intimate partner violence: a mixed method study

PubMed Central

2013-01-01

Background The prevalence and detrimental health effects of intimate partner violence have resulted in international discussions and recommendations that health care professionals should screen women for intimate partner violence during general and antenatal health care visits. Due to the lack of discussion on routine or case-based inquiry for intimate partner violence during antenatal care in Germany, this study seeks to explore its acceptability among pregnant German women. Methods A mixed methods approach was used, utilizing a self-administered survey on the acceptability of routine or case-based inquiry for intimate partner violence in a university hospital’s maternity ward in Munich and in-depth interviews with seven women who experienced violence during pregnancy. Results Of the 401 women who participated in the survey, 92 percent were in favor of routine or case-based inquiry for intimate partner violence during antenatal care. Acceptance of routine or case-based inquiry for intimate partner violence during antenatal care was significantly associated with women’s experiences of child sexual abuse, being young, less educated, single or divorced and smoking during pregnancy. Open-ended survey questions and in-depth interviews stressed adequate training for screening, sufficient time and provision of referral information as important conditions for routine or case-based inquiry for intimate partner violence. Conclusions Women in this study showed an overwhelming support for routine or case-based screening for intimate partner violence in antenatal care in Germany. Until adequate training is in place to allow providers to inquire for intimate partner violence in a professional manner, this study recommends that health care providers are made aware of the prevalence and health consequences of violence during pregnancy. PMID:23531127

The PIG in sPrInG: evidence on letter grouping from the reading of buried words.

PubMed

Humphreys, Glyn W; Mayall, Kate; Cooper, Adam C G

2003-12-01

We introduce a novel procedure for investigating factors that determine selective attention to letters in words. Participants were presented with words (in Experiments 1 and 3) and nonwords (in Experiment 2) that contained a buried word whose letters differed in color relative to the other letters present (e.g., pig, in spring). The strings were presented in single case or mixed case, keeping the letters of the buried words in one case (SpRiNg). The time in which the whole stimulus was named was shorter for same-case than for mixed-case strings (for spring: spring < SpRiNg). In contrast, the time in which buried words were named was shorter in mixed- than in same-case strings (for pig: spring > SpRiNg). Across items, the effects of case mixing were negatively correlated across the two tasks. The positive effect of case mixing for buried words also occurred irrespective of whether the whole string was a word or a nonword, and there were contributions from similarity of both letter size and case. The results suggest that case mixing can facilitate selective attention to letters, which is otherwise disrupted by size- and case-based grouping across letter strings. The study provides evidence for letter grouping using size and case information.

System equivalent model mixing

NASA Astrophysics Data System (ADS)

Klaassen, Steven W. B.; van der Seijs, Maarten V.; de Klerk, Dennis

2018-05-01

This paper introduces SEMM: a method based on Frequency Based Substructuring (FBS) techniques that enables the construction of hybrid dynamic models. With System Equivalent Model Mixing (SEMM) frequency based models, either of numerical or experimental nature, can be mixed to form a hybrid model. This model follows the dynamic behaviour of a predefined weighted master model. A large variety of applications can be thought of, such as the DoF-space expansion of relatively small experimental models using numerical models, or the blending of different models in the frequency spectrum. SEMM is outlined, both mathematically and conceptually, based on a notation commonly used in FBS. A critical physical interpretation of the theory is provided next, along with a comparison to similar techniques; namely DoF expansion techniques. SEMM's concept is further illustrated by means of a numerical example. It will become apparent that the basic method of SEMM has some shortcomings which warrant a few extensions to the method. One of the main applications is tested in a practical case, performed on a validated benchmark structure; it will emphasize the practicality of the method.

Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

PubMed

Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

2015-08-01

When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of the Jigsaw-Based Cooperative Learning Method on Student Performance in the General Certificate of Education Advanced-Level Psychology: An Exploratory Brunei Case Study

ERIC Educational Resources Information Center

Azmin, Nur Hafizah

2016-01-01

The mixed-methods study investigated the effect of the jigsaw cooperative learning method on student performance in psychology and their views towards it. Experimental data were obtained via pre-and-post tests and an open-ended questionnaire from 16 conveniently selected students at one Sixth Form College in Brunei. Moreover, the participants…

Improving ethical knowledge and sensemaking from cases through elaborative interrogation and outcome valence.

PubMed

Johnson, James F; Bagdasarov, Zhanna; MacDougall, Alexandra E; Steele, Logan; Connelly, Shane; Devenport, Lynn D; Mumford, Michael D

2014-01-01

The case-based approach to learning is popular among many applied fields. However, results of case-based education vary widely on case content and case presentation. This study examined two aspects of case-based education-outcome valence and case elaboration methods-in a two-day case-based Responsible Conduct of Research (RCR) ethics education program. Results suggest that outcome information is an integral part of a quality case. Furthermore, valence consistent outcomes may have certain advantages over mixed valence outcome information. Finally, students enjoy and excel working with case material, and the use of elaborative interrogation techniques can significantly improve internally-focused ethical sensemaking strategies associated with personal biases, constraints, and emotions.

Public hospital resource allocations in El Salvador: accounting for the case mix of patients.

PubMed

Fiedler, J L; Schmidt, R M; Wight, J B

1998-09-01

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-03-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-01-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mitecontaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan. © 2014 Japanese Society of Allergology.

Restructuring in response to case mix reimbursement in nursing homes: A contingency approach

PubMed Central

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2013-01-01

Background Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. Purpose The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. Methodology/Approach The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Findings Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Practice Implications Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring. PMID:18360162

Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

PubMed

Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

2008-01-01

Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring.

Development of self-awareness after severe traumatic brain injury through participation in occupation-based rehabilitation: mixed-methods analysis of a case series.

PubMed

Doig, Emmah; Kuipers, Pim; Prescott, Sarah; Cornwell, Petrea; Fleming, Jennifer

2014-01-01

OBJECTIVE. We examined participation in goal planning and development of self-awareness for people with impaired self-awareness after traumatic brain injury. METHOD. We performed a mixed-methods study of 8 participants recently discharged from inpatient rehabilitation. Self-awareness was measured using discrepancy between self and significant other ratings on the Mayo-Portland Adaptability Index (MPAI-4) at four time points. We calculated effect size to evaluate the change in MPAI-4 discrepancy over time. RESULTS. Seven participants identified their own goals. We found a large reduction in mean MPAI-4 discrepancy (M = 8.57, SD = 6.59, N = 7, d = 1.08) in the first 6 wk and a further small reduction (M = 5.33, SD = 9.09, N = 6, d = 0.45) in the second 6 wk of intervention. Case data indicated that 7 participants demonstrated some growth in self-awareness. CONCLUSION. Engagement in occupation-based, goal-directed rehabilitation appeared to foster awareness of injury-related changes to varying extents. Copyright © 2014 by the American Occupational Therapy Association, Inc.

Bioactivity of CaSiO3/poly-lactic acid (PLA) composites prepared by various surface loading methods of CaSiO3 powder.

PubMed

Okada, Kiyoshi; Hasegawa, Fumikazu; Kameshima, Yoshikazu; Nakajima, Akira

2007-05-01

Mixing bioactive ceramic powders with polymers is an effective method for generating bioactivity to the polymer-matrix composites but it is necessary to incorporate up to 40 vol% of bioactive ceramic powder. However, such a high mixing ratio offsets the advantages of the flexibility and formability of polymer matrix and it would be highly advantageous to lower the mixing ratio. Since surface loading of ceramic powders in the polymer is thought to be an effective way of reducing the mixing ratio of the ceramic powder while maintaining bioactive activity, CaSiO(3)/poly-lactic acid (PLA) composites were prepared by three methods; (1) casting, (2) spin coating and (3) hot pressing. In methods (1) and (2), a suspension was prepared by dissolving PLA in chloroform and dispersing CaSiO(3) powder in it. The suspension was cast and dried to form a film in the case of method (1) while it was spin-coated on a PLA substrate in method (2). In method (3), CaSiO(3) powder was surface loaded on to a PLA substrate by hot pressing. The bioactivity of these samples was investigated in vitro using simulated body fluid (SBF). Apatite formation was not observed in the samples prepared by method (1) but some apatite formation was achieved by mixing polyethylene glycol (PEG) with the PLA, producing a porous polymer matrix. In method (2), apatite was clearly observed after soaking for 7 days. Enhanced apatite formation was observed in method (3), the thickness of the resulting apatite layers becoming about 20 microm after soaking for 14 days. Since the amount of CaSiO(3) powder used in these samples was only

Bioactivity of CaSiO3/poly-lactic acid (PLA) composites prepared by various surface loading methods of CaSiO3 powder.

PubMed

Okada, Kiyoshi; Hasegawa, Fumikazu; Kameshima, Yoshikazu; Nakajima, Akira

2007-08-01

Mixing bioactive ceramic powders with polymers is an effective method for generating bioactivity to the polymer-matrix composites but it is necessary to incorporate up to 40 vol% of bioactive ceramic powder. However, such a high mixing ratio offsets the advantages of the flexibility and formability of polymer matrix and it would be highly advantageous to lower the mixing ratio. Since surface loading of ceramic powders in the polymer is thought to be an effective way of reducing the mixing ratio of the ceramic powder while maintaining bioactive activity, CaSiO(3)/poly-lactic acid (PLA) composites were prepared by three methods; (1) casting, (2) spin coating and (3) hot pressing. In methods (1) and (2), a suspension was prepared by dissolving PLA in chloroform and dispersing CaSiO(3) powder in it. The suspension was cast and dried to form a film in the case of method (1) while it was spin-coated on a PLA substrate in method (2). In method (3), CaSiO(3) powder was surface loaded on to a PLA substrate by hot-pressing. The bioactivity of these samples was investigated in vitro using simulated body fluid (SBF). Apatite formation was not observed in the samples prepared by method (1) but some apatite formation was achieved by mixing polyethylene glycol (PEG) with the PLA, producing a porous polymer matrix. In method (2), apatite was clearly observed after soaking for 7 days. Enhanced apatite formation was observed in method (3), the thickness of the resulting apatite layers becoming about 20 microm after soaking for 14 days. Since the amount of CaSiO(3) powder used in these samples was only < or =0.4 vol%, it is concluded that this preparation method is very effective in generating bioactivity in polymer-matrix composites by loading with only very small amounts of ceramic powder.

Do Financial Incentives of Introducing Case Mix Reimbursement Increase Feeding Tube Use in Nursing Home Residents?

PubMed Central

Teno, Joan M.; Feng, Zhanlian; Mitchell, Susan L.; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

2013-01-01

OBJECTIVES To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. DESIGN Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states’ adoption of case mix reimbursement. SETTING NHs in the United States. PARTICIPANTS NH residents at the time of NH inspection between 1993 and 2004. MEASUREMENTS Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. RESULTS Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. CONCLUSION The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use. PMID:18331293

Phosphate analysis of natural sausage casings preserved in brines with phosphate additives as inactivating agent - Method validation.

PubMed

Wijnker, J J; Tjeerdsma-van Bokhoven, J L M; Veldhuizen, E J A

2009-01-01

Certain phosphates have been identified as suitable additives for the improvement of the microbial and mechanical properties of processed natural sausage casings. When mixed with NaCl (sodium chloride) and used under specific treatment and storage conditions, these phosphates are found to prevent the spread of foot-and-mouth disease and classical swine fever via treated casings. The commercially available Quantichrom™ phosphate assay kit has been evaluated as to whether it can serve as a reliable and low-tech method for routine analysis of casings treated with phosphate. The outcome of this study indicates that this particular assay kit has sufficient sensitivity to qualitatively determine the presence of phosphate in treated casings without interference of naturally occurring phosphate in salt used for brines in which casings are preserved.

Hexa Helix: Modified Quad Helix Appliance to Correct Anterior and Posterior Crossbites in Mixed Dentition

PubMed Central

Yaseen, Syed Mohammed; Acharya, Ravindranath

2012-01-01

Among the commonly encountered dental irregularities which constitute developing malocclusion is the crossbite. During primary and mixed dentition phase, the crossbite is seen very often and if left untreated during these phases then a simple problem may be transformed into a more complex problem. Different techniques have been used to correct anterior and posterior crossbites in mixed dentition. This case report describes the use of hexa helix, a modified version of quad helix for the management of anterior crossbite and bilateral posterior crossbite in early mixed dentition. Correction was achieved within 15 weeks with no damage to the tooth or the marginal periodontal tissue. The procedure is a simple and effective method for treating anterior and bilateral posterior crossbites simultaneously. PMID:23119188

42 CFR 484.240 - Methodology used for the calculation of the outlier payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for each case-mix group. (b) The outlier threshold for each case-mix group is the episode payment... the same for all case-mix groups. (c) The outlier payment is a proportion of the amount of estimated...

[Effect of non-genetically modified (non-GM) soy varieties on the measured value of GM soy by a quantitative PCR method].

PubMed

Watanabe, Takahiro; Sekino, Ayako; Shiramasa, Yuko; Matsuda, Rieko; Maitani, Tamio

2008-08-01

It is very important to examine the effect of non-genetically modified (non-GM) soy varieties, which constitute the matrix of the testing sample used to quantify GM soy (RRS), on the measured value of RRS by quantitative PCR methods. Therefore, we quantified the amount of RRS in powder-mixed samples containing 1 or 5% RRS prepared by using 10 different varieties of non-GM soy as the matrix. The results revealed that the measured values were not in agreement with the powder-mixing levels and that the extent of the difference depended on the variety of non-GM soy used as the matrix. The yields of DNA extracted differed among the soy varieties. On the other hand, analysis of DNA-mixed samples, that were prepared with the DNAs extracted from RRS and non-GM soy varieties, showed that the measured values of RRS were in agreement with the DNA-mixing levels. These results strongly suggest that the proportions of DNA derived from RRS and non-GM soy were not consistent with the powder-mixing ratio in the case of some non-GM soy varieties used as a matrix, resulting in the discrepancy between the measured values and the powder-mixing levels.

Comparison of Sexual Mixing Patterns for Syphilis in Endemic and Outbreak Settings

PubMed Central

Doherty, Irene A; Adimora, Adaora A; Muth, Stephen Q; Serre, Marc L; Leone, Peter A; Miller, William C

2015-01-01

Background In a largely rural region of North Carolina during 1998–2002, outbreaks occurred of heterosexually-transmitted syphilis, tied to crack cocaine use and exchange of sex for drugs and money. Sexual partnership mixing patterns are an important characteristic of sexual networks that relate to transmission dynamics of STIs. Methods Using contact tracing data collected by Disease Intervention Specialists, we estimated Newman assortativity coefficients and compared values in counties experiencing syphilis outbreaks to non-outbreak counties, with respect to race/ethnicity, race/ethnicity and age, and the cases' number of social/sexual contacts, infected contacts, sex partners, and infected sex partners, and syphilis disease stage (primary, secondary, early latent). Results Individuals in the outbreak counties had more contacts and mixing by the number of sex partners was disassortative in outbreak counties and assortative non-outbreak counties. Whereas mixing by syphilis disease stage was minimally assortative in outbreak counties, it was disassortative in non-outbreak areas. Partnerships were relatively discordant by age, especially among older White men, who often chose considerably younger female partners. Conclusions Whether assortative mixing exacerbates or attenuates the reach of STIs into different populations depends on the characteristic/attribute and epidemiologic phase. Examination of sexual partnership characteristics and mixing patterns offers insights into the growth of STI outbreaks that complement other research methods. PMID:21217418

Social vulnerability analysis of the event flood puddle (case study in Lamongan regency, East Java province)

NASA Astrophysics Data System (ADS)

Soegiyanto; Rindawati

2018-01-01

This research was conducted in the flood plain Bonorowo in Lamongan East Java Province. The area was inundated almost every year, but people still survive and remain settled at the sites. This research is to identify and analyze the social vulnerability in the flood plains on the characteristics puddle Bonorowo This research method is the study of the characteristics and livelihood strategies of the communities living on marginal lands (floodplains Bonorowo) are regions prone to flooding / inundation. Based on the object of this study is a survey research method mix / mix method, which merge or combination of methods of quantitative and qualitative methods, so it will be obtained a description of a more comprehensive and holistic. The results obtained in this study are; Social vulnerability is not affected by the heightened puddles. Social capital is abundant making society safer and more comfortable to keep their activities and settle in the region

Parameterizing correlations between hydrometeor species in mixed-phase Arctic clouds

NASA Astrophysics Data System (ADS)

Larson, Vincent E.; Nielsen, Brandon J.; Fan, Jiwen; Ovchinnikov, Mikhail

2011-01-01

Mixed-phase Arctic clouds, like other clouds, contain small-scale variability in hydrometeor fields, such as cloud water or snow mixing ratio. This variability may be worth parameterizing in coarse-resolution numerical models. In particular, for modeling multispecies processes such as accretion and aggregation, it would be useful to parameterize subgrid correlations among hydrometeor species. However, one difficulty is that there exist many hydrometeor species and many microphysical processes, leading to complexity and computational expense. Existing lower and upper bounds on linear correlation coefficients are too loose to serve directly as a method to predict subgrid correlations. Therefore, this paper proposes an alternative method that begins with the spherical parameterization framework of Pinheiro and Bates (1996), which expresses the correlation matrix in terms of its Cholesky factorization. The values of the elements of the Cholesky matrix are populated here using a "cSigma" parameterization that we introduce based on the aforementioned bounds on correlations. The method has three advantages: (1) the computational expense is tolerable; (2) the correlations are, by construction, guaranteed to be consistent with each other; and (3) the methodology is fairly general and hence may be applicable to other problems. The method is tested noninteractively using simulations of three Arctic mixed-phase cloud cases from two field experiments: the Indirect and Semi-Direct Aerosol Campaign and the Mixed-Phase Arctic Cloud Experiment. Benchmark simulations are performed using a large-eddy simulation (LES) model that includes a bin microphysical scheme. The correlations estimated by the new method satisfactorily approximate the correlations produced by the LES.

Spatial Analysis of Case-Mix and Dialysis Modality Associations

PubMed Central

Phirtskhalaishvili, Tamar; Bayer, Florian; Edet, Stephane; Bongiovanni, Isabelle; Hogan, Julien; Couchoud, Cécile

2016-01-01

♦ Background: Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ Methods: The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ Result: The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ Conclusions: The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency. PMID:26475843

Doing Mixed Methods Research Pragmatically: Implications for the Rediscovery of Pragmatism as a Research Paradigm

ERIC Educational Resources Information Center

Feilzer, Martina Yvonne

2010-01-01

This article explores the practical relevance of pragmatism as a research paradigm through the example of a piece of pragmatic research that not only used both quantitative and qualitative research methods but also exploited the inherent duality of the data analyzed. Thus, the article aims to make the case that pragmatism as a research paradigm…

Inequality and Redistribution Policy Issues: Principles and Swedish Experience; Comment on Lindbeck's Paper [and] Discussion Paper.

ERIC Educational Resources Information Center

Lindbeck, Assar

Alternative methods of redistribution policy in mixed economies are compared in this paper. The paper deals with the objectives, methods, and problems in redistribution policy. The chief objective is to highlight principles and general problems, drawing heavily on the experiences of Sweden. This country is chosen as a case study since attempts to…

Democratic Environments Offered to Children at School, in the Family, and in Society: The Case of Turkey

ERIC Educational Resources Information Center

Kus, Zafer

2014-01-01

This research aims to investigate democratic environments offered to children in Turkey at school, in the home, and in society. A mixed method is a general type of research where qualitative and quantitative methods are used together. The researcher first collects quantitative and then the qualitative data. The study group in the research…

A Feasibility Study of Using ICT in Iranian Secondary Schools: The Case of Tehran Province

ERIC Educational Resources Information Center

Fathi Vajargah, Kourosh; Saadattlab, Ayat

2014-01-01

This research presents the results of a feasibility assessment on implementing ICT in Tehran high schools. Mixed method research (both qualitative and quantitative) was employed and due to the nature of research, data collection included two stages: library and field study. Using the cluster method with 362 subjects, data was collected using a…

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs.

PubMed

Rosen, Amy K; Loveland, Susan A; Rakovski, Carter C; Christiansen, Cindy L; Berlowitz, Dan R

2003-01-01

Although case-mix adjustment is critical for provider profiling, little is known regarding whether different case-mix measures affect assessments of provider efficiency. We examine whether two case-mix measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), result in different assessments of efficiency across service networks within the Department of Veterans Affairs (VA). Three profiling indicators examine variation in resource use. Although results from the ACGs and DCGs generally agree on which networks have greater or lesser efficiency than average, assessments of individual network efficiency vary depending upon the case-mix measure used. This suggests that caution should be used so that providers are not misclassified based on reported efficiency.

Parameterizing correlations between hydrometeor species in mixed-phase Arctic clouds

DOE Office of Scientific and Technical Information (OSTI.GOV)

Larson, Vincent E.; Nielsen, Brandon J.; Fan, Jiwen

2011-08-16

Mixed-phase Arctic clouds, like other clouds, contain small-scale variability in hydrometeor fields, such as cloud water or snow mixing ratio. This variability may be worth parameterizing in coarse-resolution numerical models. In particular, for modeling processes such as accretion and aggregation, it would be useful to parameterize subgrid correlations among hydrometeor species. However, one difficulty is that there exist many hydrometeor species and many microphysical processes, leading to complexity and computational expense.Existing lower and upper bounds (inequalities) on linear correlation coefficients provide useful guidance, but these bounds are too loose to serve directly as a method to predict subgrid correlations. Therefore,more » this paper proposes an alternative method that is based on a blend of theory and empiricism. The method begins with the spherical parameterization framework of Pinheiro and Bates (1996), which expresses the correlation matrix in terms of its Cholesky factorization. The values of the elements of the Cholesky matrix are parameterized here using a cosine row-wise formula that is inspired by the aforementioned bounds on correlations. The method has three advantages: 1) the computational expense is tolerable; 2) the correlations are, by construction, guaranteed to be consistent with each other; and 3) the methodology is fairly general and hence may be applicable to other problems. The method is tested non-interactively using simulations of three Arctic mixed-phase cloud cases from two different field experiments: the Indirect and Semi-Direct Aerosol Campaign (ISDAC) and the Mixed-Phase Arctic Cloud Experiment (M-PACE). Benchmark simulations are performed using a large-eddy simulation (LES) model that includes a bin microphysical scheme. The correlations estimated by the new method satisfactorily approximate the correlations produced by the LES.« less

Separation of Flame and Nonflame-retardant Plastics Utilizing Magneto-Archimedes Method

NASA Astrophysics Data System (ADS)

Misawa, Kohei; Kobayashi, Takayuki; Mori, Tatsuya; Mishima, Fumihito; Akiyama, Yoko; Nishijima, Shigehiro

2017-07-01

In physical recycling process, the quality of recycled plastics becomes usually poor in case various kinds of plastic materials are mixed. In order to solve the problem, we tried to separate flame and nonflame-retardant plastics used for toner cartridges as one example of mixed plastics by using magneto-Archimedes method. By using this method, we can control levitation and settlement of the particles in the medium by controlling the density and magnetic susceptibility of the medium and the magnetic field. In this study, we introduced the separation system of plastics by the combination of wet type specific gravity separation and magneto-Archimedes separation. In addition, we examined continuous and massive separation by introducing the system which can separate the plastics continuously in the flowing fluid.

Mix-infection of S. Typhi and ParaTyphi A in Typhoid Fever and Chronic Typhoid Carriers: A Nested PCR Based Study in North India

PubMed Central

Pratap, Chandra Bhan; Kumar, Gopal; Patel, Saurabh Kumar; Shukla, Vijay K; Kumar, Kailash; Singh, Tej Bali

2014-01-01

Introduction: Enteric fever is a systemic disease caused by Salmonella organism such as serotypes Typhi and ParaTyphi A, B, C. Salmonella ParaTyphi A contributes more than 50% of all the enteric fever cases and it has recently been projected as an emerging pathogen. Materials and Methods: The present study was aimed to detect Salmonella Typhi and ParaTyphi A in urine, blood and stool specimens collected from cases of enteric fever (110), chronic typhoid carriers (46) and healthy controls (75) to explore the possibility of mixed infection by nested PCR. A new nested PCR primer was designed targeting putative fimbrial protein (stkG) gene which is one of the fimbrial gene families to Salmonella ParaTyphi A and for S. Typhi already reported primers targeting flagellin (fliC) gene. Results: Large volume of urine specimens (15 ml) was found to be the best for detection of Salmonella serotypes. The urine sample was found to have mixed-infection by both the serotypes in 40.9% of the cases but lower in blood (27.3%) and stool (13.6%). Conclusion: The present study concludes that occurrence of mixed infection may be quite frequent in typhoid and chronic typhoid carriers’ individuals, although the reported recent rise in ParaTyphi A incidence may not be real. PMID:25584217

An adjoint-based framework for maximizing mixing in binary fluids

NASA Astrophysics Data System (ADS)

Eggl, Maximilian; Schmid, Peter

2017-11-01

Mixing in the inertial, but laminar parameter regime is a common application in a wide range of industries. Enhancing the efficiency of mixing processes thus has a fundamental effect on product quality, material homogeneity and, last but not least, production costs. In this project, we address mixing efficiency in the above mentioned regime (Reynolds number Re = 1000 , Peclet number Pe = 1000) by developing and demonstrating an algorithm based on nonlinear adjoint looping that minimizes the variance of a passive scalar field which models our binary Newtonian fluids. The numerical method is based on the FLUSI code (Engels et al. 2016), a Fourier pseudo-spectral code, which we modified and augmented by scalar transport and adjoint equations. Mixing is accomplished by moving stirrers which are numerically modeled using a penalization approach. In our two-dimensional simulations we consider rotating circular and elliptic stirrers and extract optimal mixing strategies from the iterative scheme. The case of optimizing shape and rotational speed of the stirrers will be demonstrated.

The long-solved problem of the best-fit straight line: application to isotopic mixing lines

NASA Astrophysics Data System (ADS)

Wehr, Richard; Saleska, Scott R.

2017-01-01

It has been almost 50 years since York published an exact and general solution for the best-fit straight line to independent points with normally distributed errors in both x and y. York's solution is highly cited in the geophysical literature but almost unknown outside of it, so that there has been no ebb in the tide of books and papers wrestling with the problem. Much of the post-1969 literature on straight-line fitting has sown confusion not merely by its content but by its very existence. The optimal least-squares fit is already known; the problem is already solved. Here we introduce the non-specialist reader to York's solution and demonstrate its application in the interesting case of the isotopic mixing line, an analytical tool widely used to determine the isotopic signature of trace gas sources for the study of biogeochemical cycles. The most commonly known linear regression methods - ordinary least-squares regression (OLS), geometric mean regression (GMR), and orthogonal distance regression (ODR) - have each been recommended as the best method for fitting isotopic mixing lines. In fact, OLS, GMR, and ODR are all special cases of York's solution that are valid only under particular measurement conditions, and those conditions do not hold in general for isotopic mixing lines. Using Monte Carlo simulations, we quantify the biases in OLS, GMR, and ODR under various conditions and show that York's general - and convenient - solution is always the least biased.

A path towards uncertainty assignment in an operational cloud-phase algorithm from ARM vertically pointing active sensors

DOE PAGES

Riihimaki, Laura D.; Comstock, Jennifer M.; Anderson, Kevin K.; ...

2016-06-10

Knowledge of cloud phase (liquid, ice, mixed, etc.) is necessary to describe the radiative impact of clouds and their lifetimes, but is a property that is difficult to simulate correctly in climate models. One step towards improving those simulations is to make observations of cloud phase with sufficient accuracy to help constrain model representations of cloud processes. In this study, we outline a methodology using a basic Bayesian classifier to estimate the probabilities of cloud-phase class from Atmospheric Radiation Measurement (ARM) vertically pointing active remote sensors. The advantage of this method over previous ones is that it provides uncertainty informationmore » on the phase classification. We also test the value of including higher moments of the cloud radar Doppler spectrum than are traditionally used operationally. Using training data of known phase from the Mixed-Phase Arctic Cloud Experiment (M-PACE) field campaign, we demonstrate a proof of concept for how the method can be used to train an algorithm that identifies ice, liquid, mixed phase, and snow. Over 95 % of data are identified correctly for pure ice and liquid cases used in this study. Mixed-phase and snow cases are more problematic to identify correctly. When lidar data are not available, including additional information from the Doppler spectrum provides substantial improvement to the algorithm. As a result, this is a first step towards an operational algorithm and can be expanded to include additional categories such as drizzle with additional training data.« less

A path towards uncertainty assignment in an operational cloud-phase algorithm from ARM vertically pointing active sensors

NASA Astrophysics Data System (ADS)

Riihimaki, Laura D.; Comstock, Jennifer M.; Anderson, Kevin K.; Holmes, Aimee; Luke, Edward

2016-06-01

Knowledge of cloud phase (liquid, ice, mixed, etc.) is necessary to describe the radiative impact of clouds and their lifetimes, but is a property that is difficult to simulate correctly in climate models. One step towards improving those simulations is to make observations of cloud phase with sufficient accuracy to help constrain model representations of cloud processes. In this study, we outline a methodology using a basic Bayesian classifier to estimate the probabilities of cloud-phase class from Atmospheric Radiation Measurement (ARM) vertically pointing active remote sensors. The advantage of this method over previous ones is that it provides uncertainty information on the phase classification. We also test the value of including higher moments of the cloud radar Doppler spectrum than are traditionally used operationally. Using training data of known phase from the Mixed-Phase Arctic Cloud Experiment (M-PACE) field campaign, we demonstrate a proof of concept for how the method can be used to train an algorithm that identifies ice, liquid, mixed phase, and snow. Over 95 % of data are identified correctly for pure ice and liquid cases used in this study. Mixed-phase and snow cases are more problematic to identify correctly. When lidar data are not available, including additional information from the Doppler spectrum provides substantial improvement to the algorithm. This is a first step towards an operational algorithm and can be expanded to include additional categories such as drizzle with additional training data.

Do nursing homes for older people have the support they need to provide end-of-life care? A mixed methods enquiry in England

PubMed Central

Seymour, Jane E; Kumar, Arun; Froggatt, Katherine

2011-01-01

Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of ‘key’ external advocates and leverage of additional resources by adoption of care pathway tools. PMID:21282349

The effect of misclassification errors on case mix measurement.

PubMed

Sutherland, Jason M; Botz, Chas K

2006-12-01

Case mix systems have been implemented for hospital reimbursement and performance measurement across Europe and North America. Case mix categorizes patients into discrete groups based on clinical information obtained from patient charts in an attempt to identify clinical or cost difference amongst these groups. The diagnosis related group (DRG) case mix system is the most common methodology, with variants adopted in many countries. External validation studies of coding quality have confirmed that widespread variability exists between originally recorded diagnoses and re-abstracted clinical information. DRG assignment errors in hospitals that share patient level cost data for the purpose of establishing cost weights affects cost weight accuracy. The purpose of this study is to estimate bias in cost weights due to measurement error of reported clinical information. DRG assignment error rates are simulated based on recent clinical re-abstraction study results. Our simulation study estimates that 47% of cost weights representing the least severe cases are over weight by 10%, while 32% of cost weights representing the most severe cases are under weight by 10%. Applying the simulated weights to a cross-section of hospitals, we find that teaching hospitals tend to be under weight. Since inaccurate cost weights challenges the ability of case mix systems to accurately reflect patient mix and may lead to potential distortions in hospital funding, bias in hospital case mix measurement highlights the role clinical data quality plays in hospital funding in countries that use DRG-type case mix systems. Quality of clinical information should be carefully considered from hospitals that contribute financial data for establishing cost weights.

Coding response to a case-mix measurement system based on multiple diagnoses.

PubMed

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

A Direct Numerical Simulation of a Temporally Evolving Liquid-Gas Turbulent Mixing Layer

NASA Astrophysics Data System (ADS)

Vu, Lam Xuan; Chiodi, Robert; Desjardins, Olivier

2017-11-01

Air-blast atomization occurs when streams of co-flowing high speed gas and low speed liquid shear to form drops. Air-blast atomization has numerous industrial applications from combustion engines in jets to sprays used for medical coatings. The high Reynolds number and dynamic pressure ratio of a realistic air-blast atomization case requires large eddy simulation and the use of multiphase sub-grid scale (SGS) models. A direct numerical simulations (DNS) of a temporally evolving mixing layer is presented to be used as a base case from which future multiphase SGS models can be developed. To construct the liquid-gas mixing layer, half of a channel flow from Kim et al. (JFM, 1987) is placed on top of a static liquid layer that then evolves over time. The DNS is performed using a conservative finite volume incompressible multiphase flow solver where phase tracking is handled with a discretely conservative volume of fluid method. This study presents statistics on velocity and volume fraction at different Reynolds and Weber numbers.

Study of Thermodynamics of Liquid Noble-Metals Alloys Through a Pseudopotential Theory

NASA Astrophysics Data System (ADS)

Vora, Aditya M.

2010-09-01

The Gibbs-Bogoliubov (GB) inequality is applied to investigate the thermodynamic properties of some equiatomic noble metal alloys in liquid phase such as Au-Cu, Ag-Cu, and Ag-Au using well recognized pseudopotential formalism. For description of the structure, well known Percus-Yevick (PY) hard sphere model is used as a reference system. By applying a variation method the best hard core diameters have been found which correspond to minimum free energy. With this procedure the thermodynamic properties such as entropy and heat of mixing have been computed. The influence of local field correction function viz; Hartree (H), Taylor (T), Ichimaru-Utsumi (IU), Farid et al. (F), and Sarkar et al. (S) is also investigated. The computed results of the excess entropy compares favourably in the case of liquid alloys while the agreement with experiment is poor in the case of heats of mixing. This may be due to the sensitivity of the heats of mixing with the potential parameters and the dielectric function.

Organizational Characteristics Associated with Staff Turnover in Nursing Homes

ERIC Educational Resources Information Center

Castle, Nicholas G.; Engberg, John

2006-01-01

Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality,…

Interprofessional practice and learning in a youth mental health service: A case study using network analysis.

PubMed

Barnett, Tony; Hoang, Ha; Cross, Merylin; Bridgman, Heather

2015-01-01

Few studies have examined interprofessional practice (IPP) from a mental health service perspective. This study applied a mixed-method approach to examine the IPP and learning occurring in a youth mental health service in Tasmania, Australia. The aims of the study were to investigate the extent to which staff were networked, how collaboratively they practiced and supported student learning, and to elicit the organisation's strengths and opportunities regarding IPP and learning. Six data sets were collected: pre- and post-test readiness for interprofessional learning surveys, Social Network survey, organisational readiness for IPP and learning checklist, "talking wall" role clarification activity, and observations of participants working through a clinical case study. Participants (n = 19) were well-networked and demonstrated a patient-centred approach. Results confirmed participants' positive attitudes to IPP and learning and identified ways to strengthen the organisation's interprofessional capability. This mixed-method approach could assist others to investigate IPP and learning.

Study of complexation process between 4'-nitrobenzo-15-crown-5 and yttrium(III) cation in binary mixed non-aqueous solvents using conductometric method

NASA Astrophysics Data System (ADS)

Habibi, N.; Rounaghi, G. H.; Mohajeri, M.

2012-12-01

The complexation reaction of macrocyclic ligand (4'-nitrobenzo-15C5) with Y3+ cation was studied in acetonitrile-methanol (AN-MeOH), acetonitrile-ethanol (AN-EtOH), acetonitrile-dimethylformamide (AN-DMF) and ethylacetate-methanol (EtOAc-MeOH) binary mixtures at different temperatures using conductometry method. The conductivity data show that in all solvent systems, the stoichiometry of the complex formed between 4'-nitrobenzo-15C5 and Y3+ cation is 1: 1 (ML). The stability order of (4'-nitrobenzo-15C5). Y3+ complex in pure non-aqueous solvents at 25°C was found to be: EtOAc > EtOH > AN ≈ DMF > MeOH, and in the case of most compositions of the binary mixed solvents at 25°C it was: AN≈MeOH ≈ AN-EtOH > AN-DMF > EtOAc-MeOH. But the results indicate that the sequence of the stability of the complex in the binary mixed solutions changes with temperature. A non-linear behavior was observed for changes of log K f of (4'-nitrobenzo-15C5 · Y3+) complex versus the composition of the binary mixed solvents, which was explained in terms of solvent-solvent interactions and also the hetero-selective solvation of the species involved in the complexation reaction. The values of thermodynamic parameters (Δ H {c/ℴ} and Δ S {c/ℴ}) for formation of the complex were obtained from temperature dependent of the stability constant using the van't Hoff plots. The results represent that in most cases, the complex is both enthalpy and entropy stabilized and the values and also the sign of thermodynamic parameters are influenced by the nature and composition of the mixed solvents.

Analysis of mixing conditions and multistage irradiation impact on NOx removal efficiency in the electron beam flue gas treatment process.

PubMed

Pawelec, Andrzej; Dobrowolski, Andrzej

2017-01-01

In the process of electron beam flue gas treatment (EBFGT), most energy is spent on NO x removal. The dose distribution in the reactor is not uniform and the flue gas flow pattern plays an important role in the process efficiency. It was found that proper construction of the reactor may increase the energy efficiency of the process. The impact of the number of irradiation stages and mixing conditions on NO x removal efficiency was investigated for an ideal case and a practical solution was presented and compared with previously known EBFGT reactor constructions. The research was performed by means of computational fluid dynamics methods in combination with empirical Wittig formula. Two versions of dose distribution were taken for calculations. The results of the research show that for an ideal case, application of multistage irradiation and interstage mixing may reduce the energy consumption in the process by up to 39%. On the other side, simulation of reactor construction modification for two-stage irradiation results in 25% energy consumption reduction. The results of presented case study may be applied for improving the existing reactors and proper design of future installations.

Basic Aspects of Deep Soil Mixing Technology Control

NASA Astrophysics Data System (ADS)

Egorova, Alexandra A.; Rybak, Jarosław; Stefaniuk, Damian; Zajączkowski, Przemysław

2017-10-01

Improving a soil is a process of increasing its physical/mechanical properties without changing its natural structure. Improvement of soil subbase is reached by means of the knitted materials, or other methods when strong connection between soil particles is established. The method of DSM (Deep Soil Mixing) columns has been invented in Japan in 1970s. The main reason of designing cement-soil columns is to improve properties of local soils (such as strength and stiffness) by mixing them with various cementing materials. Cement and calcium are the most commonly used binders. However new research undertaken worldwide proves that apart from these materials, also gypsum or fly ashes can also be successfully implemented. As the Deep Soil Mixing is still being under development, anticipating mechanical properties of columns in particular soils and the usage of cementing materials in formed columns is very difficult and often inappropriate to predict. That is why a research is carried out in order to find out what binders and mixing technology should be used. The paper presents several remarks on the testing procedures related to quality and capacity control of Deep Soil Mixing columns. Soil improvement methods, their advantages and limitations are briefly described. The authors analyse the suitability of selected testing methods on subsequent stages of design and execution of special foundations works. Chosen examples from engineering practice form the basis for recommendations for the control procedures. Presented case studies concerning testing the on capacity field samples and laboratory procedures on various categories of soil-cement samples were picked from R&D and consulting works offered by Wroclaw University of Science and Technology. Special emphasis is paid to climate conditions which may affect the availability of performing and controlling of DSM techniques in polar zones, with a special regard to sample curing.

Proxy case mix measures for nursing homes.

PubMed

Cyr, A B

1983-01-01

Nursing home case mix measures are needed for the same purposes that spurred the intensive development of case mix measures for hospitals: management and planning decisions, organizational performance research, and reimbursement policy analysis. This paper develops and validates a pair of complementary measures that are simple to compute, are easy to interpret, and use generally available data. They are not, however, definitive. A secondary purpose of this paper is thus to galvanize the development of data bases that will give rise to superior case mix measures for nursing homes.

Utilising a collective case study system theory mixed methods approach: a rural health example.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2014-07-28

Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research.

A Simple Insightful Approach to Investigating a Hospital Standardised Mortality Ratio: An Illustrative Case-Study

PubMed Central

Mohammed, Mohammed A.; Stevens, Andrew J.

2013-01-01

Background Despite methodological concerns Hospital Standardised Mortality Ratios (HSMRs) are promoted as measures of performance. Hospitals that experience an increase in their HSMR are presented with a serious challenge but with little guidance on how to investigate this complex phenomenon. We illustrate a simple penetrating approach. Methods Retrospective analysis of routinely collected hospital admissions data comparing observed and expected deaths predicted by the Dr Foster Unit case mix adjustment method over three years (n = 74,860 admissions) in Shropshire and Telford NHS Trust Hospital (SaTH) constituting PRH (Princess Royal Hospital) and RSH (Royal Shrewsbury Hospital); whose HSMR increased from 99 in the year 2008/09 to 118 in the year 2009/10. Results The step up in HSMR was primarily located in PRH (109 to 130 vs. 105 to 118 RSH). Disentangling the HSMR by plotting run charts of observed and expected deaths showed that observed deaths were stable in RSH and PRH but expected deaths, especially at PRH, had fallen. The fall in expected deaths has two possible explanations–genuinely lower risk admissions or that the case-mix adjustment model is underestimating the risk of admissions perhaps because of inadequate clinical coding. There was no evidence that the case-mix profile of admissions had changed but there was considerable evidence that clinical coding process at PRH was producing a lower depth of coding resulting in lower expected mortality. Conclusion Knowing whether the change (increase/decrease) in HSMR is driven by the numerator or the denominator is a crucial pivotal first step in understanding a given HSMR and so such information should be an integral part of the HSMR reporting methodology. PMID:23472111

Feedback using an ePortfolio for medicine long cases: quality not quantity.

PubMed

Bleasel, Jane; Burgess, Annette; Weeks, Ruth; Haq, Inam

2016-10-21

The evidence for the positive impact of an electronic Portfolio (ePortfolio) on feedback in medicine is mixed. An ePortfolio for medical long cases in a Graduate Medical Program was developed. The purpose of this study was to explore the perceptions of medical students and faculty of the impact of the ePortfolio on the feedback process. In total, 130 Year 3 medical students, and six faculty participated in the study. This is a mixed methods study, using a combination of both quantitative and qualitative approaches. Quantitative methods were used to quantify the number of long cases performed. Qualitative methods were used to explore the relationship between quantity and quality of feedback, and provide a rich understanding of both students' and faculty's experience and perceptions of the ePortfolio. Students received a variable quantity of feedback at each of the three studied clinical schools, with an average of between 4 - 5.4 feedback episodes per student. Feedback that was constructive, specific and timely and delivered by a senior academic was important. Quantity was not an essential factor, with two episodes of detailed feedback reported to be adequate. The barriers to the use of the ePortfolio were technical aspects of the platform that interfered with student engagement. Feedback using the ePortfolio for medical long cases is a valuable tool providing a senior clinician delivers detailed, constructive and personalized feedback in a timely fashion. The ePortfolio system needs to be user-friendly to engage students.

Molecular Analysis of Mixed Endometrial Carcinomas Shows Clonality in Most Cases.

PubMed

Köbel, Martin; Meng, Bo; Hoang, Lien N; Almadani, Noorah; Li, Xiaodong; Soslow, Robert A; Gilks, C Blake; Lee, Cheng-Han

2016-02-01

Mixed endometrial carcinoma refers to a tumor that comprises 2 or more distinct histotypes. We studied 18 mixed-type endometrial carcinomas-11 mixed serous and low-grade endometrioid carcinomas (SC/EC), 5 mixed clear cell and low-grade ECs (CCC/EC), and 2 mixed CCC and SCs (CCC/SC), using targeted next-generation sequencing and immunohistochemistry to compare the molecular profiles of the different histotypes present in each case. In 16 of 18 cases there was molecular evidence that both components shared a clonal origin. Eight cases (6 EC/SC, 1 EC/CCC, and 1 SC/CCC) showed an SC molecular profile that was the same in both components. Five cases (3 CCC/EC and 2 SC/EC) showed a shared endometrioid molecular profile and identical mismatch-repair protein deficiency in both components. A single SC/EC case harbored the same POLE exonuclease domain mutation in both components. One SC/CCC and 1 EC/CCC case showed both shared and unique molecular features in the 2 histotype components, suggesting early molecular divergence from a common clonal origin. In 2 cases, there were no shared molecular features, and these appear to be biologically unrelated synchronous tumors. Overall, these results show that the different histologic components in mixed endometrial carcinomas typically share the same molecular aberrations. Mixed endometrial carcinomas most commonly occur through morphologic mimicry, whereby tumors with serous-type molecular profile show morphologic features of EC or CCC, or through underlying deficiency in DNA nucleotide repair, with resulting rapid accrual of mutations and intratumoral phenotypic heterogeneity. Less commonly, mixed endometrial carcinomas are the result of early molecular divergence from a common progenitor clone or are synchronous biologically unrelated tumors (collision tumors).

Molecular analysis of mixed endometrial carcinomas shows clonality in most cases

PubMed Central

Hoang, Lien N.; Almadani, Noorah; Li, Xiaodong; Soslow, Robert A; Gilks, C. Blake; Lee, Cheng-Han

2016-01-01

Mixed endometrial carcinoma refers to a tumor that is comprised of two or more distinct histotypes. We studied 18 mixed-type endometrial carcinomas - 11 mixed serous and low-grade endometrioid carcinomas (SC/EC), 5 mixed clear cell and low-grade endometrioid carcinomas (CCC/EC), and 2 mixed clear cell and serous carcinoma (CCC/SC), using targeted next generation sequencing and immunohistochemistry to compare the molecular profiles of the different histotypes present in each case. In 16 of 18 cases there was molecular evidence that both components shared a clonal origin. Eight cases (6 EC/SC, 1 EC/CCC and 1 SC/CCC) showed a serous carcinoma molecular profile that was the same in both components. Five cases (3 CCC/EC and 2 SC/EC) showed a shared endometrioid molecular profile and identical mismatch repair protein (MMR) deficiency in both components. A single SC/EC case harbored the same POLE exonuclease domain mutation in both components. One SC/CCC and one EC/CCC case showed both shared and unique molecular features in the two histotype components, suggesting early molecular divergence from a common clonal origin. In two cases, there were no shared molecular features and these appear to be biologically unrelated synchronous tumors. Overall, these results show that the different histologic components in mixed endometrial carcinomas typically share the same molecular aberrations. Mixed endometrial carcinomas most commonly occur through morphological mimicry, whereby tumors with serous-type molecular profile show morphological features of endometrioid or clear cell carcinoma, or through underlying deficiency in DNA nucleotide repair, with resulting rapid accrual of mutations and intratumoral phenotypic heterogeneity. Less commonly, mixed endometrial carcinomas are the result of early molecular divergence from a common progenitor clone or are synchronous biologically unrelated tumors (collision tumors). PMID:26492180

Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

PubMed

Liang, Li-Lin

2015-04-01

This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

Study on Chinese common allergens of contact dermatitis.

PubMed

Fan, W X; Zhao, B

1990-01-01

Patch tests were performed according to the European Standard Allergens (ESA) in 204 cases suspected of contact dermatitis. The reaction was positive in 58.33% of the cases. The common allergens were nickel (15.7%), fragrance mix (11.8%) p-phenylenediamine (8.8%), colophony (6.9%), benzocaine (6.4%), formaldehyde (5.9%), black rubber mix (4.9%), cobalt (4.4%), balsam of Peru (3.9%), potassium dichromate (3.4%), thiuram mix (2.9%) and mercapto mix (2.9%). In 85 cases of negative reaction to the European Standard Allergens, 36 were patch tested to suspected agents based on the individual case histories, of which 21 positively reacted. The common sensitizing agents were ampicillin and thiomersal. Of 204 cases, 107 were cases of facial contact dermatitis. Patch tests showed that the most common allergens were p-phenylenediamine (15.9%), nickel (13.1%) and fragrance mix (14.95%).

A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

PubMed Central

2013-01-01

Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

A parallel metaheuristic for large mixed-integer dynamic optimization problems, with applications in computational biology

PubMed Central

Henriques, David; González, Patricia; Doallo, Ramón; Saez-Rodriguez, Julio; Banga, Julio R.

2017-01-01

Background We consider a general class of global optimization problems dealing with nonlinear dynamic models. Although this class is relevant to many areas of science and engineering, here we are interested in applying this framework to the reverse engineering problem in computational systems biology, which yields very large mixed-integer dynamic optimization (MIDO) problems. In particular, we consider the framework of logic-based ordinary differential equations (ODEs). Methods We present saCeSS2, a parallel method for the solution of this class of problems. This method is based on an parallel cooperative scatter search metaheuristic, with new mechanisms of self-adaptation and specific extensions to handle large mixed-integer problems. We have paid special attention to the avoidance of convergence stagnation using adaptive cooperation strategies tailored to this class of problems. Results We illustrate its performance with a set of three very challenging case studies from the domain of dynamic modelling of cell signaling. The simpler case study considers a synthetic signaling pathway and has 84 continuous and 34 binary decision variables. A second case study considers the dynamic modeling of signaling in liver cancer using high-throughput data, and has 135 continuous and 109 binaries decision variables. The third case study is an extremely difficult problem related with breast cancer, involving 690 continuous and 138 binary decision variables. We report computational results obtained in different infrastructures, including a local cluster, a large supercomputer and a public cloud platform. Interestingly, the results show how the cooperation of individual parallel searches modifies the systemic properties of the sequential algorithm, achieving superlinear speedups compared to an individual search (e.g. speedups of 15 with 10 cores), and significantly improving (above a 60%) the performance with respect to a non-cooperative parallel scheme. The scalability of the method is also good (tests were performed using up to 300 cores). Conclusions These results demonstrate that saCeSS2 can be used to successfully reverse engineer large dynamic models of complex biological pathways. Further, these results open up new possibilities for other MIDO-based large-scale applications in the life sciences such as metabolic engineering, synthetic biology, drug scheduling. PMID:28813442

Prognosis of children with mixed phenotype acute leukemia treated on the basis of consistent immunophenotypic criteria

PubMed Central

Mejstrikova, Ester; Volejnikova, Jana; Fronkova, Eva; Zdrahalova, Katerina; Kalina, Tomas; Sterba, Jaroslav; Jabali, Yahia; Mihal, Vladimir; Blazek, Bohumir; Cerna, Zdena; Prochazkova, Daniela; Hak, Jiri; Zemanova, Zuzana; Jarosova, Marie; Oltova, Alexandra; Sedlacek, Petr; Schwarz, Jiri; Zuna, Jan; Trka, Jan; Stary, Jan; Hrusak, Ondrej

2010-01-01

Background Mixed phenotype acute leukemia (MPAL) represents a diagnostic and therapeutic dilemma. The European Group for the Immunological Classification of Leukemias (EGIL) scoring system unambiguously defines MPAL expressing aberrant lineage markers. Discussions surrounding it have focused on scoring details, and information is limited regarding its biological, clinical and prognostic significance. The recent World Health Organization classification is simpler and could replace the EGIL scoring system after transformation into unambiguous guidelines. Design and Methods Simple immunophenotypic criteria were used to classify all cases of childhood acute leukemia in order to provide therapy directed against acute lymphoblastic leukemia or acute myeloid leukemia. Prognosis, genotype and immunoglobulin/T-cell receptor gene rearrangement status were analyzed. Results The incidences of MPAL were 28/582 and 4/107 for children treated with acute lymphoblastic leukemia and acute myeloid leukemia regimens, respectively. In immunophenotypic principal component analysis, MPAL treated as T-cell acute lymphoblastic leukemia clustered between cases of non-mixed T-cell acute lymphoblastic leukemia and acute myeloid leukemia, while other MPAL cases were included in the respective non-mixed B-cell progenitor acute lymphoblastic leukemia or acute myeloid leukemia clusters. Analogously, immunoglobulin/T-cell receptor gene rearrangements followed the expected pattern in patients treated as having acute myeloid leukemia (non-rearranged, 4/4) or as having B-cell progenitor acute lymphoblastic leukemia (rearranged, 20/20), but were missing in 3/5 analyzed cases of MPAL treated as having T-cell acute lymphobastic leukemia. In patients who received acute lymphoblastic leukemia treatment, the 5-year event-free survival of the MPAL cases was worse than that of the non-mixed cases (53±10% and 76±2% at 5 years, respectively, P=0.0075), with a more pronounced difference among B lineage cases. The small numbers of MPAL cases treated as T-cell acute lymphoblastic leukemia or as acute myeloid leukemia hampered separate statistics. We compared prognosis of all subsets with the prognosis of previously published cohorts. Conclusions Simple immunophenotypic criteria are useful for therapy decisions in MPAL. In B lineage leukemia, MPAL confers poorer prognosis. However, our data do not justify a preferential use of current acute myeloid leukemia-based therapy in MPAL. PMID:20145275

Exploring the value of mixed methods within the At Home/Chez Soi housing first project: a strategy to evaluate the implementation of a complex population health intervention for people with mental illness who have been homeless.

PubMed

Macnaughton, Eric L; Goering, Paula N; Nelson, Geoffrey B

2012-05-02

This paper is a methodological case study that describes the At Home/Chez Soi (Housing First) Initiative's mixed-methods strategy for implementation evaluation and discusses the value of these methods in evaluating the implementation of such complex population health interventions. The Housing First (HF) model is being implemented in five cities: Vancouver, Winnipeg, Toronto, Montréal and Moncton. At Home/Chez Soi is an intervention trial that aims to address the issue of homelessness in people with mental health issues. The HF model emphasizes choices, hopefulness and connecting people with resources that make a difference to their quality of life. A component of HF is supported housing, which provides a rent subsidy and rapid access to housing of choice in private apartments; a second component is support. Quantitative and qualitative methods were used to evaluate HF implementation. The findings of this case study illustrate how the critical ingredients of complex interventions, such as HF, can be adapted to different contexts while implementation fidelity is maintained at a theoretical level. The findings also illustrate how the project's mixed methods approach helped to facilitate the adaptation process. Another value of this approach is that it identifies systemic and organizational factors (e.g., housing supply, discrimination, housing procurement strategy) that affect implementation of key elements of HF. In general, the approach provides information about both whether and how key aspects of the intervention are implemented effectively across different settings. It thus provides implementation data that are rigorous, contextually relevant and practical.

Frequency and topography of small cerebrovascular lesions in vascular and in mixed dementia: a post-mortem 7-tesla magnetic resonance imaging study with neuropathological correlates.

PubMed

De Reuck, Jacques; Auger, Florent; Durieux, Nicolas; Deramecourt, Vincent; Maurage, Claude-Alain; Cordonnier, Charlotte; Pasquier, Florence; Leys, Didier; Bordet, Regis

2017-01-01

Introduction: Mixed dementia (MixD) refers to a combination of definite Alzheimer's disease (AD) and vascular encephalopathy. The existence of a "pure" type of vascular dementia (VaD) is controversial. There is a need to find magnetic resonance imaging (MRI) characteristics allowing the distinction between VaD and MixD. The present post-mortem 7.0-tesla MRI compares the frequency or severity and the topography of the small cerebrovascular lesions in brains of patients with VaD and with MixD. Material and methods: Based on neuropathological criteria, 14 brains were classified as VaD, 24 as MixD and 11 as controls. Three coronal sections of a cerebral hemisphere and a horizontal section of a cerebellar hemisphere underwent T2 and T2* 7.0-tesla MRI examination. The mean values and topographic distribution of white matter changes (WMCs), lacunar infarcts (LIs), cortical microbleeds (CoMBs) and cortical microinfarcts (CoMIs) were determined and compared between the different groups. Results: Compared to the controls, both VaD and MixD brains had significantly more severe WMCs and increased numbers of CoMBs and CoMIs. Lacunar infarcts predominated only in the VaD cases. On mutual comparison of VaD and MixD brains, CoMBs and CoMIs predominated in the frontal lobe and the cerebellum of VaD, while were mainly present in the occipital lobe of MixD. White matter changes predominated in the temporal lobe of MixD cases. Lacunar infarcts were significantly increased in the corona radiata and putamen of VaD patients. Conclusions: The present post-mortem MRI study shows clear differences in the distribution and the types of cerebrovascular lesions on high-field MRI, confirming that VaD and MixD are different diseases. .

Posttraumatic growth following a first episode of psychosis: a mixed methods research protocol using a convergent design.

PubMed

Jordan, Gerald; Malla, Ashok; Iyer, Srividya N

2016-07-25

The suffering people experience following a first episode of psychosis is great, and has been well-investigated. Conversely, potential positive outcomes following a first episode of psychosis have been under-investigated. One such outcome that may result from a first episode of psychosis is posttraumatic growth, or a positive aftermath following the trauma of a first psychotic episode. While posttraumatic growth has been described following other physical and mental illnesses, posttraumatic growth has received very little attention following a first episode of psychosis. To address this research gap, we will conduct a mixed methods study aimed at answering two research questions: 1) How do people experience posttraumatic growth following a first episode of psychosis? 2) What predicts, or facilitates, posttraumatic growth following a first episode of psychosis? The research questions will be investigated using a mixed methods convergent design. All participants will be service-users being offered treatment for a first episode of psychosis at a specialized early intervention service for young people with psychosis, as well as their case managers.. A qualitative descriptive methodology will guide data-collection through semi-structured interviews with service-users. Service-users and case managers will complete questionnaires related to posttraumatic growth and its potential predictors using quantitative methods. These predictors include the impact a first episode of psychosis on service-users' lives, the coping strategies they use; the level of social support they enjoy; and their experiences of resilience and recovery. Qualitative data will be subject to thematic analysis, quantitative data will be subject to multiple regression analyses, and results from both methods will be combined to answer the research questions in a holistic way. Findings from this study are expected to show that in addition to suffering, people with a first episode of psychosis may experience positive changes. This study will be one of few to have investigated posttraumatic growth following a first episode of psychosis, and will be the first to do so with a mixed methods approach.

[Validation of Differential Extraction Kit in forensic sexual assault cases].

PubMed

Wu, Dan; Cao, Yu; Xu, Yan; He, Bai-Fang; Bi, Gang; Zhou, Huai-Gu

2009-12-01

To evaluate the validity of Differential Extraction Kit in isolating spermatozoa and epithelial cell DNA from mixture samples. Selective lysis of spermatid and epithelial cells combined with paramagnetic particle method were applied to extract the DNA from the mock samples under controlled conditions and forensic case samples, and template DNA were analyzed by STR genotype method. This Differential Extraction Kit is efficient to obtain high quality spermatid and epithelial cell DNA from the mixture samples with different proportion of sperm to epithelial cell. The Differential Extraction Kit can be applied in DNA extraction for mixed stain from forensic sexual assault samples.

Paediatric case mix in a rural clinical school is relevant to future practice.

PubMed

Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

2017-11-29

Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences in clinical settings. Logged cases met the curriculum learning outcomes of graduates. Minor variations were readily addressed via recommendations about logging. This paper provides evidence of the legitimacy of student logs as useful tools in affirming appropriate paediatric case mix. It validates the rural clinical school context as appropriate for medical students to prepare for future clinical paediatric practice.

Productivity--a key to managing cost-per-case. Part 1.

PubMed

Orefice, J J; Jennings, M C

1983-08-01

Productivity and productivity management are critical to effective case-mix management. Case-mix management expands on traditional productivity management to include the relationship between such intermediate products as patient days, tests and meals, and the ultimate end product, the case. As hospitals search to increase the profitability of specific case types, they must focus on two critical productivity control points. First, they must examine length of stay and ancillary utilization as one level of productivity. Then they must turn to more traditional analyses and review departmental productivity in the production of the intermediate products. No case-mix management system is complete unless it focuses on both of these critical relationships. Part two of this article will explore performance reporting and its role in managing both productivity and case mix.

Improved Convergence and Robustness of USM3D Solutions on Mixed-Element Grids

NASA Technical Reports Server (NTRS)

Pandya, Mohagna J.; Diskin, Boris; Thomas, James L.; Frink, Neal T.

2016-01-01

Several improvements to the mixed-element USM3D discretization and defect-correction schemes have been made. A new methodology for nonlinear iterations, called the Hierarchical Adaptive Nonlinear Iteration Method, has been developed and implemented. The Hierarchical Adaptive Nonlinear Iteration Method provides two additional hierarchies around a simple and approximate preconditioner of USM3D. The hierarchies are a matrix-free linear solver for the exact linearization of Reynolds-averaged Navier-Stokes equations and a nonlinear control of the solution update. Two variants of the Hierarchical Adaptive Nonlinear Iteration Method are assessed on four benchmark cases, namely, a zero-pressure-gradient flat plate, a bump-in-channel configuration, the NACA 0012 airfoil, and a NASA Common Research Model configuration. The new methodology provides a convergence acceleration factor of 1.4 to 13 over the preconditioner-alone method representing the baseline solver technology.

Improved Convergence and Robustness of USM3D Solutions on Mixed-Element Grids

NASA Technical Reports Server (NTRS)

Pandya, Mohagna J.; Diskin, Boris; Thomas, James L.; Frinks, Neal T.

2016-01-01

Several improvements to the mixed-elementUSM3Ddiscretization and defect-correction schemes have been made. A new methodology for nonlinear iterations, called the Hierarchical Adaptive Nonlinear Iteration Method, has been developed and implemented. The Hierarchical Adaptive Nonlinear Iteration Method provides two additional hierarchies around a simple and approximate preconditioner of USM3D. The hierarchies are a matrix-free linear solver for the exact linearization of Reynolds-averaged Navier-Stokes equations and a nonlinear control of the solution update. Two variants of the Hierarchical Adaptive Nonlinear Iteration Method are assessed on four benchmark cases, namely, a zero-pressure-gradient flat plate, a bump-in-channel configuration, the NACA 0012 airfoil, and a NASA Common Research Model configuration. The new methodology provides a convergence acceleration factor of 1.4 to 13 over the preconditioner-alone method representing the baseline solver technology.

Is there an economic case for investing in nursing care – what does the literature tell us?

PubMed Central

Twigg, Diane E; Myers, Helen; Duffield, Christine; Giles, Margaret; Evans, Gemma

2015-01-01

Aim To determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients? Background Research has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions. Design A systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence. Data sources The MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits. Review methods The review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes. Results Four-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results. Conclusion This review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies. PMID:25430080

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

PubMed Central

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Theoretical and numerical studies of chaotic mixing

NASA Astrophysics Data System (ADS)

Kim, Ho Jun

Theoretical and numerical studies of chaotic mixing are performed to circumvent the difficulties of efficient mixing, which come from the lack of turbulence in microfluidic devices. In order to carry out efficient and accurate parametric studies and to identify a fully chaotic state, a spectral element algorithm for solution of the incompressible Navier-Stokes and species transport equations is developed. Using Taylor series expansions in time marching, the new algorithm employs an algebraic factorization scheme on multi-dimensional staggered spectral element grids, and extends classical conforming Galerkin formulations to nonconforming spectral elements. Lagrangian particle tracking methods are utilized to study particle dispersion in the mixing device using spectral element and fourth order Runge-Kutta discretizations in space and time, respectively. Comparative studies of five different techniques commonly employed to identify the chaotic strength and mixing efficiency in microfluidic systems are presented to demonstrate the competitive advantages and shortcomings of each method. These are the stirring index based on the box counting method, Poincare sections, finite time Lyapunov exponents, the probability density function of the stretching field, and mixing index inverse, based on the standard deviation of scalar species distribution. Series of numerical simulations are performed by varying the Peclet number (Pe) at fixed kinematic conditions. The mixing length (lm) is characterized as function of the Pe number, and lm ∝ ln(Pe) scaling is demonstrated for fully chaotic cases. Employing the aforementioned techniques, optimum kinematic conditions and the actuation frequency of the stirrer that result in the highest mixing/stirring efficiency are identified in a zeta potential patterned straight micro channel, where a continuous flow is generated by superposition of a steady pressure driven flow and time periodic electroosmotic flow induced by a stream-wise AC electric field. Finally, it is shown that the invariant manifold of hyperbolic periodic point determines the geometry of fast mixing zones in oscillatory flows in two-dimensional cavity.

Development of a Medicaid Behavioral Health Case-Mix Model

ERIC Educational Resources Information Center

Robst, John

2009-01-01

Many Medicaid programs have either fully or partially carved out mental health services. The evaluation of carve-out plans requires a case-mix model that accounts for differing health status across Medicaid managed care plans. This article develops a diagnosis-based case-mix adjustment system specific to Medicaid behavioral health care. Several…

Modulation of aerosol radiative forcing due to mixing state in clear and cloudy-sky: A case study from Delhi National Capital Region, India

NASA Astrophysics Data System (ADS)

Srivastava, Parul; Dey, Sagnik; Srivastava, Atul K.; Singh, Sachchidanand; Tiwari, Suresh; Agarwal, Poornima

2016-04-01

Aerosol properties change with the change in mixing state of aerosols and therefore it is a source of uncertainty in estimated aerosol radiative forcing (ARF) from observations or by models assuming a specific mixing state. The problem is important in the Indo-Gangetic Basin, Northern India, where various aerosol types mix and show strong seasonal variations. Quantifying the modulation of ARF by mixing state is hindered by lack of knowledge about proper aerosol composition. Hence, first a detailed chemical composition analysis of aerosols for Delhi National capital region (NCR) is carried out. Aerosol composition is arranged quantitatively into five major aerosol types - accumulation dust, coarse dust, water soluble (WS), water insoluble (WINS), and black carbon (BC) (directly measured by Athelometer). Eight different mixing cases - external mixing, internal mixing, and six combinations of core- shell mixing (BC over dust, WS over dust, WS over BC, BC over WS, WS over WINS, and BC over WINS; each of the combinations externally mixed with other species) have been considered. The spectral aerosol optical properties - extinction coefficient, single scattering albedo (SSA) and asymmetry parameter (g) for each of the mixing cases are calculated and finally 'clear-sky' and 'cloudy-sky' ARF at the top-of-the-atmosphere (TOA) and surface are estimated using a radiative transfer model. Comparison of surface-reaching flux for each of the cases with MERRA downward shortwave surface flux reveals the most likely mixing state. 'BC-WINS+WS+Dust' show least deviation relative to MERRA during the pre-monsoon (MAMJ) and monsoon (JAS) seasons and hence is the most probable mixing states. During the winter season (DJF), 'BC-Dust+WS+WINS' case shows the closest match with MERRA, while external mixing is the most probable mixing state in the post-monsoon season (ON). Lowest values for both TOA and surface 'clear-sky' ARF is observed for 'BC-WINS+WS+ Dust' mixing case. TOA ARF is 0.28±2.4, 2.2±1.1, -1.4±1.4, -0.15±0.13, while, surface ARF is -16.4±3.1, -7.6±1.7, -31.5±4.7, -17.1±8.4, respectively for the MAMJ, JAS, ON and DJF seasons. Post-monsoon and winter season shows negative values of TOA ARF, hence suggest 'cooling'. The associated heating rate profiles show higher values for 'WS-BC+Dust+WINS' case as compared to other cases, with relatively large values during the winter and post-monsoon seasons, while lower value was observed for 'BC-WINS+WS+Dust'. We examined the modulation of clear sky ARF by 'water-cloud' and 'ice-cloud' separately. The seasonal mean ARF for both water and ice clouds show nearly similar characteristics as observed for clear-sky case, with relatively large ARF at TOA and surface in water cloud case as compared to ice cloud during all the seasons. As a result, the associated heating rate is also relatively higher in water cloud case as compared to ice cloud. Such large modulation of ARF due to mixing state calls for a coordinated effort to create a mixing state database for this region to reduce the uncertainty in climate forcing.

Methodology issues in implementation science.

PubMed

Newhouse, Robin; Bobay, Kathleen; Dykes, Patricia C; Stevens, Kathleen R; Titler, Marita

2013-04-01

Putting evidence into practice at the point of care delivery requires an understanding of implementation strategies that work, in what context and how. To identify methodological issues in implementation science using 4 studies as cases and make recommendations for further methods development. Four cases are presented and methodological issues identified. For each issue raised, evidence on the state of the science is described. Issues in implementation science identified include diverse conceptual frameworks, potential weaknesses in pragmatic study designs, and the paucity of standard concepts and measurement. Recommendations to advance methods in implementation include developing a core set of implementation concepts and metrics, generating standards for implementation methods including pragmatic trials, mixed methods designs, complex interventions and measurement, and endorsing reporting standards for implementation studies.

SU-C-207A-05: Feature Based Water Equivalent Path Length (WEPL) Determination for Proton Radiography by the Technique of Time Resolved Dose Measurement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, R; Jee, K; Sharp, G

Purpose: Studies show that WEPL can be determined from modulated dose rate functions (DRF). However, the previous calibration method based on statistics of the DRF is sensitive to energy mixing of protons due to scattering through different materials (termed as range mixing here), causing inaccuracies in the determination of WEPL. This study intends to explore time-domain features of the DRF to reduce the effect of range mixing in proton radiography (pRG) by this technique. Methods: An amorphous silicon flat panel (PaxScan™ 4030CB, Varian Medical Systems, Inc., Palo Alto, CA) was placed behind phantoms to measure DRFs from a proton beammore » modulated by a specially designed modulator wheel. The performance of two methods, the previously used method based on the root mean square (RMS) and the new approach based on time-domain features of the DRF, are compared for retrieving WEPL and RSP from pRG of a Gammex phantom. Results: Calibration by T{sub 80} (the time point for 80% of the major peak) was more robust to range mixing and produced WEPL with improved accuracy. The error of RSP was reduced from 8.2% to 1.7% for lung equivalent material, with the mean error for all other materials reduced from 1.2% to 0.7%. The mean error of the full width at half maximum (FWHM) of retrieved inserts was decreased from 25.85% to 5.89% for the RMS and T{sub 80} method respectively. Monte Carlo simulations in simplified cases also demonstrated that the T{sub 80} method is less sensitive to range mixing than the RMS method. Conclusion: WEPL images have been retrieved based on single flat panel measured DRFs, with inaccuracies reduced by exploiting time-domain features as the calibration parameter. The T{sub 80} method is validated to be less sensitive to range mixing and can thus retrieve the WEPL values in proximity of interfaces with improved numerical and spatial accuracy for proton radiography.« less

Integrated Warfighter Biodefense Program (IWBP) - Phase 2

DTIC Science & Technology

2011-03-03

one another or with environments to spread disease such as indirect transmission of cholera via water. In this paper only localized mixing is...from WHO reports and other sources. Cholera , Pneumonia, Malaria, and Hepatitis A were selected as representative diseases as their methods of...A(H1N1) and US NORTHCOM In March 2009, the US identified its first cases of „swine flu‟ in New York. Initial reports of cases in Mexico , where the

Mixing, segregation, and flow of granular materials

NASA Astrophysics Data System (ADS)

McCarthy, Joseph J.

1998-11-01

This dissertation addresses mixing, segregation, and flow of granular materials with the ultimate goal of providing fundamental understanding and tools for the rational design and optimization of mixing devices. In particular, the paradigm cases of a slowly rotated tumbler mixer and flow down an inclined plane are examined. Computational work, as well as supporting experiments, are used to probe both two and three dimensional systems. In the avalanching regime, the mixing and flow can be viewed either on a global-scale or a local-scale. On the global-scale, material is transported via avalanches whose gross motion can be well described by geometrical considerations. On the local-scale, the dynamics of the particle motion becomes important; particles follow complicated trajectories that are highly sensitive to differences in size/density/morphology. By decomposing the problem in this way, it is possible to study the implications of the geometry and dynamics separately and to add complexities in a controlled fashion. This methodology allows even seemingly difficult problems (i.e., mixing in non-convex geometries, and mixing of dissimilar particles) to be probed in a simple yet methodical way. In addition this technique provides predictions of optimal mixing conditions in an avalanching tumbler, a criterion for evaluating the effect of mixer shape, and mixing enhancement strategies for both two and three dimensional mixers. In the continuous regime, the flow can be divided into two regions: a rapid flow region of the cascading layer at the free surface, and a fixed bed region undergoing solid body rotation. A continuum-based description, in which averages are taken across the layer, generates quantitative predictions about the flow in the cascading layer and agrees well with experiment. Incorporating mixing through a diffusive flux (as well as constitutive expression for segregation) within the cascading layer allows for the determination of optimal mixing conditions. Segregation requires a detailed understanding of the interplay between the flow and the properties of the particles. A relatively mature simulation technique, particle dynamics (PD), aptly captures these effects and is eminently suited to mixing studies; particle properties can be varied on a particle-by-particle basis and detailed mixed structures are easily captured and visualized. However, PD is computationally intensive and is therefore of questionable general utility. By combining PD and geometrical insight-in essence, by focusing the particle dynamics simulation only where it is needed-a new hybrid method of simulation, which is much faster than a conventional particle dynamics method, can be achieved. This technique can yield more than an order of magnitude increase in computational speed while maintaining the versatility of a particle dynamics simulation. Alternatively, by utilizing PD to explore segregation mechanisms in simple flows-e.g., flow down an inclined plane-heuristic models and constitutive relations for segregation can be tested. Incorporating these segregation flux terms into a continuum description of the flow in a tumbler allows rapid Lagrangian simulation of the competition between mixing and segregation. For the case of density segregation, this produces good agreement between theory and experiment with essentially no adjustable parameters. In addition, an accurate quantitative prediction of the optimal mixing time is obtained.

A comparison of patient-centered and case-mix reimbursement for nursing home care.

PubMed Central

Willemain, T R

1980-01-01

The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term. PMID:7461971

Case mix planning in hospitals: a review and future agenda.

PubMed

Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

2017-06-01

The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

A comparison of patient-centered and case-mix reimbursement for nursing home care.

PubMed

Willemain, T R

1980-01-01

The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

Understanding the role of individual consumer-provider relationships within assertive community treatment.

PubMed

Stanhope, Victoria; Matejkowski, Jason

2010-08-01

The widespread adoption of assertive community treatment has resulted in a shift from an individual model to a team model of case management. The shift has had implications for individual relationships between case managers and consumers, but still little is known about how these relationships develop in teams. This exploratory mixed methods study looked at how case managers and consumers negotiate individual relationships within a team model. Quantitative methods identified high and low service intensity relationships between consumers and case managers and qualitative methods explored and compared these relationships. Consumers in high service intensity relationships described a preference for certain case managers and the burden of working with multiple people. Case managers invested high service intensity relationships with special therapeutic value, articulated the challenges of coordinating care across the team, and utilized team limit setting techniques. In contrast, low service intensity relationships were more likely to reflect integration with the entire team. Findings suggest that teams need to consider how individual relationships enhance care for their consumers and how to nurture these relationships while maintaining the support necessary for case managers and consumers.

Intratumor Heterogeneity of ALK-Rearrangements and Homogeneity of EGFR-Mutations in Mixed Lung Adenocarcinoma

PubMed Central

Marino, Federica Zito; Liguori, Giuseppina; Aquino, Gabriella; La Mantia, Elvira; Bosari, Silvano; Ferrero, Stefano; Rosso, Lorenzo; Gaudioso, Gabriella; De Rosa, Nicla; Scrima, Marianna; Martucci, Nicola; La Rocca, Antonello; Normanno, Nicola; Morabito, Alessandro; Rocco, Gaetano; Botti, Gerardo; Franco, Renato

2015-01-01

Background Non Small Cell Lung Cancer is a highly heterogeneous tumor. Histologic intratumor heterogeneity could be ‘major’, characterized by a single tumor showing two different histologic types, and ‘minor’, due to at least 2 different growth patterns in the same tumor. Therefore, a morphological heterogeneity could reflect an intratumor molecular heterogeneity. To date, few data are reported in literature about molecular features of the mixed adenocarcinoma. The aim of our study was to assess EGFR-mutations and ALK-rearrangements in different intratumor subtypes and/or growth patterns in a series of mixed adenocarcinomas and adenosquamous carcinomas. Methods 590 Non Small Cell Lung Carcinomas tumor samples were revised in order to select mixed adenocarcinomas with available tumor components. Finally, only 105 mixed adenocarcinomas and 17 adenosquamous carcinomas were included in the study for further analyses. Two TMAs were built selecting the different intratumor histotypes. ALK-rearrangements were detected through FISH and IHC, and EGFR-mutations were detected through IHC and confirmed by RT-PCR. Results 10/122 cases were ALK-rearranged and 7 from those 10 showing an intratumor heterogeneity of the rearrangements. 12/122 cases were EGFR-mutated, uniformly expressing the EGFR-mutated protein in all histologic components. Conclusion Our data suggests that EGFR-mutations is generally homogeneously expressed. On the contrary, ALK-rearrangement showed an intratumor heterogeneity in both mixed adenocarcinomas and adenosquamous carcinomas. The intratumor heterogeneity of ALK-rearrangements could lead to a possible impact on the therapeutic responses and the disease outcomes. PMID:26422230

A Place-Oriented, Mixed-Level Regionalization Method for Constructing Geographic Areas in Health Data Dissemination and Analysis

PubMed Central

Mu, Lan; Wang, Fahui; Chen, Vivien W.; Wu, Xiao-Cheng

2015-01-01

Similar geographic areas often have great variations in population size. In health data management and analysis, it is desirable to obtain regions of comparable population by decomposing areas of large population (to gain more spatial variability) and merging areas of small population (to mask privacy of data). Based on the Peano curve algorithm and modified scale-space clustering, this research proposes a mixed-level regionalization (MLR) method to construct geographic areas with comparable population. The method accounts for spatial connectivity and compactness, attributive homogeneity, and exogenous criteria such as minimum (and approximately equal) population or disease counts. A case study using Louisiana cancer data illustrates the MLR method and its strengths and limitations. A major benefit of the method is that most upper level geographic boundaries can be preserved to increase familiarity of constructed areas. Therefore, the MLR method is more human-oriented and place-based than computer-oriented and space-based. PMID:26251551

Developing a methodology to assess the impact of research grant funding: a mixed methods approach.

PubMed

Bloch, Carter; Sørensen, Mads P; Graversen, Ebbe K; Schneider, Jesper W; Schmidt, Evanthia Kalpazidou; Aagaard, Kaare; Mejlgaard, Niels

2014-04-01

This paper discusses the development of a mixed methods approach to analyse research funding. Research policy has taken on an increasingly prominent role in the broader political scene, where research is seen as a critical factor in maintaining and improving growth, welfare and international competitiveness. This has motivated growing emphasis on the impacts of science funding, and how funding can best be designed to promote socio-economic progress. Meeting these demands for impact assessment involves a number of complex issues that are difficult to fully address in a single study or in the design of a single methodology. However, they point to some general principles that can be explored in methodological design. We draw on a recent evaluation of the impacts of research grant funding, discussing both key issues in developing a methodology for the analysis and subsequent results. The case of research grant funding, involving a complex mix of direct and intermediate effects that contribute to the overall impact of funding on research performance, illustrates the value of a mixed methods approach to provide a more robust and complete analysis of policy impacts. Reflections on the strengths and weaknesses of the methodology are used to examine refinements for future work. Copyright © 2014 Elsevier Ltd. All rights reserved.

Interactive Land-Use Optimization Using Laguerre Voronoi Diagram with Dynamic Generating Point Allocation

NASA Astrophysics Data System (ADS)

Chaidee, S.; Pakawanwong, P.; Suppakitpaisarn, V.; Teerasawat, P.

2017-09-01

In this work, we devise an efficient method for the land-use optimization problem based on Laguerre Voronoi diagram. Previous Voronoi diagram-based methods are more efficient and more suitable for interactive design than discrete optimization-based method, but, in many cases, their outputs do not satisfy area constraints. To cope with the problem, we propose a force-directed graph drawing algorithm, which automatically allocates generating points of Voronoi diagram to appropriate positions. Then, we construct a Laguerre Voronoi diagram based on these generating points, use linear programs to adjust each cell, and reconstruct the diagram based on the adjustment. We adopt the proposed method to the practical case study of Chiang Mai University's allocated land for a mixed-use complex. For this case study, compared to other Voronoi diagram-based method, we decrease the land allocation error by 62.557 %. Although our computation time is larger than the previous Voronoi-diagram-based method, it is still suitable for interactive design.

Simultaneous occurrence of focal nodular hyperplasia and HNF1A-inactivated hepatocellular adenoma: a collision tumor simulating a composite FNH-HCA.

PubMed

Shih, Angela; Lauwers, Gregory Y; Balabaud, Charles; Bioulac-Sage, Paulette; Misdraji, Joseph

2015-09-01

Mixed focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) within a single tumor mass is rarely reported, and most of these cases are examples of tumors with features intermediate between FNH and HCA. Although a few reported cases are probably examples of true mixed tumors, none was evaluated immunohistochemically or confirmed by molecular analysis. We report a mixed FNH and HCA arising in a woman with several HNF1A-inactivated adenomas. Our case is the first case of mixed FNH and HNF1A-inactivated HCA documented by immunohistochemistry.

A comparison of fitness-case sampling methods for genetic programming

NASA Astrophysics Data System (ADS)

Martínez, Yuliana; Naredo, Enrique; Trujillo, Leonardo; Legrand, Pierrick; López, Uriel

2017-11-01

Genetic programming (GP) is an evolutionary computation paradigm for automatic program induction. GP has produced impressive results but it still needs to overcome some practical limitations, particularly its high computational cost, overfitting and excessive code growth. Recently, many researchers have proposed fitness-case sampling methods to overcome some of these problems, with mixed results in several limited tests. This paper presents an extensive comparative study of four fitness-case sampling methods, namely: Interleaved Sampling, Random Interleaved Sampling, Lexicase Selection and Keep-Worst Interleaved Sampling. The algorithms are compared on 11 symbolic regression problems and 11 supervised classification problems, using 10 synthetic benchmarks and 12 real-world data-sets. They are evaluated based on test performance, overfitting and average program size, comparing them with a standard GP search. Comparisons are carried out using non-parametric multigroup tests and post hoc pairwise statistical tests. The experimental results suggest that fitness-case sampling methods are particularly useful for difficult real-world symbolic regression problems, improving performance, reducing overfitting and limiting code growth. On the other hand, it seems that fitness-case sampling cannot improve upon GP performance when considering supervised binary classification.

Mixed squamous cell and glandular papilloma of the lung: a case study and literature review.

PubMed

Inamura, Kentaro; Kumasaka, Toshio; Furuta, Reiko; Shimada, Kei; Hiyama, Noriko; Furuhata, Yoshiaki; Tanaka, Isao; Takemura, Tamiko

2011-04-01

Mixed squamous cell and glandular papilloma (mixed papilloma) of the lung is an extremely rare neoplasm, with only 10 cases reported so far in the English literature. We present a case study of endobronchial mixed papilloma with immunohistochemical and etiological investigations. A 49-year-old male with a smoking history complained of hemoptysis, presented with a lung mass closely adjacent to large vessels in the computed tomography findings, and underwent lobectomy. The 3.0-cm sized polypoid tumor was histologically diagnosed as endobronchial mixed papilloma. Immunohistochemically, intracellular mucin was positive for MUC5AC, which is expressed in tracheobronchial goblet cells. CAM5.2 and CK19 were diffusely positive, indicating that the tumor originated from the columnar epithelium by squamous metaplasia. CEA and CA19-9 were focally positive. A human papillomavirus (HPV) investigation with in situ hybridization using a wide spectrum probe and a newly-developed PCR system did not detect any HPV infection. Including this case with a detailed HPV investigation, all of the reported cases of mixed papilloma were HPV-negative, and a literature review including newly-reported cases indicated a high frequency of smoking in such cases. Endobronchial mixed papillomas might have a smoking-related etiology. © 2011 The Authors. Pathology International © 2011 Japanese Society of Pathology and Blackwell Publishing Asia Pty Ltd.

Toxoplasma gondii Infection and Mixed Anxiety and Depressive Disorder: A Case-Control Seroprevalence Study in Durango, Mexico

PubMed Central

Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Berumen-Segovia, Luis Omar; Torres-Prieto, Yazmin Elizabeth; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ortiz-Jurado, Maria Nalleli; Molotla-de-Leon, Gabriel; Beristain Garcia, Isabel; Rabago-Sanchez, Elizabeth; Liesenfeld, Oliver

2016-01-01

Background The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. Methods Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Results Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P < 0.001). The frequency of high (> 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P < 0.00001). Patients aged 31 - 50 years old had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (OR: 21.04; 95% CI: 5.22 - 84.80; P < 0.00001). Anti-T. gondii IgM antibodies were found in four (26.7%) of the 15 anti-T. gondii IgG seropositive cases and in 10 (55.6%) of the 18 anti-T. gondii IgG seropositive controls (P = 0.15). Conclusions Results support for the first time an association between seropositivity to T. gondii and mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed. PMID:27298660

Why carers use adult day respite: a mixed method case study

PubMed Central

2014-01-01

Background We need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services. Methods A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis. Results Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. Conclusion The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services. PMID:24906239

Creating Advantages with Franchising in Healthcare: An Explorative Mixed Methods Study on the Role of the Relationship between the Franchisor and Units

PubMed Central

Nijmeijer, Karlijn Jojanneke; Fabbricotti, Isabelle Natalina; Huijsman, Robbert

2015-01-01

Background Franchising is a promising and increasingly used organizational form to improve strategic, organizational, professional and client-related results in healthcare. However, evidence is scarce regarding how franchises should be operated to actualize such results. This paper aimed to explore the association between the results achieved by healthcare franchises and the working relationships among actors in these franchises. Methods A sequential mixed methods approach was used to obtain both in-depth and broader quantifiable insights into a little-investigated phenomenon. We first employed a qualitative multiple embedded case study. Data were collected through observations, document analyses, and 96 in-depth semi-structured interviews in three Dutch healthcare franchises. Within-case and cross-case comparative analyses were conducted. Subsequently, a cross-sectional survey was developed based on the qualitative study and disseminated among 19 healthcare franchises. 40 franchisors and 346 unit actors filled in the questionnaire. Findings It seems important to have open, committed, cooperative franchise relationships in which professional franchisees and unit managers feel and trust that they have the opportunity to introduce ideas and articulate their needs to the franchisor. Such relationships help ensure satisfaction, survival, and quality of care, because they serve to foster synergy realization and local fit and prevent reinventing the wheel and professional resistance. PMID:25664581

Frequent homozygosity in both mature and immature ovarian teratomas: a shared genetic basis of tumorigenesis.

PubMed

Snir, Olivia L; DeJoseph, Maura; Wong, Serena; Buza, Natalia; Hui, Pei

2017-10-01

Although homozygosity is well documented in mature teratomas, the genetic zygosity of ovarian immature teratomas and mixed germ cell tumors is less well studied. Ten cases of mature cystic teratomas, eleven cases of grade 2 or 3 immature teratomas, and seven cases of mixed germ cell tumors with an immature teratoma component were investigated by short tandem repeat genotyping to interrogate their genetic zygosity. DNA genotyping was informative in eight mature teratomas, seven immature teratomas and six cases of mixed germ cell tumors. Out of the eight mature teratomas, five cases showed partial or complete homozygosity (63%) with two cases demonstrating complete homozygosity (25%). Of the immature teratomas, six cases showed partial or complete homozygosity (86%) with two cases demonstrating complete homozygosity (29%). For the mixed germ cell tumors, two cases showed partial homozygosity (33%) and none displayed complete homozygosity. Long-term clinical follow-up was available for five immature teratomas (mean follow-up 110 months) and five mixed germ cell tumors (mean follow-up 66 months). None of the five patients with pure immature teratoma had a recurrence; in contrast, four out of five mixed ovarian germ cell tumors recurred between 4 months to 8 years (P=0.048). In conclusion, both immature and mature teratomas harbor frequent genetic homozygosity suggesting a common cellular origin involving germ cells at the same developmental stage. The difference in the rate of homozygosity and tumor recurrence between pure immature teratomas and mixed germ cell tumors suggests that the two entities may involve different pathogenetic pathways and likely pursue different biological behaviors.

Reasons for Vocabulary Attrition: Revisiting the State of the Art

ERIC Educational Resources Information Center

Alharthi, Thamer

2015-01-01

This paper reports on a one year, mixed-methods longitudinal case study investigating the neglected area of the perceived reasons why participants forget vocabulary knowledge. The participants were 43 fourth year male Saudi EFL majors at King Abdulaziz University KAU, Saudi Arabia. Quantitative and qualitative data including self-reported…

Faculty and Community Collaboration in Sustained Community-University Engagement Partnerships

ERIC Educational Resources Information Center

Allen, Angela Danyell

2009-01-01

This dissertation is a qualitative case study of the factors of collaboration between faculty and community partners in sustained community-university engagement partnerships at a public research university in the Midwest. Based on secondary data from an annual, online, mixed-method survey of faculty-reported engagement activity, parallel yet…

Exploring Aging Attitudes through a Puppet Making Research Study

ERIC Educational Resources Information Center

Whiteland, Susan R.

2016-01-01

Intergenerational programs often reduce ageism and stereotypical thinking. This author uses a mixed methods case study to investigate how attitudes may change when older adults and children participate in an intergenerational art project. The research question, "Is there a positive correlation in children's attitudes toward older adults and…

The Leadership Gap: Preparing Leaders for Urban Schools

ERIC Educational Resources Information Center

Lee, Omaira Z.

2010-01-01

The purpose of this mixed-methods, purposive case study was to investigate the impact of participation in the Metropolitan ISD Principal Coaching Initiative (MPCI) on leadership practice. The MPCI is a district-wide executive leadership capacity building strategy, which combines the District's standards-based leadership curriculum with a…

Student Perceptions of Their Doctoral Programs: Case Study

ERIC Educational Resources Information Center

Moffett, David W.

2015-01-01

The Investigator studied three Doctor of Philosophy program concentrations for a two year period, 2013-2015. The intent of the confidential study was to determine factors affecting program participants' perceptions most. A mixed methods embedded study was applied, with the quantitative portion representing the secondary data source and the…

Providing Culturally Responsive Teaching in Field-Based and Student Teaching Experiences: A Case Study

ERIC Educational Resources Information Center

Kea, Cathy D.; Trent, Stanley C.

2013-01-01

This mixed design study chronicles the yearlong outcomes of 27 undergraduate preservice teacher candidates' ability to design and deliver culturally responsive lesson plans during field-based experience lesson observations and student teaching settings after receiving instruction in a special education methods course. While components of…

Can a Library Building's Design Cue New Behaviors? A Case Study

ERIC Educational Resources Information Center

O'Kelly, Mary; Scott-Webber, Lennie; Garrison, Julie; Meyer, Kristin

2017-01-01

This study explores the relationship between architecture and interior space on student engagement at a newly constructed academic library. Using an action, mixed-methods approach with a convenience sample, researchers evaluated 744 photographs, 125 behavioral observations, and six group interviews. Analysis revealed four key attributes of…

Teaching Complicated Conceptual Knowledge with Simulation Videos in Foundational Electrical Engineering Courses

ERIC Educational Resources Information Center

Chen, Baiyun; Wei, Lei; Li, Huihui

2016-01-01

Building a solid foundation of conceptual knowledge is critical for students in electrical engineering. This mixed-method case study explores the use of simulation videos to illustrate complicated conceptual knowledge in foundational communications and signal processing courses. Students found these videos to be very useful for establishing…

Everybody Leads: A Model for Collaborative Leadership

ERIC Educational Resources Information Center

Maxfield, C. Robert; Klocko, Barbara A.

2010-01-01

This mixed-methods case study analyzes the perceptions of participants in a year-long collaborative leadership initiative conducted at a small school district situated between larger urban districts and multiple suburban districts in a midwestern state. The initiative was facilitated by the Galileo Institute for Teacher Leadership in cooperation…

Shared-use bus priority lanes on city streets : case studies in design and management [research brief].

DOT National Transportation Integrated Search

2012-04-01

This study examines the design and operations of bus lanes in major congested urban centers. It focuses on shared-use bus lanes that operate in mixed traffic conditions. : Study Methods : The key questions addressed are: : 1. How do the many public a...

Investigating Teacher Presence in Courses Using Synchronous Videoconferencing

ERIC Educational Resources Information Center

Rehn, Nicole; Maor, Dorit; McConney, Andrew

2016-01-01

This research examines teacher presence in high school distance courses that are delivered by synchronous videoconference. In rural and remote areas, many school districts are using videoconferencing as way to reach dispersed students. This collective case study uses mixed methods to unpack the notion of presence from the perspective of teachers…

Finding Diego: A Bilingual Student Integrates School, Language, and Identity

ERIC Educational Resources Information Center

Danzak, Robin L.; Wilkinson, Louise C.

2017-01-01

This article presents a mixed-methods case study of Diego, a bilingual teen who completed public school in Florida. During adolescence, Diego negotiated multiple identities: successful student, Mexican American, bilingual, and typical U.S. teenager. Diego provided interviews and bilingual (English/Spanish) writing (narrative/expository) in 2008…

Empowering Discourse: Discourse Analysis as Method and Practice in the Sociology Classroom

ERIC Educational Resources Information Center

Hjelm, Titus

2013-01-01

Collaborative learning and critical pedagogy are widely recognized as "empowering" pedagogies for higher education. Yet, the practical implementation of both has a mixed record. The question, then, is: How could collaborative and critical pedagogies be empowered themselves? This paper makes a primarily theoretical case for discourse…

Laptop Computers in the Elementary Classroom: Authentic Instruction with At-Risk Students

ERIC Educational Resources Information Center

Kemker, Kate; Barron, Ann E.; Harmes, J. Christine

2007-01-01

This case study investigated the integration of laptop computers into an elementary classroom in a low socioeconomic status (SES) school. Specifically, the research examined classroom management techniques and aspects of authentic learning relative to the student projects and activities. A mixed methods approach included classroom observations,…

Supporting School Leaders in Blended Learning with Blended Learning

ERIC Educational Resources Information Center

Acree, Lauren; Gibson, Theresa; Mangum, Nancy; Wolf, Mary Ann; Kellogg, Shaun; Branon, Suzanne

2017-01-01

This study provides a mixed-methods case-study design evaluation of the Leadership in Blended Learning (LBL) program. The LBL program uses blended approaches, including face-to-face and online, to prepare school leaders to implement blended learning initiatives in their schools. This evaluation found that the program designers effectively…

After-School Literacy Engagements with Struggling Readers

ERIC Educational Resources Information Center

Piazza, Susan V.; Duncan, Lonnie E.

2012-01-01

Parental incarceration, poverty, urban violence, and drug use can be underlying factors of academic achievement gaps between Black urban males and their counterparts. These risk factors have the potential to position low-income urban students as struggling readers. Two qualitative case studies obtained from a larger mixed methods study illustrate…

Teaching Teamwork through Coteaching in the Business Classroom

ERIC Educational Resources Information Center

Kliegl, Julie A.; Weaver, Kari D.

2014-01-01

Business educators recognize the importance of developing teamwork as an employability skill. However, current methods used to teach teamwork have been met with mixed results from both students and educators. This article integrates research on the importance of teamwork, team development processes, and coteaching through examining a case study…

Mix and match: how to regain your balance.

PubMed

Jupiter, Daniel C

2013-01-01

In retrospective studies, a demographic imbalance often exists between cases and controls. This imbalance may affect outcome, independent of experimental group. We discuss matching methods that allow us to overcome these imbalances. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Attribution of horizontal and vertical contributions to spurious mixing in an Arbitrary Lagrangian-Eulerian ocean model

NASA Astrophysics Data System (ADS)

Gibson, Angus H.; Hogg, Andrew McC.; Kiss, Andrew E.; Shakespeare, Callum J.; Adcroft, Alistair

2017-11-01

We examine the separate contributions to spurious mixing from horizontal and vertical processes in an ALE ocean model, MOM6, using reference potential energy (RPE). The RPE is a global diagnostic which changes only due to mixing between density classes. We extend this diagnostic to a sub-timestep timescale in order to individually separate contributions to spurious mixing through horizontal (tracer advection) and vertical (regridding/remapping) processes within the model. We both evaluate the overall spurious mixing in MOM6 against previously published output from other models (MOM5, MITGCM and MPAS-O), and investigate impacts on the components of spurious mixing in MOM6 across a suite of test cases: a lock exchange, internal wave propagation, and a baroclinically-unstable eddying channel. The split RPE diagnostic demonstrates that the spurious mixing in a lock exchange test case is dominated by horizontal tracer advection, due to the spatial variability in the velocity field. In contrast, the vertical component of spurious mixing dominates in an internal waves test case. MOM6 performs well in this test case owing to its quasi-Lagrangian implementation of ALE. Finally, the effects of model resolution are examined in a baroclinic eddies test case. In particular, the vertical component of spurious mixing dominates as horizontal resolution increases, an important consideration as global models evolve towards higher horizontal resolutions.

Clustering of samples and variables with mixed-type data

PubMed Central

Edelmann, Dominic; Kopp-Schneider, Annette

2017-01-01

Analysis of data measured on different scales is a relevant challenge. Biomedical studies often focus on high-throughput datasets of, e.g., quantitative measurements. However, the need for integration of other features possibly measured on different scales, e.g. clinical or cytogenetic factors, becomes increasingly important. The analysis results (e.g. a selection of relevant genes) are then visualized, while adding further information, like clinical factors, on top. However, a more integrative approach is desirable, where all available data are analyzed jointly, and where also in the visualization different data sources are combined in a more natural way. Here we specifically target integrative visualization and present a heatmap-style graphic display. To this end, we develop and explore methods for clustering mixed-type data, with special focus on clustering variables. Clustering of variables does not receive as much attention in the literature as does clustering of samples. We extend the variables clustering methodology by two new approaches, one based on the combination of different association measures and the other on distance correlation. With simulation studies we evaluate and compare different clustering strategies. Applying specific methods for mixed-type data proves to be comparable and in many cases beneficial as compared to standard approaches applied to corresponding quantitative or binarized data. Our two novel approaches for mixed-type variables show similar or better performance than the existing methods ClustOfVar and bias-corrected mutual information. Further, in contrast to ClustOfVar, our methods provide dissimilarity matrices, which is an advantage, especially for the purpose of visualization. Real data examples aim to give an impression of various kinds of potential applications for the integrative heatmap and other graphical displays based on dissimilarity matrices. We demonstrate that the presented integrative heatmap provides more information than common data displays about the relationship among variables and samples. The described clustering and visualization methods are implemented in our R package CluMix available from https://cran.r-project.org/web/packages/CluMix. PMID:29182671

Methodological and practical viewpoints of qualitative-driven mixed method design: the case of decentralisation of primary healthcare services in Nepal.

PubMed

Regmi, Krishna

2018-01-01

Although considerable attention has been paid to the use of quantitative methods in health research, there has been limited focus on decentralisation research using a qualitative-driven mixed method design. Decentralisation presents both a problematic concept and methodological challenges, and is more context-specific and is often multi-dimensional. Researchers often consider using more than one method design when researching phenomena is complex in nature. Aim To explore the effects of decentralisation on the provision of primary healthcare services. Qualitative-driven mixed method design, employing three methods of data collections: focus group discussions (FGDs), semi-structured interviews (SSIs) and participant observations under two components, that is, core component and supplementary components were used. Four FGDs with health service practitioners, three FGDs with district stakeholders, 20 SSIs with health service users and 20 SSIs with national stakeholders were carried out. These were conducted sequentially. NVivo10, a data management program, was utilised to code the field data, employing a content analysis method for searching the underlying themes or concepts in the text material. Findings Both positive and negative experiences related to access, quality, planning, supplies, coordination and supervision were identified. This study suggests some evidence of the effects of decentralisation on health outcomes in general, as well as filling a gap of understanding and examining healthcare through a qualitative-driven mixed methods approach, in particular. Future research in the area of qualitative in-depth understanding of the problems (why decentralisation, why now and what for) would provoke an important data set that benefits the researchers and policy-makers for planning and implementing effective health services.

A comparison of methods for estimating the random effects distribution of a linear mixed model.

PubMed

Ghidey, Wendimagegn; Lesaffre, Emmanuel; Verbeke, Geert

2010-12-01

This article reviews various recently suggested approaches to estimate the random effects distribution in a linear mixed model, i.e. (1) the smoothing by roughening approach of Shen and Louis,(1) (2) the semi-non-parametric approach of Zhang and Davidian,(2) (3) the heterogeneity model of Verbeke and Lesaffre( 3) and (4) a flexible approach of Ghidey et al. (4) These four approaches are compared via an extensive simulation study. We conclude that for the considered cases, the approach of Ghidey et al. (4) often shows to have the smallest integrated mean squared error for estimating the random effects distribution. An analysis of a longitudinal dental data set illustrates the performance of the methods in a practical example.

Organizational climate and hospital nurses' caring practices: a mixed-methods study.

PubMed

Roch, Geneviève; Dubois, Carl-Ardy; Clarke, Sean P

2014-06-01

Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices. © 2014 Wiley Periodicals, Inc.

Can mixed assessment methods make biology classes more equitable?

PubMed

Cotner, Sehoya; Ballen, Cissy J

2017-01-01

Many factors have been proposed to explain the attrition of women in science, technology, engineering and math fields, among them the lower performance of women in introductory courses resulting from deficits in incoming preparation. We focus on the impact of mixed methods of assessment, which minimizes the impact of high-stakes exams and rewards other methods of assessment such as group participation, low-stakes quizzes and assignments, and in-class activities. We hypothesized that these mixed methods would benefit individuals who otherwise underperform on high-stakes tests. Here, we analyze gender-based performance trends in nine large (N > 1000 students) introductory biology courses in fall 2016. Females underperformed on exams compared to their male counterparts, a difference that does not exist with other methods of assessment that compose course grade. Further, we analyzed three case studies of courses that transitioned their grading schemes to either de-emphasize or emphasize exams as a proportion of total course grade. We demonstrate that the shift away from an exam emphasis consequently benefits female students, thereby closing gaps in overall performance. Further, the exam performance gap itself is reduced when the exams contribute less to overall course grade. We discuss testable predictions that follow from our hypothesis, and advocate for the use of mixed methods of assessments (possibly as part of an overall shift to active learning techniques). We conclude by challenging the student deficit model, and suggest a course deficit model as explanatory of these performance gaps, whereby the microclimate of the classroom can either raise or lower barriers to success for underrepresented groups in STEM.

Can mixed assessment methods make biology classes more equitable?

PubMed Central

Ballen, Cissy J.

2017-01-01

Many factors have been proposed to explain the attrition of women in science, technology, engineering and math fields, among them the lower performance of women in introductory courses resulting from deficits in incoming preparation. We focus on the impact of mixed methods of assessment, which minimizes the impact of high-stakes exams and rewards other methods of assessment such as group participation, low-stakes quizzes and assignments, and in-class activities. We hypothesized that these mixed methods would benefit individuals who otherwise underperform on high-stakes tests. Here, we analyze gender-based performance trends in nine large (N > 1000 students) introductory biology courses in fall 2016. Females underperformed on exams compared to their male counterparts, a difference that does not exist with other methods of assessment that compose course grade. Further, we analyzed three case studies of courses that transitioned their grading schemes to either de-emphasize or emphasize exams as a proportion of total course grade. We demonstrate that the shift away from an exam emphasis consequently benefits female students, thereby closing gaps in overall performance. Further, the exam performance gap itself is reduced when the exams contribute less to overall course grade. We discuss testable predictions that follow from our hypothesis, and advocate for the use of mixed methods of assessments (possibly as part of an overall shift to active learning techniques). We conclude by challenging the student deficit model, and suggest a course deficit model as explanatory of these performance gaps, whereby the microclimate of the classroom can either raise or lower barriers to success for underrepresented groups in STEM. PMID:29281676

Fluid Structure Interaction Techniques For Extrusion And Mixing Processes

NASA Astrophysics Data System (ADS)

Valette, Rudy; Vergnes, Bruno; Coupez, Thierry

2007-05-01

This work focuses on the development of numerical techniques devoted to the simulation of mixing processes of complex fluids such as twin-screw extrusion or batch mixing. In mixing process simulation, the absence of symmetry of the moving boundaries (the screws or the rotors) implies that their rigid body motion has to be taken into account by using a special treatment We therefore use a mesh immersion technique (MIT), which consists in using a P1+/P1-based (MINI-element) mixed finite element method for solving the velocity-pressure problem and then solving the problem in the whole barrel cavity by imposing a rigid motion (rotation) to nodes found located inside the so called immersed domain, each sub-domain (screw, rotor) being represented by a surface CAD mesh (or its mathematical equation in simple cases). The independent meshes are immersed into a unique background computational mesh by computing the distance function to their boundaries. Intersections of meshes are accounted for, allowing to compute a fill factor usable as for the VOF methodology. This technique, combined with the use of parallel computing, allows to compute the time-dependent flow of generalized Newtonian fluids including yield stress fluids in a complex system such as a twin screw extruder, including moving free surfaces, which are treated by a "level set" and Hamilton-Jacobi method.

Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases.

PubMed

Eaton, J L; Mohammad, A; Mohr, D C; Brustein, D J; Kirkhorn, S R

2017-12-30

Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners. Published by Oxford University Press on behalf of The Society of Occupational Medicine 2017.

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging, fun, and control and choice.

PubMed

King, Gillian; Gibson, Barbara E; Mistry, Bhavnita; Pinto, Madhu; Goh, Freda; Teachman, Gail; Thompson, Laura

2014-01-01

The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities - those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a "following a thread" technique and case-by-case analysis. The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths' experiences.

Pre-service elementary science teaching self-efficacy and teaching practices: A mixed-methods, dual-phase, embedded case study

NASA Astrophysics Data System (ADS)

Sangueza, Cheryl Ramirez

This mixed-method, dual-phase, embedded-case study employed the Social Cognitive Theory and the construct of self-efficacy to examine the contributors to science teaching self-efficacy and science teaching practices across different levels of efficacy in six pre-service elementary teachers during their science methods course and student teaching experiences. Data sources included the Science Teaching Efficacy Belief Instrument (STEBI-B) for pre-service teachers, questionnaires, journals, reflections, student teaching lesson observations, and lesson debriefing notes. Results from the STEBI-B show that all participants measured an increase in efficacy throughout the study. The ANOVA analysis of the STEBI-B revealed a statistically significant increase in level of efficacy during methods course, student teaching, and from the beginning of the study to the end. Of interest in this study was the examination of the participants' science teaching practices across different levels of efficacy. Results of this analysis revealed how the pre-service elementary teachers in this study contextualized their experiences in learning to teach science and its influences on their science teaching practices. Key implications involves the value in exploring how pre-service teachers interpret their learning to teach experiences and how their interpretations influence the development of their science teaching practices.

A pseudospectral Legendre method for hyperbolic equations with an improved stability condition

NASA Technical Reports Server (NTRS)

Tal-Ezer, Hillel

1986-01-01

A new pseudospectral method is introduced for solving hyperbolic partial differential equations. This method uses different grid points than previously used pseudospectral methods: in fact the grid points are related to the zeroes of the Legendre polynomials. The main advantage of this method is that the allowable time step is proportional to the inverse of the number of grid points 1/N rather than to 1/n(2) (as in the case of other pseudospectral methods applied to mixed initial boundary value problems). A highly accurate time discretization suitable for these spectral methods is discussed.

A pseudospectral Legendre method for hyperbolic equations with an improved stability condition

NASA Technical Reports Server (NTRS)

Tal-Ezer, H.

1984-01-01

A new pseudospectral method is introduced for solving hyperbolic partial differential equations. This method uses different grid points than previously used pseudospectral methods: in fact the grid are related to the zeroes of the Legendre polynomials. The main advantage of this method is that the allowable time step is proportional to the inverse of the number of grid points 1/N rather than to 1/n(2) (as in the case of other pseudospectral methods applied to mixed initial boundary value problems). A highly accurate time discretization suitable for these spectral methods is discussed.

The long-solved problem of the best-fit straight line: Application to isotopic mixing lines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wehr, Richard; Saleska, Scott R.

It has been almost 50 years since York published an exact and general solution for the best-fit straight line to independent points with normally distributed errors in both x and y. York's solution is highly cited in the geophysical literature but almost unknown outside of it, so that there has been no ebb in the tide of books and papers wrestling with the problem. Much of the post-1969 literature on straight-line fitting has sown confusion not merely by its content but by its very existence. The optimal least-squares fit is already known; the problem is already solved. Here we introducemore » the non-specialist reader to York's solution and demonstrate its application in the interesting case of the isotopic mixing line, an analytical tool widely used to determine the isotopic signature of trace gas sources for the study of biogeochemical cycles. The most commonly known linear regression methods – ordinary least-squares regression (OLS), geometric mean regression (GMR), and orthogonal distance regression (ODR) – have each been recommended as the best method for fitting isotopic mixing lines. In fact, OLS, GMR, and ODR are all special cases of York's solution that are valid only under particular measurement conditions, and those conditions do not hold in general for isotopic mixing lines. Here, using Monte Carlo simulations, we quantify the biases in OLS, GMR, and ODR under various conditions and show that York's general – and convenient – solution is always the least biased.« less

The long-solved problem of the best-fit straight line: Application to isotopic mixing lines

DOE PAGES

Wehr, Richard; Saleska, Scott R.

2017-01-03

It has been almost 50 years since York published an exact and general solution for the best-fit straight line to independent points with normally distributed errors in both x and y. York's solution is highly cited in the geophysical literature but almost unknown outside of it, so that there has been no ebb in the tide of books and papers wrestling with the problem. Much of the post-1969 literature on straight-line fitting has sown confusion not merely by its content but by its very existence. The optimal least-squares fit is already known; the problem is already solved. Here we introducemore » the non-specialist reader to York's solution and demonstrate its application in the interesting case of the isotopic mixing line, an analytical tool widely used to determine the isotopic signature of trace gas sources for the study of biogeochemical cycles. The most commonly known linear regression methods – ordinary least-squares regression (OLS), geometric mean regression (GMR), and orthogonal distance regression (ODR) – have each been recommended as the best method for fitting isotopic mixing lines. In fact, OLS, GMR, and ODR are all special cases of York's solution that are valid only under particular measurement conditions, and those conditions do not hold in general for isotopic mixing lines. Here, using Monte Carlo simulations, we quantify the biases in OLS, GMR, and ODR under various conditions and show that York's general – and convenient – solution is always the least biased.« less

The adaptive buffered force QM/MM method in the CP2K and AMBER software packages

DOE PAGES

Mones, Letif; Jones, Andrew; Götz, Andreas W.; ...

2015-02-03

We present the implementation and validation of the adaptive buffered force (AdBF) quantum-mechanics/molecular-mechanics (QM/MM) method in two popular packages, CP2K and AMBER. The implementations build on the existing QM/MM functionality in each code, extending it to allow for redefinition of the QM and MM regions during the simulation and reducing QM-MM interface errors by discarding forces near the boundary according to the buffered force-mixing approach. New adaptive thermostats, needed by force-mixing methods, are also implemented. Different variants of the method are benchmarked by simulating the structure of bulk water, water autoprotolysis in the presence of zinc and dimethyl-phosphate hydrolysis usingmore » various semiempirical Hamiltonians and density functional theory as the QM model. It is shown that with suitable parameters, based on force convergence tests, the AdBF QM/MM scheme can provide an accurate approximation of the structure in the dynamical QM region matching the corresponding fully QM simulations, as well as reproducing the correct energetics in all cases. Adaptive unbuffered force-mixing and adaptive conventional QM/MM methods also provide reasonable results for some systems, but are more likely to suffer from instabilities and inaccuracies.« less

The adaptive buffered force QM/MM method in the CP2K and AMBER software packages

PubMed Central

Mones, Letif; Jones, Andrew; Götz, Andreas W; Laino, Teodoro; Walker, Ross C; Leimkuhler, Ben; Csányi, Gábor; Bernstein, Noam

2015-01-01

The implementation and validation of the adaptive buffered force (AdBF) quantum-mechanics/molecular-mechanics (QM/MM) method in two popular packages, CP2K and AMBER are presented. The implementations build on the existing QM/MM functionality in each code, extending it to allow for redefinition of the QM and MM regions during the simulation and reducing QM-MM interface errors by discarding forces near the boundary according to the buffered force-mixing approach. New adaptive thermostats, needed by force-mixing methods, are also implemented. Different variants of the method are benchmarked by simulating the structure of bulk water, water autoprotolysis in the presence of zinc and dimethyl-phosphate hydrolysis using various semiempirical Hamiltonians and density functional theory as the QM model. It is shown that with suitable parameters, based on force convergence tests, the AdBF QM/MM scheme can provide an accurate approximation of the structure in the dynamical QM region matching the corresponding fully QM simulations, as well as reproducing the correct energetics in all cases. Adaptive unbuffered force-mixing and adaptive conventional QM/MM methods also provide reasonable results for some systems, but are more likely to suffer from instabilities and inaccuracies. © 2015 The Authors. Journal of Computational Chemistry Published by Wiley Periodicals, Inc. PMID:25649827

Effect of various pretreatment methods on anaerobic mixed microflora to enhance biohydrogen production utilizing dairy wastewater as substrate.

PubMed

Venkata Mohan, S; Lalit Babu, V; Sarma, P N

2008-01-01

Influence of different pretreatment methods applied on anaerobic mixed inoculum was evaluated for selectively enriching the hydrogen (H(2)) producing mixed culture using dairy wastewater as substrate. The experimental data showed the feasibility of molecular biohydrogen generation utilizing dairy wastewater as primary carbon source through metabolic participation. However, the efficiency of H(2) evolution and substrate removal efficiency were found to be dependent on the type of pretreatment procedure adopted on the parent inoculum. Among the studied pretreatment methods, chemical pretreatment (2-bromoethane sulphonic acid sodium salt (0.2 g/l); 24 h) procedure enabled higher H(2) yield along with concurrent substrate removal efficiency. On the contrary, heat-shock pretreatment (100 degrees C; 1 h) procedure resulted in relatively low H(2) yield. Compared to control experiments all the adopted pretreatment methods documented higher H(2) generation efficiency. In the case of combination experiments, integration of pH (pH 3; adjusted with ortho-phosphoric acid; 24 h) and chemical pretreatment evidenced higher H(2) production. Data envelopment analysis (DEA), a frontier analysis technique model was successfully applied to enumerate the relative efficiency of different pretreatment methods studied by considered pretreatment procedures as input and cumulative H(2) production rate and substrate degradation rate as corresponding two outputs.

The adaptive buffered force QM/MM method in the CP2K and AMBER software packages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mones, Letif; Jones, Andrew; Götz, Andreas W.

We present the implementation and validation of the adaptive buffered force (AdBF) quantum-mechanics/molecular-mechanics (QM/MM) method in two popular packages, CP2K and AMBER. The implementations build on the existing QM/MM functionality in each code, extending it to allow for redefinition of the QM and MM regions during the simulation and reducing QM-MM interface errors by discarding forces near the boundary according to the buffered force-mixing approach. New adaptive thermostats, needed by force-mixing methods, are also implemented. Different variants of the method are benchmarked by simulating the structure of bulk water, water autoprotolysis in the presence of zinc and dimethyl-phosphate hydrolysis usingmore » various semiempirical Hamiltonians and density functional theory as the QM model. It is shown that with suitable parameters, based on force convergence tests, the AdBF QM/MM scheme can provide an accurate approximation of the structure in the dynamical QM region matching the corresponding fully QM simulations, as well as reproducing the correct energetics in all cases. Adaptive unbuffered force-mixing and adaptive conventional QM/MM methods also provide reasonable results for some systems, but are more likely to suffer from instabilities and inaccuracies.« less

Cost-Effectiveness of Chagas Disease Vector Control Strategies in Northwestern Argentina

PubMed Central

Vazquez-Prokopec, Gonzalo M.; Spillmann, Cynthia; Zaidenberg, Mario; Kitron, Uriel; Gürtler, Ricardo E.

2009-01-01

Background Control and prevention of Chagas disease rely mostly on residual spraying of insecticides. In Argentina, vector control shifted from a vertical to a fully horizontal strategy based on community participation between 1992 and 2004. The effects of such strategy on Triatoma infestans, the main domestic vector, and on disease transmission have not been assessed. Methods and Findings Based on retrospective (1993–2004) records from the Argentinean Ministry of Health for the Moreno Department, Northwestern Argentina, we performed a cost-effectiveness (CE) analysis and compared the observed CE of the fully horizontal vector control strategy with the expected CE for a vertical or a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy. Total direct costs (in 2004 US$) of the horizontal and mixed strategies were, respectively, 3.3 and 1.7 times lower than the costs of the vertical strategy, due to reductions in personnel costs. The estimated CE ratios for the vertical, mixed and horizontal strategies were US$132, US$82 and US$45 per averted human case, respectively. When per diems were excluded from the costs (i.e., simulating the decentralization of control activities), the CE of vertical, mixed and horizontal strategies was reduced to US$60, US$42 and US$32 per averted case, respectively. Conclusions and Significance The mixed strategy would have averted between 1.6 and 4.0 times more human cases than the fully horizontal strategy, and would have been the most cost-effective option to interrupt parasite transmission in the Department. In rural and dispersed areas where waning vertical vector programs cannot accomplish full insecticide coverage, alternative strategies need to be developed. If properly implemented, community participation represents not only the most appealing but also the most cost-effective alternative to accomplish such objectives. PMID:19156190

Dual-tracer method to estimate coral reef response to a plume of chemically modified seawater

NASA Astrophysics Data System (ADS)

Maclaren, J. K.; Caldeira, K.

2013-12-01

We present a new method, based on measurement of seawater samples, to estimate the response of a reef ecosystem to a plume of an additive (for example, a nutrient or other chemical). In the natural environment, where there may be natural variability in concentrations, it can be difficult to distinguish between changes in concentrations that would occur naturally and changes in concentrations that result from a chemical addition. Furthermore, in the unconfined natural environment, chemically modified water can mix with waters that have not been modified, making it difficult to distinguish between effects of dilution and effects of chemical fluxes or transformations. We present a dual-tracer method that extracts signals from observations that may be affected by both natural variability and dilution. In this dual-tracer method, a substance (in our example case, alkalinity) is added to the water in known proportion to a passive conservative tracer (in our example case, Rhodamine WT dye). The resulting plume of seawater is allowed to flow over the study site. Two transects are drawn across the plume at the front and back of the study site. If, in our example, alkalinity is plotted as a function of dye concentration for the front transect, the slope of the resulting mixing line is the ratio of alkalinity to dye in the added fluid. If a similar mixing line is measured and calculated for the back transect, the slope of this mixing line will indicate the amount of added alkalinity that remains in the water flowing out of the study site per unit of added dye. The ratio of the front and back slopes indicates the fraction of added alkalinity that was taken up by the reef. The method is demonstrated in an experiment performed on One Tree Reef (Queensland, Australia) aimed at showing that ocean acidification is already affecting coral reef growth. In an effort to chemically reverse some of the changes to seawater chemistry that have occurred over the past 200 years, we added sodium hydroxide to increase alkalinity in the plume and controlled for dilution with Rhodamine WT dye. Preliminary data will be presented and analyzed using the approach described above.

29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. 1614.303 Section 1614.303 Labor Regulations Relating to Labor (Continued) EQUAL... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file...

29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. 1614.303 Section 1614.303 Labor Regulations Relating to Labor (Continued) EQUAL... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file...

29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. 1614.303 Section 1614.303 Labor Regulations Relating to Labor (Continued) EQUAL... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file...

29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. 1614.303 Section 1614.303 Labor Regulations Relating to Labor (Continued) EQUAL... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file...

29 CFR 1614.303 - Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. 1614.303 Section 1614.303 Labor Regulations Relating to Labor (Continued) EQUAL... Petitions to the EEOC from MSPB decisions on mixed case appeals and complaints. (a) Who may file...

Decision-case mix model for analyzing variation in cesarean rates.

PubMed

Eldenburg, L; Waller, W S

2001-01-01

This article contributes a decision-case mix model for analyzing variation in c-section rates. Like recent contributions to the literature, the model systematically takes into account the effect of case mix. Going beyond past research, the model highlights differences in physician decision making in response to obstetric factors. Distinguishing the effects of physician decision making and case mix is important in understanding why c-section rates vary and in developing programs to effect change in physician behavior. The model was applied to a sample of deliveries at a hospital where physicians exhibited considerable variation in their c-section rates. Comparing groups with a low versus high rate, the authors' general conclusion is that the difference in physician decision tendencies (to perform a c-section), in response to specific obstetric factors, is at least as important as case mix in explaining variation in c-section rates. The exact effects of decision making versus case mix depend on how the model application defines the obstetric condition of interest and on the weighting of deliveries by their estimated "risk of Cesarean." The general conclusion is supported by an additional analysis that uses the model's elements to predict individual physicians' annual c-section rates.

[Etiological analysis and establishment of a discriminant model for lower respiratory tract infections in hospitalized patients].

PubMed

Chen, Y S; Lin, X H; Li, H R; Hua, Z D; Lin, M Q; Huang, W S; Yu, T; Lyu, H Y; Mao, W P; Liang, Y Q; Peng, X R; Chen, S J; Zheng, H; Lian, S Q; Hu, X L; Yao, X Q

2017-12-12

Objective: To analyze the pathogens of lower respiratory tract infection(LRTI) including bacterial, viral and mixed infection, and to establish a discriminant model based on clinical features in order to predict the pathogens. Methods: A total of 243 hospitalized patients with lower respiratory tract infections were enrolled in Fujian Provincial Hospital from April 2012 to September 2015. The clinical data and airway (sputum and/or bronchoalveolar lavage) samples were collected. Microbes were identified by traditional culture (for bacteria), loop-mediated isothermal amplification(LAMP) and gene sequencing (for bacteria and atypical pathogen), or Real-time quantitative polymerase chain reaction (Real-time PCR)for viruses. Finally, a discriminant model was established by using the discriminant analysis methods to help to predict bacterial, viral and mixed infections. Results: Pathogens were detected in 53.9% (131/243) of the 243 cases.Bacteria accounted for 23.5%(57/243, of which 17 cases with the virus, 1 case with Mycoplasma pneumoniae and virus), mainly Pseudomonas Aeruginosa and Klebsiella Pneumonia. Atypical pathogens for 4.9% (12/243, of which 3 cases with the virus, 1 case of bacteria and viruses), all were mycoplasma pneumonia. Viruses for 34.6% (84/243, of which 17 cases of bacteria, 3 cases with Mycoplasma pneumoniae, 1 case with Mycoplasma pneumoniae and bacteria) of the cases, mainly Influenza A virus and Human Cytomegalovirus, and other virus like adenovirus, human parainfluenza virus, respiratory syncytial virus, human metapneumovirus, human boca virus were also detected fewly. Seven parameters including mental status, using antibiotics prior to admission, complications, abnormal breath sounds, neutrophil alkaline phosphatase (NAP) score, pneumonia severity index (PSI) score and CRUB-65 score were enrolled after univariate analysis, and discriminant analysis was used to establish the discriminant model by applying the identified pathogens as the dependent variable. The total positive predictive value was 64.7%(77/119), with 66.7% for bacterial infection, 78.0% for viral infection and 33.3% for the mixed infection. Conclusions: The mostly detected pathogens were Pseudomonas aeruginosa, atypitcal pathogens, Klebsiella pneumoniae, influenza A virus and human cytomegalovirus in hospitalized patients with LRTI in this hospital. The discriminant diagnostic model established by clinical features may contribute to predict the pathogens of LRTI.

A case-mix in-service education program.

PubMed

Arons, R R

1985-01-01

The new case-mix in-service education program at the Presbyterian Hospital in the City of New York is a fine example of physicians and administration working together to achieve success under the new prospective pricing system. The hospital's office of Case-Mix Studies has developed an accurate computer-based information system with historical, clinical, and demographic data for patients discharged from the hospital over the past five years. Reports regarding the cases, diagnoses, finances, and characteristics are shared in meetings with the hospital administration and directors of sixteen clinical departments, their staff, attending physicians, and house officers in training. The informative case-mix reports provide revealing sociodemographic summaries and have proven to be an invaluable tool for planning, marketing, and program evaluation.

Combustor assembly for use in a turbine engine and methods of assembling same

DOEpatents

Uhm, Jong Ho; Johnson, Thomas Edward

2013-05-14

A fuel nozzle assembly for use with a turbine engine is described herein. The fuel nozzle assembly includes a plurality of fuel nozzles positioned within an air plenum defined by a casing. Each of the plurality of fuel nozzles is coupled to a combustion liner defining a combustion chamber. Each of the plurality of fuel nozzles includes a housing that includes an inner surface that defines a cooling fluid plenum and a fuel plenum therein, and a plurality of mixing tubes extending through the housing. Each of the mixing tubes includes an inner surface defining a flow channel extending between the air plenum and the combustion chamber. At least one mixing tube of the plurality of mixing tubes including at least one cooling fluid aperture for channeling a flow of cooling fluid from the cooling fluid plenum to the flow channel.

Connecting Past with Present: A Mixed-Methods Science Ethics Course and its Evaluation.

PubMed

Semendeferi, Ioanna; Tsiamyrtzis, Panagiotis; Dcosta, Malcolm; Pavlidis, Ioannis

2016-02-01

We present a graduate science ethics course that connects cases from the historical record to present realities and practices in the areas of social responsibility, authorship, and human/animal experimentation. This content is delivered with mixed methods, including films, debates, blogging, and practicum; even the instructional team is mixed, including a historian of science and a research scientist. What really unites all of the course's components is the experiential aspect: from acting in historical debates to participating in the current scientific enterprise. The course aims to change the students' culture into one deeply devoted to the science ethics cause. To measure the sought after cultural change, we developed and validated a relevant questionnaire. Results of this questionnaire from students who took the course, demonstrate that the course had the intended effect on them. Furthermore, results of this questionnaire from controls indicate the need for cultural change in that cohort. All these quantitative results are reinforced by qualitative outcomes.

Measuring case-mix complexity of tertiary care hospitals using DRGs.

PubMed

Park, Hayoung; Shin, Youngsoo

2004-02-01

The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

Child protective services utilization of child abuse pediatricians: A mixed methods study.

PubMed

Girardet, Rebecca; Bolton, Kelly; Hashmi, Syed; Sedlock, Emily; Khatri, Rachna; Lahoti, Nina; Lukefahr, James

2018-02-01

Several children's hospitals and medical schools across Texas have child abuse pediatricians (CAPs) who work closely with child protection workers to help ensure accurate assessments of the likelihood of maltreatment in cases of suspected abuse and neglect. Since the state does not mandate which cases should be referred to a CAP center, we were interested in studying factors that may influence workers' decisions to consult a CAP. We used a mixed methods study design consisting of a focus group followed by a survey. The focus group identified multiple factors that impact workers' decision-making, including several that involve medical providers. Responses from 436 completed surveys were compared to employees' number of years of employment and to the state region in which they worked. Focus group findings and survey responses revealed frustration among many workers when dealing with medical providers, and moderate levels of confidence in workers' abilities to make accurate determinations in cases involving medical information. Workers were more likely to refer cases involving serious physical injury than other types of cases. Among workers who reported prior interactions with a CAP, experiences and attitudes regarding CAPs were typically positive. The survey also revealed significant variability in referral practices by state region. Our results suggest that standard guidelines regarding CAP referrals may help workers who deal with cases involving medical information. Future research and quality improvement efforts to improve transfers of information and to better understand the qualities that CPS workers appreciate in CAP teams should improve CAP-CPS coordination. Copyright © 2017 Elsevier Ltd. All rights reserved.

Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

PubMed

Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

2010-12-01

Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

Nursing home case mix in Wisconsin. Findings and policy implications.

PubMed

Arling, G; Zimmerman, D; Updike, L

1989-02-01

Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, i.e., minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time.

Case mix of home health patients under capitated and fee-for-service payment.

PubMed Central

Shaughnessy, P W; Schlenker, R E; Hittle, D F

1995-01-01

OBJECTIVE. We compare case mix of Medicare home health patients under HMO and FFS payment. STUDY DESIGN. A pseudo-experimental design was employed to study case mix using three types of Medicare-certified home health agencies (HHAs): HMO-owned agencies, pure FFS agencies that admit few Medicare HMO patients (less than 5 percent of admissions are Medicare HMO patients), and mixed (or contractual) agencies that admit at least 15 Medicare FFS patients and 15 Medicare HMO patients per month. SAMPLES OF PROVIDERS AND PATIENTS. Random samples of Medicare-aged patients (> or = 65 years) were selected at admission between June 1989 and November 1991 from the 38 study HHAs. Sample sizes by agency type were: 308 patients from 9 HMO-owned agencies; 529 patients from 15 pure FFS agencies; and 381 HMO patients and 414 FFS patients from 14 contractual agencies. DATA. Primary longitudinal data were prospectively collected at admission for all patients on health status indicators, demographics, admission source, and home environment. MEASURES. The most important case-mix measures were functional and physiologic indicators of health status, including (instrumental) activities of daily living ([I]ADLs). Selected indicators of demographic variables, prior location, living situation, characteristics of informal caregivers, mental/behavioral factors, and resource needs were also used. PRINCIPAL FINDINGS. (a) The case mix of Medicare FFS patients compared with Medicare HMO patients was more intense in terms of impairments in ADLs, IADLs, and various physiologic conditions. Pressure ulcers as well as neurological and orthopedic impairments requiring rehabilitation care were also more prevalent among FFS patients. (b) Relative to HMO patients admitted to contractual agencies, HMO patients admitted to HMO-owned agencies were moderately more dependent in ADLs and IADLs. However, only 62 percent of HMO patients admitted to HMO-owned agencies, in contrast to 77 percent of HMO patients admitted to contractual agencies, had been hospitalized during the 30 days prior to home health admission. (c) In all, the case mix of patients receiving care from HMO-owned agencies is more heterogeneous than the case mix of HMO patients receiving care from contractual agencies. CONCLUSIONS. The case-mix (and selected utilization) findings indicate that HMOs use home health care differently than does the FFS sector. The greater diversity of case mix for HMO-owned agencies and the narrower or less diverse case mix that characterizes HMO patients receiving home care on a contractual basis point to the likelihood of cost differences among the two types of HMO patients and FFS patients, and raise the question of possible outcome differences. PMID:7721587

Complete ensemble local mean decomposition with adaptive noise and its application to fault diagnosis for rolling bearings

NASA Astrophysics Data System (ADS)

Wang, Lei; Liu, Zhiwen; Miao, Qiang; Zhang, Xin

2018-06-01

Mode mixing resulting from intermittent signals is an annoying problem associated with the local mean decomposition (LMD) method. Based on noise-assisted approach, ensemble local mean decomposition (ELMD) method alleviates the mode mixing issue of LMD to some degree. However, the product functions (PFs) produced by ELMD often contain considerable residual noise, and thus a relatively large number of ensemble trials are required to eliminate the residual noise. Furthermore, since different realizations of Gaussian white noise are added to the original signal, different trials may generate different number of PFs, making it difficult to take ensemble mean. In this paper, a novel method is proposed called complete ensemble local mean decomposition with adaptive noise (CELMDAN) to solve these two problems. The method adds a particular and adaptive noise at every decomposition stage for each trial. Moreover, a unique residue is obtained after separating each PF, and the obtained residue is used as input for the next stage. Two simulated signals are analyzed to illustrate the advantages of CELMDAN in comparison to ELMD and CEEMDAN. To further demonstrate the efficiency of CELMDAN, the method is applied to diagnose faults for rolling bearings in an experimental case and an engineering case. The diagnosis results indicate that CELMDAN can extract more fault characteristic information with less interference than ELMD.

Patellar Tendinopathy

PubMed Central

Schwartz, Aaron; Watson, Jonathan N.; Hutchinson, Mark R.

2015-01-01

Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Conclusion: Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. PMID:26502416

Molten salt synthesis of La0.8Sr0.2MnO3 powders for SOFC cathode electrode

NASA Astrophysics Data System (ADS)

Gu, Sin-il; Shin, Hyo-soon; Hong, Youn-woo; Yeo, Dong-hun; Kim, Jong-hee; Nahm, Sahn; Yoon, Sang-ok

2012-08-01

For La0.8Sr0.2MnO3 (LSM) perovskite, used as the cathode material for solid oxide fuel cells (SOFC), it is known that the formation of a triple-phase-boundary is restrained due to the formation of a second phase at the YSZ/electrode interface at high temperature. To decrease the 2nd phase, lowering the sintering temperature has been used. LSM powder was synthesized by molten salt synthesis method to control its particle size, shape, and agglomeration. We have characterized the phase formation, particle size, shape, and sintering behavior of LSM in the synthesis using the variation of KCl, LiCl, KF and its mixed salts as raw materials. In the case of KCl and KCl-KF salts, the particle size and shape of the LSM was well controlled and synthesized. However, in the case of LiCl and KCl-LiCl salts, LiMnOx as 2nd phase and LSM were synthesized simultaneously. In the case of the mixed salt of KCl-KF, the growth mechanism of the LSM particle was changed from `diffusion-controlled' to `reaction-controlled' according to the amount of mixed salt. The sintering temperature can be decreased below 1000 °C by using the synthesized LSM powder.

A new framework to enhance the interpretation of external validation studies of clinical prediction models.

PubMed

Debray, Thomas P A; Vergouwe, Yvonne; Koffijberg, Hendrik; Nieboer, Daan; Steyerberg, Ewout W; Moons, Karel G M

2015-03-01

It is widely acknowledged that the performance of diagnostic and prognostic prediction models should be assessed in external validation studies with independent data from "different but related" samples as compared with that of the development sample. We developed a framework of methodological steps and statistical methods for analyzing and enhancing the interpretation of results from external validation studies of prediction models. We propose to quantify the degree of relatedness between development and validation samples on a scale ranging from reproducibility to transportability by evaluating their corresponding case-mix differences. We subsequently assess the models' performance in the validation sample and interpret the performance in view of the case-mix differences. Finally, we may adjust the model to the validation setting. We illustrate this three-step framework with a prediction model for diagnosing deep venous thrombosis using three validation samples with varying case mix. While one external validation sample merely assessed the model's reproducibility, two other samples rather assessed model transportability. The performance in all validation samples was adequate, and the model did not require extensive updating to correct for miscalibration or poor fit to the validation settings. The proposed framework enhances the interpretation of findings at external validation of prediction models. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

WT1 immunoreactivity in breast carcinoma: selective expression in pure and mixed mucinous subtypes.

PubMed

Domfeh, Akosua B; Carley, AnnaMarie L; Striebel, Joan M; Karabakhtsian, Rouzan G; Florea, Anca V; McManus, Kim; Beriwal, Sushil; Bhargava, Rohit

2008-10-01

Current literature suggests that strong WT1 expression in a carcinoma of unknown origin virtually excludes a breast primary. Our previous pilot study on WT1 expression in breast carcinomas has shown WT1 expression in approximately 10% of carcinomas that show mixed micropapillary and mucinous morphology (Mod Pathol 2007;20(Suppl 2):38A). To definitively assess as to what subtype of breast carcinoma might express WT1 protein, we examined 153 cases of invasive breast carcinomas. These consisted of 63 consecutive carcinomas (contained 1 mucinous tumor), 20 cases with micropapillary morphology (12 pure and 8 mixed), 6 micropapillary 'mimics' (ductal no special type carcinomas with retraction artifacts), 33 pure mucinous carcinomas and 31 mixed mucinous carcinomas (mucinous mixed with other morphologic types). Overall, WT1 expression was identified in 33 carcinomas, that is, 22 of 34 (65%) pure mucinous carcinomas and in 11 of 33 (33%) mixed mucinous carcinomas. The non-mucinous component in these 11 mixed mucinous carcinomas was either a ductal no special type carcinoma (8 cases) or a micropapillary component (3 cases). WT1 expression level was similar in both the mucinous and the non-mucinous components. The degree of WT1 expression was generally weak to moderate (>90% cases) and rarely strong (<10% cases). None of the breast carcinoma subtype unassociated with mucinous component showed WT1 expression.

The "Nursing Home Compare" measure of urinary/fecal incontinence: cross-sectional variation, stability over time, and the impact of case mix.

PubMed

Li, Yue; Schnelle, John; Spector, William D; Glance, Laurent G; Mukamel, Dana B

2010-02-01

To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R(2) were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R(2)<0.10), even for facilities with more extreme or more unstable outcome. Current "Nursing Home Compare" incontinence QM reflects considerable case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS.

Transient Chaotic Mixing

NASA Astrophysics Data System (ADS)

Gollub, J. P.; Rothstein, David; Losert, Wolfgang

1998-11-01

We report a systematic experimental study of transient mixing in a family of two-dimensional vortex flows driven by magneto-hydrodynamic forces. The forcing method allows a number of distinct cases to be investigated spanning the range from Lagrangian chaos to 2D turbulence. Both spatially ordered and spatially irregular forcing situations are considered. The basic methodology is to label half of the fluid layer with a fluorescent dye, and to measure the subsequent dye distribution with a precision CCD camera. Diagnostics are devised that allow us separately to monitor the stretching of fluid elements and development of fine striations, diffusive smearing, and the transport of material across the cell. Various statistical measures are used, including the probability distribution, the scalar gradient PDF, and the power spectrum. We find major differences between the time-periodic and nonperiodic cases. The former generally show evidence of "KAM surfaces" or barriers to transport, so that mixing, while substantial, is incomplete. After a modest number of cycles (typically 10-20), the flow structure usually reaches a slowly evolving limiting form whose amplitude then decays, as has been proposed in several theoretical studies.

[Clinical characteristics of aerobic vaginitis and its mixed infections].

PubMed

Fan, Ai-Ping; Xue, Feng-Xia

2010-12-01

To investigate clinical characteristics of aerobic vaginitis (AV) and its mixed infections for diagnosis efficiently. From April 2008 to December 2008, 516 patients with vaginitis treated in Tianjin Medical University General Hospital were enrolled in this study. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV), and cytolytic vaginosis (CV) were diagnosed based on symptoms, sign and vaginal discharge examination. Among 516 cases, AV cases were found in 14.7% (76/516), and AV was common vaginal infection. AV mixed infections was diagnosed in 58% (44/76), including mixed with BV (45%, 20/44), mixed with VVC (30%, 13/44), and mixed with TV (25%, 11/44). Those common symptom of AV were yellow vaginal discharge (63%, 20/32), more vaginal discharge (44%, 14/32). Vaginal pH value was usually more than 4.5 (84%, 27/32). Vaginal cleanliness mainly was grade III - IV (88%, 28/32). Six cases with enterococcus faecium and 4 cases with streptococci were frequently isolated. The symptom and sign of mixed AV infection was atypical. Aerobic vaginitis is a common lower vaginal infection and easily mixed with other pathogens, especially with BV, VVC or TV. When patients were diagnosed with AV or other vaginal infection, it should be mentioned whether those patients have mixed vaginal infection or AV.

Improving Transportation Services for the University of the Thai Chamber of Commerce: A Case Study on Solving the Mixed-Fleet Vehicle Routing Problem with Split Deliveries

NASA Astrophysics Data System (ADS)

Suthikarnnarunai, N.; Olinick, E.

2009-01-01

We present a case study on the application of techniques for solving the Vehicle Routing Problem (VRP) to improve the transportation service provided by the University of The Thai Chamber of Commerce to its staff. The problem is modeled as VRP with time windows, split deliveries, and a mixed fleet. An exact algorithm and a heuristic solution procedure are developed to solve the problem and implemented in the AMPL modeling language and CPLEX Integer Programming solver. Empirical results indicate that the heuristic can find relatively good solutions in a small fraction of the time required by the exact method. We also perform sensitivity analysis and find that a savings in outsourcing cost can be achieved with a small increase in vehicle capacity.

The effects of couplings to symmetric and antisymmetric modes and minor asymmetry on the spectral properties of mixed-valence and related charge-transfer systems

NASA Astrophysics Data System (ADS)

Reimers, J. R.; Hush, N. S.

1996-08-01

The most common methods used to describe the energy levels of charge-transfer systems (including mixed-valence systems) are the linear response approach of Rice and co-workers and the essentially equivalent PKS model described initially by Piepho, Krausz, and Schatz. While these methods were quite successful, in their original form they omitted the effects of overall symmetric vibrations. As a consequence, in particular they were not capable of adequately describing the electronic band width in the strong-coupling limit: Hush and later Ondrechen et al. demonstrated that symmetric modes are essential in this case, and modern versions of these models now include them. Here, we explore the relationship between symmetric and antisymmetric modes, concentrating on how this is modified by the presence of weak (e.g., environmentally or substitutionally induced) asymmetry. For the symmetric case, we show that when the electronic Hamiltonian operators are transformed from their usual localized diabatic representation into a delocalized diabatic representation, the effects of the symmetric and antisymmetric modes are interchanged. The primary effect of weak asymmetry is to mix the properties of the various modes, and possible consequences of this for the spectroscopy of bacterial photosynthetic reaction centre and substituted Creutz—Taube cations are discussed. We also consider the problem from an adiabatic Bom—Oppenheimer perspective and examine the regions in which this approach is appropriate.

Evaluation of joint probability density function models for turbulent nonpremixed combustion with complex chemistry

NASA Technical Reports Server (NTRS)

Smith, N. S. A.; Frolov, S. M.; Bowman, C. T.

1996-01-01

Two types of mixing sub-models are evaluated in connection with a joint-scalar probability density function method for turbulent nonpremixed combustion. Model calculations are made and compared to simulation results for homogeneously distributed methane-air reaction zones mixing and reacting in decaying turbulence within a two-dimensional enclosed domain. The comparison is arranged to ensure that both the simulation and model calculations a) make use of exactly the same chemical mechanism, b) do not involve non-unity Lewis number transport of species, and c) are free from radiation loss. The modified Curl mixing sub-model was found to provide superior predictive accuracy over the simple relaxation-to-mean submodel in the case studied. Accuracy to within 10-20% was found for global means of major species and temperature; however, nitric oxide prediction accuracy was lower and highly dependent on the choice of mixing sub-model. Both mixing submodels were found to produce non-physical mixing behavior for mixture fractions removed from the immediate reaction zone. A suggestion for a further modified Curl mixing sub-model is made in connection with earlier work done in the field.

A balanced perspective: using nonfinancial measures to assess financial performance.

PubMed

Watkins, Ann L

2003-11-01

Assessments of hospitals' financial performance have traditionally been based exclusively on analysis of a concise set of key financial ratios. One study, however, demonstrates that analysis of a hospital's financial condition can be significantly enhanced with the addition of several nonfinancial measures, including case-mix adjusted admissions, case-mix adjusted admissions per full-time equivalent, and case-mix adjusted admissions per beds in service.

Regression analysis of mixed recurrent-event and panel-count data

PubMed Central

Zhu, Liang; Tong, Xinwei; Sun, Jianguo; Chen, Manhua; Srivastava, Deo Kumar; Leisenring, Wendy; Robison, Leslie L.

2014-01-01

In event history studies concerning recurrent events, two types of data have been extensively discussed. One is recurrent-event data (Cook and Lawless, 2007. The Analysis of Recurrent Event Data. New York: Springer), and the other is panel-count data (Zhao and others, 2010. Nonparametric inference based on panel-count data. Test 20, 1–42). In the former case, all study subjects are monitored continuously; thus, complete information is available for the underlying recurrent-event processes of interest. In the latter case, study subjects are monitored periodically; thus, only incomplete information is available for the processes of interest. In reality, however, a third type of data could occur in which some study subjects are monitored continuously, but others are monitored periodically. When this occurs, we have mixed recurrent-event and panel-count data. This paper discusses regression analysis of such mixed data and presents two estimation procedures for the problem. One is a maximum likelihood estimation procedure, and the other is an estimating equation procedure. The asymptotic properties of both resulting estimators of regression parameters are established. Also, the methods are applied to a set of mixed recurrent-event and panel-count data that arose from a Childhood Cancer Survivor Study and motivated this investigation. PMID:24648408

A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use.

PubMed

McQuoid, Julia; Thrul, Johannes; Ling, Pamela

2018-04-01

Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants' everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals' experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Acceptance of routine or case-based inquiry for intimate partner violence: a mixed method study.

PubMed

Stöckl, Heidi; Hertlein, Linda; Himsl, Isabelle; Ditsch, Nina; Blume, Carolin; Hasbargen, Uwe; Friese, Klaus; Stöckl, Doris

2013-03-26

The prevalence and detrimental health effects of intimate partner violence have resulted in international discussions and recommendations that health care professionals should screen women for intimate partner violence during general and antenatal health care visits. Due to the lack of discussion on routine or case-based inquiry for intimate partner violence during antenatal care in Germany, this study seeks to explore its acceptability among pregnant German women. A mixed methods approach was used, utilizing a self-administered survey on the acceptability of routine or case-based inquiry for intimate partner violence in a university hospital's maternity ward in Munich and in-depth interviews with seven women who experienced violence during pregnancy. Of the 401 women who participated in the survey, 92 percent were in favor of routine or case-based inquiry for intimate partner violence during antenatal care. Acceptance of routine or case-based inquiry for intimate partner violence during antenatal care was significantly associated with women's experiences of child sexual abuse, being young, less educated, single or divorced and smoking during pregnancy. Open-ended survey questions and in-depth interviews stressed adequate training for screening, sufficient time and provision of referral information as important conditions for routine or case-based inquiry for intimate partner violence. Women in this study showed an overwhelming support for routine or case-based screening for intimate partner violence in antenatal care in Germany. Until adequate training is in place to allow providers to inquire for intimate partner violence in a professional manner, this study recommends that health care providers are made aware of the prevalence and health consequences of violence during pregnancy.

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Dubois, Marie-France; Roberge, Pasquale; Loignon, Christine; Tchouaket, Éric; Lambert, Mireille; Hudon, Émilie; Diadiou, Fatoumata; Bouliane, Danielle

2018-05-01

This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation ( P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs. © 2018 Annals of Family Medicine, Inc.

Same Program, Distinctive Development: Exploring the Biliteracy Trajectories of Two Dual Language Schools

ERIC Educational Resources Information Center

Babino, Alexandra

2017-01-01

Using a mixed methods comparative case study, the researcher explored the dual language contexts at each school before examining the second- through fifth-grade Spanish and English reading biliteracy trajectories. While both campuses' students experienced positive trajectories toward biliteracy by the end of fifth grade, each campus was…

Spaces of Spiritual Citizenship: Children's Relational and Emotional Encounters with the Everyday School Environment

ERIC Educational Resources Information Center

Hemming, Peter J.

2013-01-01

This article addresses the issue of children's spiritual, relational and emotional encounters with the primary school environment, with reference to concepts and theories from both education studies and human geography. Drawing on mixed-method qualitative research in two case study institutions, the article examines pupils' photographed "special…

Organizational Structure, Collegial Trust, and College Faculty Teaching Efficacy: A Case Study

ERIC Educational Resources Information Center

Okpogba, Desmond

2011-01-01

The purpose of this mixed-method study was to explore the relationship between faculty self-efficacy, organizational structure, and collegial trust. The concepts of teacher self-efficacy, organizational structure, and collegial trust were used to investigate any possible empirical relationships existing between these variables in a private,…

Making the Case for Space: The Effect of Learning Spaces on Teaching and Learning

ERIC Educational Resources Information Center

Byers, Terry; Imms, Wesley; Hartnell-Young, Elizabeth

2014-01-01

An explanatory, mixed method study examined the impact of learning spaces on teachers' pedagogy, student engagement and student learning outcomes in a technology-rich school setting. Its quasi-experimental design allowed examination of differences in these variables between two settings--'traditional' classrooms, and 'new generation learning…

Use of Appreciative Inquiry to Explore the Experiences of Faculty Advisors

ERIC Educational Resources Information Center

Myers, Valerie Ann-Marie

2013-01-01

Academic advising significantly impacts student achievement, persistence, and retention, yet it continues to be an area of weakness for many institutions. The purpose of this sequential mixed-methods case study was to explore the experiences of faculty advisors to identify strengths and weaknesses in their knowledge and skills. Appreciative…

A Mixed Method Case Study on Learner Engagement in e-Learning Professional Training

ERIC Educational Resources Information Center

Zhao, Jane Yanfeng

2014-01-01

Previous research showed that learners' reluctance in participating in e-Learning training is a major obstacle in achieving training objectives. This study focused on learners' e-Learning engagement in professional training in the chapter of the American Society for Training and Development (ASTD). The participants were 21 chapter members.…

Automated Simultaneous Assembly of Multistage Testlets for a High-Stakes Licensing Examination

ERIC Educational Resources Information Center

Breithaupt, Krista; Hare, Donovan R.

2007-01-01

Many challenges exist for high-stakes testing programs offering continuous computerized administration. The automated assembly of test questions to exactly meet content and other requirements, provide uniformity, and control item exposure can be modeled and solved by mixed-integer programming (MIP) methods. A case study of the computerized…

Written Feedback in Intercultural Doctoral Supervision: A Case Study

ERIC Educational Resources Information Center

Xu, Linlin

2017-01-01

This paper explores the feedback interactions in an intercultural supervision context between a white New Zealand supervisor and a Chinese international doctoral student, who is also the author (and researcher) of this study. Using mixed methods, it examines the supervisor's written feedback on a draft PhD proposal and the student's feedback…

Evaluating Graduate Education and Transcending Biases in Music Teachers' Professional Development

ERIC Educational Resources Information Center

Laor, Lia

2015-01-01

Research concerning professional development and its contribution to the formation of professional identity is prevalent in both general and music education. However, its implications for music educators in the context of graduate programs for music education are seldom discussed. This mixed-methods case study examined experienced music teachers'…

Evaluation Criteria for Competency-Based Syllabi: A Chilean Case Study Applying Mixed Methods

ERIC Educational Resources Information Center

Jerez, Oscar; Valenzuela, Leslier; Pizarro, Veronica; Hasbun, Beatriz; Valenzuela, Gabriela; Orsini, Cesar

2016-01-01

In recent decades, higher education institutions worldwide have been moving from knowledge-based to competence-based curricula. One of the greatest challenges in this transition is the difficulty in changing the knowledge-oriented practices of teachers. This study evaluates the consistency between syllabus design and the requirements imposed by a…

Evaluation of a Family-Centred Children's Weight Management Intervention

ERIC Educational Resources Information Center

Jinks, Annette; English, Sue; Coufopoulos, Anne

2013-01-01

Purpose: The purpose of this paper is to conduct an in-depth quantitative and qualitative evaluation of a family-based weight loss and healthy life style programme for clinically obese children in England. Design/methodology/approach: The mixed method case study evaluation used included obtaining pre and post measurements of anthropometry and a…

Creative Leadership? "It's Just the Norm"

ERIC Educational Resources Information Center

Keamy, Ron

2016-01-01

Creativity in teaching and leadership continues to be a topic of interest in education. This article focuses on comments made by a school's leadership team as part of a larger study in which a mixed methods case study design involving the school's leadership team and staff who taught Arts (either as specialist teachers or generalist classroom…

Navigating a Divided Society: Educational Research Strategies for Post-Conflict Bosnia and Herzegovina

ERIC Educational Resources Information Center

Komatsu, Taro

2012-01-01

This article discusses methodological issues associated with education research in Bosnia and Herzegovina (BiH) and describes strategies taken to address them. Within a case study, mixed methods allowed the author to examine school leaders' perceptions multi-dimensionally. Multi-level analysis was essential to the understanding of policy-making…

A Framework for Enabling Graduate Outcomes in Undergraduate Programmes

ERIC Educational Resources Information Center

Bond, C. H.; Spronken-Smith, R.; McLean, A.; Smith, N.; Frielick, S.; Jenkins, M.; Marshall, S.

2017-01-01

Our research aim was to determine what enables engagement with graduate outcomes in tertiary institutions in Aotearoa/New Zealand. We used a mixed methods approach comprising a survey sent to all tertiary institutions, follow-up interviews with 10 academic leaders and eight case studies of good practice of programmes engaged with graduate outcomes…

When Worlds Collide: Identity, Culture and the Lived Experiences of Research When "Teaching-Led"

ERIC Educational Resources Information Center

Sharp, John G.; Hemmings, Brian; Kay, Russell; Callinan, Carol

2015-01-01

This article presents detailed findings from the qualitative or interpretive phase of a mixed-methods case study focusing on the professional identities and lived experiences of research among six lecturers working in different capacities across the field of education in a "teaching-led" higher education institution. Building upon the…

Documenting Elementary Teachers' Sustainability of Instructional Practices: A Mixed Method Case Study

ERIC Educational Resources Information Center

Cotner, Bridget A.

2014-01-01

School reform programs focus on making educational changes; however, research on interventions past the funded implementation phase to determine what was sustained is rarely done (Beery, Senter, Cheadle, Greenwald, Pearson, et al., 2005). This study adds to the research on sustainability by determining what instructional practices, if any, of the…

Interrelations between Policymakers' Intentions and School Agents' Interpretation of Accountability Policy in Israel

ERIC Educational Resources Information Center

Amdur, Lisa; Mero-Jaffe, Irit

2017-01-01

The study examined the interrelations between policymakers' intentions for test-based accountability policy and school agents' perceptions and actions with regard to this policy. Mixed methods were used and encompassed 24 policymakers, 80 school principals, 168 teachers and case studies of four schools. New institutional theory, including the…

Promoting "Quality" Feedback: First-Year Teachers' Self-Reports on Their Development as Classroom Managers

ERIC Educational Resources Information Center

Kwok, Andrew

2018-01-01

Through a program wide survey (n = 87) and qualitative data of five case participants, this mixed methods study explores how teachers develop as urban classroom managers throughout their first year. Results indicate teachers learned from programmatic training and personnel, school personnel, and classroom experience. Specifically, personnel who…

Beginning Teachers' Perception of Their Induction into the Teaching Profession

ERIC Educational Resources Information Center

Kidd, Lynda; Brown, Natalie; Fitzallen, Noleine

2015-01-01

Beginning teachers' induction into the teaching profession needs to be personally and professionally fulfilling, which is often not the case. The main objective of this mixed method study was to gain a deeper understanding of beginning teachers' experiences and the perceptions of their induction into the teaching profession and the support they…

Technology-Based Professional Development for Teaching and Learning in K-12 Classrooms

ERIC Educational Resources Information Center

Byrd, Nijia

2017-01-01

In an urban Georgia school district, teacher satisfaction surveys revealed that technology-based professional development was not equipping teachers with the skills or support needed to implement technology into their teaching practices. The purpose of this mixed-methods case study was to explore teachers' experiences and perceptions of…

A New Era of Leadership: Preparing Leaders for Urban Schools & the 21st Century

ERIC Educational Resources Information Center

Abbott, Sunday C.

2010-01-01

The purpose of this study was to investigate the impact of principal participation in the Davis Principal Coaching Initiative, an executive leadership capacity building development program, on leader practice and professional practice of teachers. This mixed-method comparative case study investigated the following five research questions: (1) How…

Climate Cases: Learning about Student Conceptualizations of Global Climate Change

ERIC Educational Resources Information Center

Tierney, Benjamin P.

2013-01-01

The complex topic of global climate change continues to be a challenging yet important topic among science educators and researchers. This mixed methods study adds to the growing research by investigating student conceptions of climate change from a system theory perspective (Von Bertalanffy, 1968) by asking the question, "How do differences…

Factors Affecting Student Retention at One Independent School in the Southwest

ERIC Educational Resources Information Center

Ahlstrom, Dan Roger

2013-01-01

This mixed-methods case study determined the factors and examined the issues associated with student retention at a faith-based independent day school in southwestern United States of America. The data included online surveys, personal interviews, collection of archival information, and the researcher's extensive field notes. Surveys (530) were…

The Effect of Suspension as a Deterrent to Student Misconduct

ERIC Educational Resources Information Center

Jackson, Angela Coleman

2014-01-01

The purpose of this study was to examine the effect of suspension as a deterrent to student misconduct. A mixed methods approach using both qualitative (interviews of administrators and teachers) and quantitative (discipline records of identified sixth graders) were utilized. In this case study approach, one-on-one semi-structured interviews were…

Relationship between Self-Control and Facebook Use: Case of CEIT Students

ERIC Educational Resources Information Center

Firat, Mehmet

2017-01-01

This is an explanatory mixed-method study that analyzes the relationship between the variables of students' self-control and Facebook usage. TIME's online Facebook calculator and the Brief Self-Control Scale are used for data collection. The research participants are 60 students in a department of computer education and instructional technology…

A Professional Learning Program Designed to Increase K-12 Teachers' Instructional Technology Use

ERIC Educational Resources Information Center

Spencer, Lisa A.

2014-01-01

Despite the ready availability of many instructional-technology resources, many teachers in the researched Maryland school district are uncomfortable using technology to deliver content. This concurrent mixed methods case study examined the impact of Sharing Technology with Educators Program (STEP) on 269 K-12 teachers' technology use. The study…

Eportfolio Adoption's Mediating Influence on Faculty Perspectives: An Activity Theory View

ERIC Educational Resources Information Center

Thomas, Jonathan M.

2017-01-01

A case-comparative mixed methods approach was used to discover how faculty members' teaching perspectives changed as they adopted an eportfolio tool (Pathbrite). Ten faculty members took the Teaching Perspectives Inventory (TPI) before and after using the tool during Fall semester 2015. Also, systems logs were collected and interviews were…

Building Political Participation: The Role of Family Policy and Political Science Courses

ERIC Educational Resources Information Center

Parrott, Emily

2017-01-01

This mixed-methods study examined the long-term associations between two kinds of politics courses--required political science courses and required family policy courses--and the political participation, knowledge, skill, efficacy, and politically engaged identity of child and family studies alumni. Two special cases were examined: those who…

Behavior Change after Adventure Education Courses: Do Work Colleagues Notice?

ERIC Educational Resources Information Center

Rhodes, Heather M.; Martin, Andrew J.

2014-01-01

In this case study, a mixed-method approach is used to examine the extent and type of changes in workplace attitudes and behavior, as self-reported by soldiers who had participated in 6- to 10-day "Experiential Leadership Development Activities" (ELDAs) delivered by the New Zealand Army Leadership Centre. Observations made by workplace…

Brokering Boundaries: Literacy Change Agents at Work

ERIC Educational Resources Information Center

VanDeusen-MacLeod, Elizabeth A.

2009-01-01

The purpose of this mixed-method descriptive case study is to investigate the role technical assistance providers within the context of one state's large-scale literacy grant program. This study provides an in-depth examination of one state's technical assistance providers known as Reading First Facilitators (RFF) through the study of a group of…

Students' Perceptions of the Introduction of a Blended Learning Environment: An Exploratory Case Study

ERIC Educational Resources Information Center

Osgerby, Julia

2013-01-01

Virtual Learning Environments (VLE) provide the opportunity to deliver blended learning approaches that combine mixes of Information and Communications Technology (ICT) with various delivery methods and media. In 2008 and 2009, the University of Winchester in the UK redesigned a variety of accounting and financial management modules for…

Social Responsibility and Community Development: Lessons from the Sistema de Aprendizaje Tutorial in Honduras

ERIC Educational Resources Information Center

Honeyman, Catherine A.

2010-01-01

This article extends understanding of the connections between education, social capital, and development through a mixed-methods case study of the Sistema de Aprendizaje Tutorial, or SAT, an innovative secondary-level education system. The quantitative dimension of the research used survey measures of social responsibility to compare 93 SAT…

Developing Graduate Students' Self-Efficacy with Learner-Centred Lecturing

ERIC Educational Resources Information Center

Troop, Meagan; Wallar, Lauren; Aspenlieder, Erin

2015-01-01

This paper presents the findings of a mixed-method case study conducted at the University of Guelph on the relationship between practice lecturing and graduate student self-efficacy. Building on the work of Boman (2013), and using surveys and individual interviews, we measured and characterized the perceived changes in graduate students'…

Teacher Participation in Online Professional Development: Exploring Academic Year Classroom Impacts

ERIC Educational Resources Information Center

Opfer, Thomas

2017-01-01

The purpose of this mixed methods case study research was to investigate the reasons teachers chose online professional development (OPD) focusing on technology integration and how this OPD impacted teachers' classroom practices over a six month period. Previous research identified that OPD provides flexibility beyond what traditional face-to-face…

Student and Instructor Responses to Emotional Motivational Feedback Messages in an Online Instructional Environment

ERIC Educational Resources Information Center

Sarsar, Firat

2017-01-01

The purpose of this study was to investigate the effectiveness of Emotional Motivational Feedback Message (EMFEM) in an online learning environment. This exploratory research was conducted using mixed method single case study design. Participants were 15 undergraduate students enrolled in an instructional technology course in a large state…

What Makes Blogging Attractive to Bloggers: A Case of College-Level Constituency Users

ERIC Educational Resources Information Center

Huang, Y-H.; Lo, Y-F.

2012-01-01

This study presents a new perspective to facilitate learner-centred weblog evaluation, based on content attractiveness, blogging support, and the value-added service construct. A mixed method, combining fishbone diagram, fuzzy logic techniques, and the analytic hierarchy process, was conducted to identify further the criteria that attract bloggers…

Seeding Success: Schools That Work for Aboriginal Students

ERIC Educational Resources Information Center

Munns, Geoff; O'Rourke, Virginia; Bodkin-Andrews, Gawaian

2013-01-01

This article reports on a large mixed methods research project that investigated the conditions of success for Aboriginal school students. The article presents the qualitative case study component of the research. It details the work of four schools identified as successful for Aboriginal students with respect to social and academic outcomes, and…

Impact of RFID on Retail Value Chain: A Mixed Method Study

ERIC Educational Resources Information Center

Bhattacharya, Mithu

2011-01-01

Radio Frequency Identification (RFID) mandates by large retailers and various government agencies have driven a large number of organizations to roll out the technology. Despite these commitments the business case for RFID is far from reality and is still at its infancy. This dissertation work aims at providing realistic perspective on the…

Experiential High School Career Education, Self-Efficacy, and Motivation

ERIC Educational Resources Information Center

Gaylor, Lisa; Nicol, Jennifer J.

2016-01-01

Students' perceived self-efficacy and motivation in the context of experiential high school career education was examined through an exploratory mixed methods case study of an elective experiential career education class offered in Saskatchewan public schools. Data were generated by having students (N = 14) complete two measures at the start and…

Mutual Adaptaion in Action

ERIC Educational Resources Information Center

Siskin, Leslie Santee

2016-01-01

Building on an expanded concept of mutual adaptation, this chapter explores a distinctive and successful aspect of International Baccalaureate's effort to scale up, as they moved to expand their programs and support services in Title I schools. Based on a three-year, mixed-methods study, it offers a case where we see not only local adaptations…

The Perceived Impact of External Evaluation: The System, Organisation and Individual Levels-Estonian Case

ERIC Educational Resources Information Center

Seema, Riin; Udam, Maiki; Mattisen, Heli; Lauri, Liia

2017-01-01

The purpose of this article is to provide an overview of how the employees of higher education institutions perceive the impact of external evaluations. The study was conducted using the concurrent mixed method and involved 361 employees from Estonian universities and professional higher education institutions. The results indicated that…

The Progressive Discipline Matrix and Its Effects on Discipline in High Schools

ERIC Educational Resources Information Center

Jones, Vincent L.

2017-01-01

The purpose of this mixed-method case study was to determine the effectiveness of the progressive discipline matrix in high schools in one Tennessee school district. The further intent was to investigate how discipline practices influenced the perceptions of teachers and administrators. Findings from quantitative data stated that progressive…

Analysis of Risk Management in Adapted Physical Education Textbooks

ERIC Educational Resources Information Center

Murphy, Kelle L.; Donovan, Jacqueline B.; Berg, Dominck A.

2016-01-01

Physical education teacher education (PETE) programs vary on how the topics of safe teaching and risk management are addressed. Common practices to cover such issues include requiring textbooks, lesson planning, peer teaching, videotaping, reflecting, and reading case law analyses. We used a mixed methods design to examine how risk management is…

Case studies within a mixed methods paradigm: toward a resolution of the alienation between researcher and practitioner in psychotherapy research.

PubMed

Dattilio, Frank M; Edwards, David J A; Fishman, Daniel B

2010-12-01

This article addresses the long-standing divide between researchers and practitioners in the field of psychotherapy, regarding what really works in treatment and the extent to which interventions should be governed by outcomes generated in a "laboratory atmosphere." This alienation has its roots in a positivist paradigm, which is epistemologically incomplete because it fails to provide for context-based practical knowledge. In other fields of evaluation research, it has been superseded by a mixed methods paradigm, which embraces pragmatism and multiplicity. On the basis of this paradigm, we propose and illustrate new scientific standards for research on the evaluation of psychotherapeutic treatments. These include the requirement that projects should comprise several parallel studies that involve randomized controlled trials, qualitative examinations of the implementation of treatment programs, and systematic case studies. The uniqueness of this article is that it contributes a guideline for involving a set of complementary publications, including a review that offers an overall synthesis of the findings from different methodological approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

How recalibration method, pricing, and coding affect DRG weights

PubMed Central

Carter, Grace M.; Rogowski, Jeannette A.

1992-01-01

We compared diagnosis-related group (DRG) weights calculated using the hospital-specific relative-value (HSR V) methodology with those calculated using the standard methodology for each year from 1985 through 1989 and analyzed differences between the two methods in detail for 1989. We provide evidence suggesting that classification error and subsidies of higher weighted cases by lower weighted cases caused compression in the weights used for payment as late as the fifth year of the prospective payment system. However, later weights calculated by the standard method are not compressed because a statistical correlation between high markups and high case-mix indexes offsets the cross-subsidization. HSR V weights from the same files are compressed because this methodology is more sensitive to cross-subsidies. However, both sets of weights produce equally good estimates of hospital-level costs net of those expenses that are paid by outlier payments. The greater compression of the HSR V weights is counterbalanced by the fact that more high-weight cases qualify as outliers. PMID:10127456

The preparation of BP single crystals by high pressure flux method

NASA Technical Reports Server (NTRS)

Kumashiro, Y.; Misawa, S.; Gonda, S.

1984-01-01

Single crystals of BP, a III-V compound semiconductor, were obtained by the high pressure flux method. Cu3P and Ni12P5 powders were used as the flux, and mixed with BP powder. Two kinds of mixtures were prepared: (1) 1.8g (BP) + 35 G (Cu3P) and (2) 1.7 g (BP) + 25 g (Ni12P5). They were compressed into pellets, heated at 1300 C for 24 h in an induction furnace under a pressure of 1 MPa using Ar-P2 gas, and slowly cooled to room temperature. In case (1), BP single crystals grew along the (III) plane, and in case (2) they grew as an aggregate of crystallites. The cathodoluminescence spectra of the synthetic BP crystals showed peaks near 680 nm (1.82 eV) for case (1), and 500 nm (2.47 eV) for case (2). By using the high pressure flux method conventional sized crystals were obtained in a relatively short time.

Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

PubMed

Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

2014-01-01

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

Creating advantages with franchising in healthcare: an explorative mixed methods study on the role of the relationship between the franchisor and units.

PubMed

Nijmeijer, Karlijn Jojanneke; Fabbricotti, Isabelle Natalina; Huijsman, Robbert

2015-01-01

Franchising is a promising and increasingly used organizational form to improve strategic, organizational, professional and client-related results in healthcare. However, evidence is scarce regarding how franchises should be operated to actualize such results. This paper aimed to explore the association between the results achieved by healthcare franchises and the working relationships among actors in these franchises. A sequential mixed methods approach was used to obtain both in-depth and broader quantifiable insights into a little-investigated phenomenon. We first employed a qualitative multiple embedded case study. Data were collected through observations, document analyses, and 96 in-depth semi-structured interviews in three Dutch healthcare franchises. Within-case and cross-case comparative analyses were conducted. Subsequently, a cross-sectional survey was developed based on the qualitative study and disseminated among 19 healthcare franchises. 40 franchisors and 346 unit actors filled in the questionnaire. It seems important to have open, committed, cooperative franchise relationships in which professional franchisees and unit managers feel and trust that they have the opportunity to introduce ideas and articulate their needs to the franchisor. Such relationships help ensure satisfaction, survival, and quality of care, because they serve to foster synergy realization and local fit and prevent reinventing the wheel and professional resistance.

Comparing a single case to a control group - Applying linear mixed effects models to repeated measures data.

PubMed

Huber, Stefan; Klein, Elise; Moeller, Korbinian; Willmes, Klaus

2015-10-01

In neuropsychological research, single-cases are often compared with a small control sample. Crawford and colleagues developed inferential methods (i.e., the modified t-test) for such a research design. In the present article, we suggest an extension of the methods of Crawford and colleagues employing linear mixed models (LMM). We first show that a t-test for the significance of a dummy coded predictor variable in a linear regression is equivalent to the modified t-test of Crawford and colleagues. As an extension to this idea, we then generalized the modified t-test to repeated measures data by using LMMs to compare the performance difference in two conditions observed in a single participant to that of a small control group. The performance of LMMs regarding Type I error rates and statistical power were tested based on Monte-Carlo simulations. We found that starting with about 15-20 participants in the control sample Type I error rates were close to the nominal Type I error rate using the Satterthwaite approximation for the degrees of freedom. Moreover, statistical power was acceptable. Therefore, we conclude that LMMs can be applied successfully to statistically evaluate performance differences between a single-case and a control sample. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mixed methods research in mental health nursing.

PubMed

Kettles, A M; Creswell, J W; Zhang, W

2011-08-01

Mixed methods research is becoming more widely used in order to answer research questions and to investigate research problems in mental health and psychiatric nursing. However, two separate literature searches, one in Scotland and one in the USA, revealed that few mental health nursing studies identified mixed methods research in their titles. Many studies used the term 'embedded' but few studies identified in the literature were mixed methods embedded studies. The history, philosophical underpinnings, definition, types of mixed methods research and associated pragmatism are discussed, as well as the need for mixed methods research. Examples of mental health nursing mixed methods research are used to illustrate the different types of mixed methods: convergent parallel, embedded, explanatory and exploratory in their sequential and concurrent combinations. Implementing mixed methods research is also discussed briefly and the problem of identifying mixed methods research in mental and psychiatric nursing are discussed with some possible solutions to the problem proposed. © 2011 Blackwell Publishing.

Theoretical investigation of mixing in warm clouds – Part 2: Homogeneous mixing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pinsky, Mark; Khain, Alexander; Korolev, Alexei

Evolution of monodisperse and polydisperse droplet size distributions (DSD) during homogeneous mixing is analyzed. Time-dependent universal analytical expressions for supersaturation and liquid water content are derived. For an initial monodisperse DSD, these quantities are shown to depend on a sole non-dimensional parameter. The evolution of moments and moment-related functions in the course of homogeneous evaporation of polydisperse DSD is analyzed using a parcel model. It is shown that the classic conceptual scheme, according to which homogeneous mixing leads to a decrease in droplet mass at constant droplet concentration, is valid only in cases of monodisperse or initially very narrow polydispersemore » DSD. In cases of wide polydisperse DSD, mixing and successive evaporation lead to a decrease of both mass and concentration, so the characteristic droplet sizes remain nearly constant. As this feature is typically associated with inhomogeneous mixing, we conclude that in cases of an initially wide DSD at cloud top, homogeneous mixing is nearly indistinguishable from inhomogeneous mixing.« less

Theoretical investigation of mixing in warm clouds – Part 2: Homogeneous mixing

DOE PAGES

Pinsky, Mark; Khain, Alexander; Korolev, Alexei; ...

2016-07-28

Evolution of monodisperse and polydisperse droplet size distributions (DSD) during homogeneous mixing is analyzed. Time-dependent universal analytical expressions for supersaturation and liquid water content are derived. For an initial monodisperse DSD, these quantities are shown to depend on a sole non-dimensional parameter. The evolution of moments and moment-related functions in the course of homogeneous evaporation of polydisperse DSD is analyzed using a parcel model. It is shown that the classic conceptual scheme, according to which homogeneous mixing leads to a decrease in droplet mass at constant droplet concentration, is valid only in cases of monodisperse or initially very narrow polydispersemore » DSD. In cases of wide polydisperse DSD, mixing and successive evaporation lead to a decrease of both mass and concentration, so the characteristic droplet sizes remain nearly constant. As this feature is typically associated with inhomogeneous mixing, we conclude that in cases of an initially wide DSD at cloud top, homogeneous mixing is nearly indistinguishable from inhomogeneous mixing.« less

Qualitative case study methodology in nursing research: an integrative review.

PubMed

Anthony, Susan; Jack, Susan

2009-06-01

This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research. Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology. In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria. Whittemore and Knafl's integrative review method guided the analysis. Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research. Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.

Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews.

PubMed

Pluye, Pierre; Hong, Quan Nha

2014-01-01

This article provides an overview of mixed methods research and mixed studies reviews. These two approaches are used to combine the strengths of quantitative and qualitative methods and to compensate for their respective limitations. This article is structured in three main parts. First, the epistemological background for mixed methods will be presented. Afterward, we present the main types of mixed methods research designs and techniques as well as guidance for planning, conducting, and appraising mixed methods research. In the last part, we describe the main types of mixed studies reviews and provide a tool kit and examples. Future research needs to offer guidance for assessing mixed methods research and reporting mixed studies reviews, among other challenges.

The economic implications of case-mix Medicaid reimbursement for nursing home care.

PubMed

Grabowski, David C

2002-01-01

In recent years, there has been large growth in the nursing home industry in the use of case-mix adjusted Medicaid payment systems that employ resident characteristics to predict the relative use of resources in setting payment levels. Little attention has been paid to the access and quality incentives that these systems provide in the presence of excess demand conditions due to certificate-of-need (CON) and construction moratoria. Using 1991 to 1998 panel data for all certified U.S. nursing homes, a fixed-effects model indicates that adoption of a case-mix payment system led to increased access for more dependent residents, but the effect was modified in excess demand markets. Quality remained relatively stable with the introduction of case-mix reimbursement, regardless of the presence of excess demand conditions. These results suggest that CON and construction moratoria are still important barriers within the nursing home market, and recent quality assurance activities related to the introduction of case-mix payment systems may have been effective.

Using mixed methods research designs in health psychology: an illustrated discussion from a pragmatist perspective.

PubMed

Bishop, Felicity L

2015-02-01

To outline some of the challenges of mixed methods research and illustrate how they can be addressed in health psychology research. This study critically reflects on the author's previously published mixed methods research and discusses the philosophical and technical challenges of mixed methods, grounding the discussion in a brief review of methodological literature. Mixed methods research is characterized as having philosophical and technical challenges; the former can be addressed by drawing on pragmatism, the latter by considering formal mixed methods research designs proposed in a number of design typologies. There are important differences among the design typologies which provide diverse examples of designs that health psychologists can adapt for their own mixed methods research. There are also similarities; in particular, many typologies explicitly orient to the technical challenges of deciding on the respective timing of qualitative and quantitative methods and the relative emphasis placed on each method. Characteristics, strengths, and limitations of different sequential and concurrent designs are identified by reviewing five mixed methods projects each conducted for a different purpose. Adapting formal mixed methods designs can help health psychologists address the technical challenges of mixed methods research and identify the approach that best fits the research questions and purpose. This does not obfuscate the need to address philosophical challenges of mixing qualitative and quantitative methods. Statement of contribution What is already known on this subject? Mixed methods research poses philosophical and technical challenges. Pragmatism in a popular approach to the philosophical challenges while diverse typologies of mixed methods designs can help address the technical challenges. Examples of mixed methods research can be hard to locate when component studies from mixed methods projects are published separately. What does this study add? Critical reflections on the author's previously published mixed methods research illustrate how a range of different mixed methods designs can be adapted and applied to address health psychology research questions. The philosophical and technical challenges of mixed methods research should be considered together and in relation to the broader purpose of the research. © 2014 The British Psychological Society.

Effects of a Periodic Disturbance on Structure and Mixing in Turbulent Shear Layers and Wakes

DTIC Science & Technology

1985-01-01

needs to be separated into four different cases corresponding to initial locations in one of four quadrants about the vortex center. The four cases are...replaced with a pair of two-inch honey- combs spaced two inches apart. Each honeycomb had a chopper screen on the downstream end. The reader is refered to...34 " ’ -... ’ ’ .... oe -13- . relevant information on the absorption method are discussed in Appendix A. During the absorption runs, four

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

PubMed

Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

2011-01-01

Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

A parallel metaheuristic for large mixed-integer dynamic optimization problems, with applications in computational biology.

PubMed

Penas, David R; Henriques, David; González, Patricia; Doallo, Ramón; Saez-Rodriguez, Julio; Banga, Julio R

2017-01-01

We consider a general class of global optimization problems dealing with nonlinear dynamic models. Although this class is relevant to many areas of science and engineering, here we are interested in applying this framework to the reverse engineering problem in computational systems biology, which yields very large mixed-integer dynamic optimization (MIDO) problems. In particular, we consider the framework of logic-based ordinary differential equations (ODEs). We present saCeSS2, a parallel method for the solution of this class of problems. This method is based on an parallel cooperative scatter search metaheuristic, with new mechanisms of self-adaptation and specific extensions to handle large mixed-integer problems. We have paid special attention to the avoidance of convergence stagnation using adaptive cooperation strategies tailored to this class of problems. We illustrate its performance with a set of three very challenging case studies from the domain of dynamic modelling of cell signaling. The simpler case study considers a synthetic signaling pathway and has 84 continuous and 34 binary decision variables. A second case study considers the dynamic modeling of signaling in liver cancer using high-throughput data, and has 135 continuous and 109 binaries decision variables. The third case study is an extremely difficult problem related with breast cancer, involving 690 continuous and 138 binary decision variables. We report computational results obtained in different infrastructures, including a local cluster, a large supercomputer and a public cloud platform. Interestingly, the results show how the cooperation of individual parallel searches modifies the systemic properties of the sequential algorithm, achieving superlinear speedups compared to an individual search (e.g. speedups of 15 with 10 cores), and significantly improving (above a 60%) the performance with respect to a non-cooperative parallel scheme. The scalability of the method is also good (tests were performed using up to 300 cores). These results demonstrate that saCeSS2 can be used to successfully reverse engineer large dynamic models of complex biological pathways. Further, these results open up new possibilities for other MIDO-based large-scale applications in the life sciences such as metabolic engineering, synthetic biology, drug scheduling.

Complex sparse spatial filter for decoding mixed frequency and phase coded steady-state visually evoked potentials.

PubMed

Morikawa, Naoki; Tanaka, Toshihisa; Islam, Md Rabiul

2018-07-01

Mixed frequency and phase coding (FPC) can achieve the significant increase of the number of commands in steady-state visual evoked potential-based brain-computer interface (SSVEP-BCI). However, the inconsistent phases of the SSVEP over channels in a trial and the existence of non-contributing channels due to noise effects can decrease accurate detection of stimulus frequency. We propose a novel command detection method based on a complex sparse spatial filter (CSSF) by solving ℓ 1 - and ℓ 2,1 -regularization problems for a mixed-coded SSVEP-BCI. In particular, ℓ 2,1 -regularization (aka group sparsification) can lead to the rejection of electrodes that are not contributing to the SSVEP detection. A calibration data based canonical correlation analysis (CCA) and CSSF with ℓ 1 - and ℓ 2,1 -regularization cases were demonstrated for a 16-target stimuli with eleven subjects. The results of statistical test suggest that the proposed method with ℓ 1 - and ℓ 2,1 -regularization significantly achieved the highest ITR. The proposed approaches do not need any reference signals, automatically select prominent channels, and reduce the computational cost compared to the other mixed frequency-phase coding (FPC)-based BCIs. The experimental results suggested that the proposed method can be usable implementing BCI effectively with reduce visual fatigue. Copyright © 2018 Elsevier B.V. All rights reserved.

Application of case mix index in the allocation of nursing human resources.

PubMed

Han, Binru; Chen, Xi; Li, Qiuping

2018-02-23

To investigate the feasibility of the case mix index and compare the allocation of nursing human resources between two departments of a hospital with different case mix indexes in China. The case mix index is used to assess the resource allocation of all cases in two departments of a hospital. Its values can determine the resource allocation required to diagnose and treat the patients. Clinical data were obtained from 23 different departments in 2015 and analysed retrospectively from October to November, 2016. Factors influencing the allocation of registered nurses were identified, and balanced quantities of patients with different case mix indexes were chosen from two departments. Spearman correlation analysis was performed. The per capita nursing workload was significant (r = .669, p = .000). The length of hospital stay, quantity of nurses, and department case mix index were correlated with the nursing workload (t = 4.211, p = .000; t = 2.962, p = .008; t = 2.266, p = .035). Education levels (Z = -1.391, p = .164) and the professional titles (Z = -1.832, p = .067) of the nurses were not statistically significant, whereas the registered nurse level differed between two departments (Z = -2.125, p = .034). The case management index provides references for the efficient allocation of registered nurses in clinical practice. © 2018 John Wiley & Sons Ltd.

Modelling rainfall amounts using mixed-gamma model for Kuantan district

NASA Astrophysics Data System (ADS)

Zakaria, Roslinazairimah; Moslim, Nor Hafizah

2017-05-01

An efficient design of flood mitigation and construction of crop growth models depend upon good understanding of the rainfall process and characteristics. Gamma distribution is usually used to model nonzero rainfall amounts. In this study, the mixed-gamma model is applied to accommodate both zero and nonzero rainfall amounts. The mixed-gamma model presented is for the independent case. The formulae of mean and variance are derived for the sum of two and three independent mixed-gamma variables, respectively. Firstly, the gamma distribution is used to model the nonzero rainfall amounts and the parameters of the distribution (shape and scale) are estimated using the maximum likelihood estimation method. Then, the mixed-gamma model is defined for both zero and nonzero rainfall amounts simultaneously. The formulae of mean and variance for the sum of two and three independent mixed-gamma variables derived are tested using the monthly rainfall amounts from rainfall stations within Kuantan district in Pahang Malaysia. Based on the Kolmogorov-Smirnov goodness of fit test, the results demonstrate that the descriptive statistics of the observed sum of rainfall amounts is not significantly different at 5% significance level from the generated sum of independent mixed-gamma variables. The methodology and formulae demonstrated can be applied to find the sum of more than three independent mixed-gamma variables.

Mutation-selection equilibrium in games with mixed strategies.

PubMed

Tarnita, Corina E; Antal, Tibor; Nowak, Martin A

2009-11-07

We develop a new method for studying stochastic evolutionary game dynamics of mixed strategies. We consider the general situation: there are n pure strategies whose interactions are described by an nxn payoff matrix. Players can use mixed strategies, which are given by the vector (p(1),...,p(n)). Each entry specifies the probability to use the corresponding pure strategy. The sum over all entries is one. Therefore, a mixed strategy is a point in the simplex S(n). We study evolutionary dynamics in a well-mixed population of finite size. Individuals reproduce proportional to payoff. We consider the case of weak selection, which means the payoff from the game is only a small contribution to overall fitness. Reproduction can be subject to mutation; a mutant adopts a randomly chosen mixed strategy. We calculate the average abundance of every mixed strategy in the stationary distribution of the mutation-selection process. We find the crucial conditions that specify if a strategy is favored or opposed by selection. One condition holds for low mutation rate, another for high mutation rate. The result for any mutation rate is a linear combination of those two. As a specific example we study the Hawk-Dove game. We prove general statements about the relationship between games with pure and with mixed strategies.

FV-MHMM: A Discussion on Weighting Schemes.

NASA Astrophysics Data System (ADS)

Franc, J.; Gerald, D.; Jeannin, L.; Egermann, P.; Masson, R.

2016-12-01

Upscaling or homogenization techniques consist in finding block-equivalentor equivalent upscaled properties on a coarse grid from heterogeneousproperties defined on an underlying fine grid. However, this couldbecome costly and resource consuming. Harder et al., 2013, have developeda Multiscale Hybrid-Mixed Method (MHMM) of upscaling to treat Darcytype equations on heterogeneous fields formulated using a finite elementmethod. Recently, Franc et al. 2016, has extended this method of upscalingto finite volume formulation (FV-MHMM). Although convergence refiningLagrange multipliers space has been observed, numerical artefactscan occur while trapping numerically the flow in regions of low permeability. This work will present the development of the method along with theresults obtained from its classical formulation. Then, two weightingschemes and their benefits on the FV-MHMM method will be presented insome simple random permeability cases. Next example will involve alarger heterogeneous 2D permeability field extracted from the 10thSPE test case. Eventually, multiphase flow will be addressed asan extension of this single phase flow method. An elliptic pressureequation solved on the coarse grid via FV-MHMM will be sequentiallycoupled with a hyperbolic saturation equation on the fine grid. Theimproved accuracy thanks to the weighting scheme will be measuredcompared to a finite volume fine grid solution. References: Harder, C., Paredes, D. and Valentin, F., A family of multiscalehybrid-mixed finite element methods for the Darcy equation with roughcoefficients, Journal of Computational Physics, 2013. Franc J., Debenest G., Jeannin L., Egermann P. and Masson R., FV-MHMMfor reservoir modelling ECMOR XV-15th European Conference on the Mathematicsof Oil Recovery, 2015.

Estimating continuous floodplain and major river bed topography mixing ordinal coutour lines and topographic points

NASA Astrophysics Data System (ADS)

Bailly, J. S.; Dartevelle, M.; Delenne, C.; Rousseau, A.

2017-12-01

Floodplain and major river bed topography govern many river biophysical processes during floods. Despite the grow of direct topographic measurements from LiDARS on riverine systems, it still room to develop methods for large (e.g. deltas) or very local (e.g. ponds) riverine systems that take advantage of information coming from simple SAR or optical image processing on floodplain, resulting from waterbodies delineation during flood up or down, and producing ordered coutour lines. The next challenge is thus to exploit such data in order to estimate continuous topography on the floodplain combining heterogeneous data: a topographic points dataset and a located but unknown and ordered contourline dataset. This article is comparing two methods designed to estimate continuous topography on the floodplain mixing ordinal coutour lines and continuous topographic points. For both methods a first estimation step is to value each contourline with elevation and a second step is next to estimate the continuous field from both topographic points and valued contourlines. The first proposed method is a stochastic method starting from multigaussian random-fields and conditional simualtion. The second is a deterministic method based on radial spline fonction for thin layers used for approximated bivariate surface construction. Results are first shown and discussed from a set of synoptic case studies presenting various topographic points density and topographic smoothness. Next, results are shown and discuss on an actual case study in the Montagua laguna, located in the north of Valparaiso, Chile.

Estimating continuous floodplain and major river bed topography mixing ordinal coutour lines and topographic points

NASA Astrophysics Data System (ADS)

Brown, T. G.; Lespez, L.; Sear, D. A.; Houben, P.; Klimek, K.

2016-12-01

Floodplain and major river bed topography govern many river biophysical processes during floods. Despite the grow of direct topographic measurements from LiDARS on riverine systems, it still room to develop methods for large (e.g. deltas) or very local (e.g. ponds) riverine systems that take advantage of information coming from simple SAR or optical image processing on floodplain, resulting from waterbodies delineation during flood up or down, and producing ordered coutour lines. The next challenge is thus to exploit such data in order to estimate continuous topography on the floodplain combining heterogeneous data: a topographic points dataset and a located but unknown and ordered contourline dataset. This article is comparing two methods designed to estimate continuous topography on the floodplain mixing ordinal coutour lines and continuous topographic points. For both methods a first estimation step is to value each contourline with elevation and a second step is next to estimate the continuous field from both topographic points and valued contourlines. The first proposed method is a stochastic method starting from multigaussian random-fields and conditional simualtion. The second is a deterministic method based on radial spline fonction for thin layers used for approximated bivariate surface construction. Results are first shown and discussed from a set of synoptic case studies presenting various topographic points density and topographic smoothness. Next, results are shown and discuss on an actual case study in the Montagua laguna, located in the north of Valparaiso, Chile.

Case-mix adjustment and the comparison of community health center performance on patient experience measures.

PubMed

Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

2010-06-01

To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment.

PubMed

Berlowitz, D R; Ash, A S; Brandeis, G H; Brand, H K; Halpern, J L; Moskowitz, M A

1996-03-15

To determine the importance of case-mix adjustment in interpreting differences in rates of pressure ulcer development in Department of Veterans Affairs long- term care facilities. A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of pressure ulcer development; the resulting model was validated in a separate sample. Facility-level rates of pressure ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Department of Veterans Affairs long-term care facilities. The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of pressure ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Development of a stage 2 or greater pressure ulcer. 11 factors predicted pressure ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of pressure ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.

On-orbit servicing system assessment and optimization methods based on lifecycle simulation under mixed aleatory and epistemic uncertainties

NASA Astrophysics Data System (ADS)

Yao, Wen; Chen, Xiaoqian; Huang, Yiyong; van Tooren, Michel

2013-06-01

To assess the on-orbit servicing (OOS) paradigm and optimize its utilities by taking advantage of its inherent flexibility and responsiveness, the OOS system assessment and optimization methods based on lifecycle simulation under uncertainties are studied. The uncertainty sources considered in this paper include both the aleatory (random launch/OOS operation failure and on-orbit component failure) and the epistemic (the unknown trend of the end-used market price) types. Firstly, the lifecycle simulation under uncertainties is discussed. The chronological flowchart is presented. The cost and benefit models are established, and the uncertainties thereof are modeled. The dynamic programming method to make optimal decision in face of the uncertain events is introduced. Secondly, the method to analyze the propagation effects of the uncertainties on the OOS utilities is studied. With combined probability and evidence theory, a Monte Carlo lifecycle Simulation based Unified Uncertainty Analysis (MCS-UUA) approach is proposed, based on which the OOS utility assessment tool under mixed uncertainties is developed. Thirdly, to further optimize the OOS system under mixed uncertainties, the reliability-based optimization (RBO) method is studied. To alleviate the computational burden of the traditional RBO method which involves nested optimum search and uncertainty analysis, the framework of Sequential Optimization and Mixed Uncertainty Analysis (SOMUA) is employed to integrate MCS-UUA, and the RBO algorithm SOMUA-MCS is developed. Fourthly, a case study on the OOS system for a hypothetical GEO commercial communication satellite is investigated with the proposed assessment tool. Furthermore, the OOS system is optimized with SOMUA-MCS. Lastly, some conclusions are given and future research prospects are highlighted.