Concept: Absolute deviation
BACKGROUND: To evaluate institutional nursing care performance in the context of national comparative statistics (benchmarks), approximately one in every three major healthcare institutions (over 1,800 hospitals) across the United States, have joined the National Database for Nursing Quality Indicators[REGISTERED SIGN] (NDNQI[REGISTERED SIGN]). With over 18,000 hospital units contributing data for nearly 200 quantitative measures at present, a reliable and efficient input data screening for all quantitative measures for data quality control is critical to the integrity, validity, and on-time delivery of NDNQI reports. METHODS: With Monte Carlo simulation and quantitative NDNQI indicator examples, we compared two ad-hoc methods using robust scale estimators, Inter Quartile Range (IQR) and Median Absolute Deviation from the Median (MAD), to the classic, theoretically-based Minimum Covariance Determinant (FAST-MCD) approach, for initial univariate outlier detection. RESULTS: While the theoretically based FAST-MCD used in one dimension can be sensitive and is better suited for identifying groups of outliers because of its high breakdown point, the ad-hoc IQR and MAD approaches are fast, easy to implement, and could be more robust and efficient, depending on the distributional property of the underlying measure of interest. CONCLUSION: With highly skewed distributions for most NDNQI indicators within a short data screen window, the FAST-MCD approach, when used in one dimensional raw data setting, could overestimate the false alarm rates for potential outliers than the IQR and MAD with the same pre-set of critical value, thus, overburden data quality control at both the data entry and administrative ends in our setting.
BACKGROUND: The ability to drive is important for ensuring quality of life for many older adults. Glaucoma is prevalent in this age group and may affect driving. The purpose of this study is to determine if glaucoma and glaucomatous visual field (VF) loss are associated with driving cessation, limitations, and deference to another driver in older adults. METHODS: Cross-sectional study. Eighty-one glaucoma subjects and 58 glaucoma suspect controls between age 60 and 80 reported if they had ceased driving, limited their driving in various ways, or preferred another to drive. RESULTS: Twenty-three percent of glaucoma subjects and 6.9% of suspects had ceased driving (p = 0.01). Glaucoma subjects also had more driving limitations than suspects (2.0 vs. 1.1, p = 0.007). In multivariable models, driving cessation was more likely for glaucoma subjects as compared to suspects (OR = 4.0; 95% CI = 1.1-14.7; p = 0.03). The odds of driving cessation doubled with each 5 decibel (dB) decrement in the better-eye VF mean deviation (MD) (OR = 2.0; 95% CI = 1.4-2.9; p < 0.001). Glaucoma subjects were also more likely than suspects to report a greater number of driving limitations (OR = 4.7; 95% CI = 1.3-16.8; p = 0.02). The likelihood of reporting more limitations increased with the VF loss severity (OR = 1.6/5 dB decrement in the better-eye VF MD; 95% CI = 1.1-2.4; p = 0.02). Neither glaucoma nor VF MD was associated with other driver preference (p > 0.1 for both). CONCLUSIONS: Glaucoma and glaucomatous VF loss are associated with greater likelihood of driving cessation and greater limitation of driving in the elderly. Further prospective study is merited to assess when and why people with glaucoma change their driving habits, and to determine if their observed self-regulation of driving is adequate to ensure safety.
Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study
- The Journal of orthopaedic and sports physical therapy
- Published over 1 year ago
Study Design Cross-sectional repeated measures. Background Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall. Objectives This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA. Methods Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance). Results Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0.005; P = .01). Inter-rectus distance and the distortion index did not change from rest or differ between tasks for controls (P≥.55). Conclusion Narrowing of the IRD during automatic curl-up in DRA distorts the LA. The distortion index requires further validation, but findings imply that less IRD narrowing with TrA preactivation might improve force transfer between sides of the abdomen. The clinical implication is that reduced IRD narrowing by TrA contraction, which has been discouraged, may positively impact abdominal mechanics. J Orthop Sports Phys Ther 2016;46(7):580-589. doi:10.2519/jospt.2016.6536.
BACKGROUND: We sought to characterise the frequency, health outcomes and economic consequences of diagnostic errors in the USA through analysis of closed, paid malpractice claims. METHODS: We analysed diagnosis-related claims from the National Practitioner Data Bank (1986-2010). We describe error type, outcome severity and payments (in 2011 US dollars), comparing diagnostic errors to other malpractice allegation groups and inpatient to outpatient within diagnostic errors. RESULTS: We analysed 350 706 paid claims. Diagnostic errors (n=100 249) were the leading type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, p<0.001) and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001). The inflation-adjusted, 25-year sum of diagnosis-related payments was US$38.8 billion (mean per-claim payout US$386 849; median US$213 250; IQR US$74 545-484 500). Per-claim payments for permanent, serious morbidity that was 'quadriplegic, brain damage, lifelong care' (4.5%; mean US$808 591; median US$564 300), 'major' (13.3%; mean US$568 599; median US$355 350), or 'significant' (16.9%; mean US$419 711; median US$269 255) exceeded those where the outcome was death (40.9%; mean US$390 186; median US$251 745). CONCLUSIONS: Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.
- IEEE transactions on image processing : a publication of the IEEE Signal Processing Society
- Published over 5 years ago
Recently, there has been significant interest in robust fractal image coding for the purpose of robustness against outliers. However, the known robust fractal coding methods (HFIC and LAD-FIC, etc.) are not optimal, since, besides the high computational cost, they use the corrupted domain block as the independent variable in the robust regression model, which may adversely affect the robust estimator to calculate the fractal parameters (depending on the noise level). This paper presents a Huber fitting plane-based fractal image coding (HFPFIC) method. This method builds Huber fitting planes (HFPs) for the domain and range blocks, respectively, ensuring the use of an uncorrupted independent variable in the robust model. On this basis, a new matching error function is introduced to robustly evaluate the best scaling factor. Meanwhile, a median absolute deviation (MAD) about the median decomposition criterion is proposed to achieve fast adaptive quadtree partitioning for the image corrupted by salt & pepper noise. In order to reduce computational cost, the no-search method is applied to speedup the encoding process. Experimental results show that the proposed HFPFIC can yield superior performance over conventional robust fractal image coding methods in encoding speed and the quality of the restored image. Furthermore, the no-search method can significantly reduce encoding time and achieve less than 2.0 s for the HFPFIC with acceptable image quality degradation. In addition, we show that, combined with the MAD decomposition scheme, the HFP technique used as a robust method can further reduce the encoding time while maintaining image quality.
Background The anterolateral thigh (ALT) flap has been widely used in reconstruction of soft tissue defects. The anatomic variations of perforators increase the difficulties of flap elevation. The ABC system has been described for locating the most common three perforators in Western populations. Less evidence has been found regarding whether it is suitable for Chinese population. The purpose of this study is to explore the improvement of preoperative location technology and flap design for Chinese people.Methods Detection for perforator signals on the bilateral thigh surface was perfromed on 50 Chinese adults using handheld Doppler. Define the A-P line as the line between the anterior superior iliac spin (ASIS) and the superolateral corner of the patella (P). We defined a coordinate system on the thigh surface to record the data of each signal point. The A-P line was y-axis in this coordinate system, and the midpoint of the line was the zero point. The data of these signals were recorded in the form of coordinates. Statistics and mathematic methods were used to analyze the regularity of signal distribution and the correlation between body mass index (BMI) and signal distribution. The findings were applied in five patients who underwent the ALT flap transplantation to confirm its clinical value.Results The results showed that most of the signals appeared near the A-P line. Most signals were located 1 cm lateral (mean 0.5 cm lateral) to the A-P line. The mean vertical distance between perforator B and perforators A and C was 4 cm . More perforator signals were detected at the two horizontal level (as shown in the picture above) than other horizontal levels. The rate of accurate preoperative detection was 40% (6 of 15 perforators) and the error rate was 20% (3 of 15 perforators). The mean deviation was 1.34 cm, which is acceptable for clinical application. The mean vertical distance between perforator B and perforators A and C in clinical study (4.81 cm) corresponded to the finding of the Doppler study (4.2 cm), whereas the mean distance between perforators and the A-P line (1.57 cm) was more than the Doppler finding (0.48 cm).Conclusion The A-P line is still a reliable guiding line for Doppler detection and flap design. The ABC system is suitable for the Chinese population but must be adjusted: perforator B is marked first at the midpoint and 0.5 cm lateral to the A-P line and perforators A and C are marked 4 cm distal and proximal to perforator B, respectively. In designing the flap, the region 3 cm around point B and the region between the two horizontal planes at point B and 4 cm lower should both be contained into the flap, no matter what the finding of Doppler detection is.
To develop and implement a quality control protocol using real-time patient data with immediate failure analysis and prevention of releasing results that exceed the allowable total error. Design and Methods Patient data are analyzed in real time using algorithms that incorporate moving medians and moving means for selected chemistry analytes. Simulation software was developed to determine optimal algorithms, establish error limits, and number of patient results for calculation of a single cumulative datum point. Algorithms for moving median (MovMed) and mean (MovMen) were chosen and validated for each analyte. Error limits (TEa) were established using biological and analytical variation with a goal of greater than 90% error detection rate during simulation runs. Middleware software was developed to prohibit the release of patient results upon error detection.
The method mix of contraceptive use is severely unbalanced in many countries, with over half of all use provided by just 1 or 2 methods. That tends to limit the range of user options and constrains the total prevalence of use, leading to unplanned pregnancies and births or abortions. Previous analyses of method mix distortions focused on countries where a single method accounted for more than half of all use (the 50% rule). We introduce a new measure that uses the average deviation (AD) of method shares around their own mean and apply that to a secondary analysis of method mix data for 8 contraceptive methods from 666 national surveys in 123 countries. A high AD value indicates a skewed method mix while a low AD value indicates a more uniform pattern across methods; the values can range from 0 to 21.9. Most AD values ranged from 6 to 19, with an interquartile range of 8.6 to 12.2. Using the AD measure, we identified 15 countries where the method mix has evolved from a distorted one to a better balanced one, with AD values declining, on average, by 35% over time. Countries show disparate paths in method gains and losses toward a balanced mix, but 4 patterns are suggested: (1) rise of one method partially offset by changes in other methods, (2) replacement of traditional with modern methods, (3) continued but declining domination by a single method, and (4) declines in dominant methods with increases in other methods toward a balanced mix. Regions differ markedly in their method mix profiles and preferences, raising the question of whether programmatic resources are best devoted to better provision of the well-accepted methods or to deploying neglected or new ones, or to a combination of both approaches.
Relative sea/land level changes are fundamental to people living in deltas. Net subsidence is complex and attributed to tectonics, compaction, sedimentation and anthropogenic causes. It can have severe impacts and needs to be quantified and where possible (for subsidence due to anthropogenic causes) avoided. For the highly populated Ganges-Brahmaputra-Meghna delta, a large range of net subsidence rates are described in the literature, yet the reasons behind this wide range of values are poorly understood. This paper documents and analyses rates of subsidence (for publications until 2014) and relates these findings to human influences (development). 205 point measurements of net subsidence were found, reported in 24 studies. Reported measurements were often repetitive in multiple journals, with some lacking detail as to precise location, cause and method, questioning reliability of the rate of subsidence. Rates differed by locality, methodology and period of measurement. Ten different measurement methods were recorded, with radio-carbon dating being the most common. Temporal and spatially, rates varied between -1.1mm/yr (i.e. uplift) and 43.8mm/yr. The overall mean reported rate was 5.6mm/yr, and the overall median 2.9mm/yr, with 7.3mm/yr representing one standard deviation. These rates were reduced if inaccurate or vague records were omitted. The highest rates were recorded in the Sylhet Plateau, Dhaka and Kolkata. Highest rates were recorded in the last 1000years, where the mean increased to 8.8mm/yr and a standard deviation of 7.5mm/yr. This could be partly due to shorter-term measurement records, or anthropogenic influence as multiple high rates are often found in urban settings. Continued development may cause rates to locally increase (e.g. due to groundwater abstraction and/or drainage). Improved monitoring is required over a wider area, to determine long-term trends, particularly as short-term records are highly variable. Focus in regions where wide spread development is occurring or is expected would be advantageous.
Oxygen isotope analysis of archaeological skeletal remains is an increasingly popular tool to study past human migrations. It is based on the assumption that human body chemistry preserves the δ18O of precipitation in such a way as to be a useful technique for identifying migrants and, potentially, their homelands. In this study, the first such global survey, we draw on published human tooth enamel and bone bioapatite data to explore the validity of using oxygen isotope analyses to identify migrants in the archaeological record. We use human δ18O results to show that there are large variations in human oxygen isotope values within a population sample. This may relate to physiological factors influencing the preservation of the primary isotope signal, or due to human activities (such as brewing, boiling, stewing, differential access to water sources and so on) causing variation in ingested water and food isotope values. We compare the number of outliers identified using various statistical methods. We determine that the most appropriate method for identifying migrants is dependent on the data but is likely to be the IQR or median absolute deviation from the median under most archaeological circumstances. Finally, through a spatial assessment of the dataset, we show that the degree of overlap in human isotope values from different locations across Europe is such that identifying individuals' homelands on the basis of oxygen isotope analysis alone is not possible for the regions analysed to date. Oxygen isotope analysis is a valid method for identifying first-generation migrants from an archaeological site when used appropriately, however it is difficult to identify migrants using statistical methods for a sample size of less than c. 25 individuals. In the absence of local previous analyses, each sample should be treated as an individual dataset and statistical techniques can be used to identify migrants, but in most cases pinpointing a specific homeland should not be attempted.