Representation Of Proportion Research Articles

153. Development of a Pathway for Removal of Inappropriate Penicillin Allergy Labels in Hospitalized Patients

BackgroundMore than 90% of reported penicillin allergies are found inaccurate when formally assessed. These allergy labels lead to decreased utilization of first-line beta-lactam antibiotics, and adverse clinical outcomes. The objective of this study was to develop a multi-disciplinary approach to decrease inaccurate labeling among hospitalized patients with documented penicillin allergy.MethodsA team of clinicians, pharmacists, and nurses utilized the DMAIC quality strategy to improve accuracy of penicillin allergy labeling. Allergic reactions were stratified to develop a penicillin allergy de-labeling algorithm (Figure 1). Admission to the intensive care unit (ICU) for anaphylaxis was defined as a balancing measure. We reviewed baseline data from patients with a documented penicillin allergy admitted to a single inpatient floor at Mayo Clinic, Rochester between June and October 2019. A cause and effect diagram was used to conduct a root cause analysis. The intervention was then applied to patients who reported penicillin allergy admitted to the same floor from November 2019 to January 2020. Study data were collected and basic descriptive statistics generated.Figure 1: Penicillin allergy delabeling algorithm Results96 patients were included in the control group with mean age of 71 years (range 65–84 years) and 55% females. Breakdown of documented allergic reactions are represented in Figure 2. 58 (60%) received an antibiotic for a median duration of 1.5 days (IQR: 0 – 6). Of these, 7(12%) received penicillin-class antibiotics, and 41 (70.6%) received non-beta-lactam antibiotics. 2 (2%) of these patients were de-labeled without any penicillin skin tests. Detailed metrics of each PDSA cycle are shown in Table 1. During PDSA cycle 2, inaccurate penicillin documentation was removed in 9/19 (47.4%) of hospitalized patients. There were no ICU admissions for anaphylaxis.Figure 2: Graphic representation of proportion of type of documented allergic reactions to penicillin Table 1: Metrics and outcomes at baseline and during successive PDSA cycles ConclusionVarious factors contribute to penicillin allergy mislabeling. Our comprehensive algorithm addresses nuances of penicillin allergic reactions and increased accurate penicillin allergy labeling in 47.4% of the cases. Beta-lactam use also increased to 37% through our pilot project while maintaining patient safety. A multi-disciplinary and patient-centered approach aligned with institutional workflows is necessary to improve patient outcomes.Disclosures All Authors: No reported disclosures

A unified Bayesian mixture model framework via spatial information for grayscale image segmentation

Because of the Student-t distribution owning heavier tailed than the Gaussian distribution, under a Bayesian framework, a spatially variant finite mixture model with Student’s t-distribution component function is proposed for grayscale image segmentation. To avoid additional computational step and improve the efficiency of the proposed model, a representation of contextual mixing proportion is adopted. Secondly, the spatial information of the pixels is closely related to the Gaussian distribution of their neighborhood system. Thirdly, the inherent relationship between the Gaussian distribution and the Student’s t-distribution is adopted to optimize the unknown parameters of the proposed model, which simplifies the inference process and makes the proposed model to be easily implemented. Comprehensive experiments on synthetic noise images, simulated medical images and real-world grayscale images are presented to illustrate the superior performance of the proposed model in terms of the visual and quantitative comparison.

Jōyō kanji as core building blocks of the Japanese writing system

The architecture of writing systems metaphor has special relevance for understanding the structural nature of the Japanese writing system, and, more specifically, for appreciating how the 2,136 kanji of the 常用漢字表 /jō-yō-kan-ji-hyō/* ‘List of characters for general use’ function as the core building blocks in the orthographic representation of a considerable proportion of the Japanese lexicon. In seeking to illuminate the multiple layers of internal structure within Japanese kanji, the Japanese lexicon, and the Japanese writing system, the paper draws on insights and observations gained from an ongoing project to construct a large-scale Japanese lexical database system. Reflecting structural distinctions within the database, the paper consists of three main sections addressing the different structural levels of kanji components, jōyō kanji, and the lexicon. Keywords: Japanese writing system; building blocks; jōyō kanji; components; orthographic structure; database

HEURISTIC REASONING IN INTERPRETING BOX PLOTS: THE INFLUENCE OF ORIENTATION

Abstract: We studied how graph design principles can predict specific reasoning mechanisms that occur when misinterpreting box plots, and, more specifically, the misinterpretation of the area as a representation of frequency or proportion of observations, instead of density. In previous studies this misinterpretation has been shown to be heuristic in nature and is elicited by the fact that box plots do not use space in a natural way. Graph design principles provide a theoretical framework for assuming that the orientation of a box plot could influence its interpretation. By analyzing reaction times and accuracy rates for different item types, we explored whether there indeed is an influence of the orientation of a box plot on the way it is interpreted. Results indicate that the misinterpretation manifests itself in both orientations to the same extent, suggesting that the orientation of a box plot does not influence the reasoning mechanisms it provokes.Key wo rds: du al-process theory, gra ph design, misinterpretation, heuristic, box plotsINTERPRETACIA RAMCEKOVÝCH GRAFOV: VPLYV PRIESTOROVEJ ORIENTACIES. L e m, C. V a n d e b e e k, P. O n g h e n a , L. V e r s c h a f f e l, W. V a n D o o r e nSuhrn: Sk umali sme ako principy navrhu grafov predikuju specificke mechanizmy usudzovania, k u k torým dochadza pri sk reslenej interpretacii ramcekových grafov, presnejsie, pri ich sk reslenej interpretacii a ko reprezentacie frekvencie alebo miery pozorovani, a nie hustoty. Predchadzajuce studie uk aza li, ze skreslena interpretacia ma heuristický charakter a vyvolava ju sk utocnost, ze ramcekove grafy nevyuziva ju priestor prirodzeným sposobom. Principy navrhovania grafov posk ytuju teoretický ramec pre predpoklad, ze priestorova orientacia ramcekoveho gra fu moze ovplyvnit jeho interpreta ciu . Pomocou analýzy reakcných casov a miery presnosti pre rozne typy poloziek sme zistova li, ci priestorova orientacia ramcekoveho grafu sku tocne vplýva na sposob, ak ým je interpretova ný. Výsledky naznacuju, ze skreslena interpretacia sa vyskytova la v rovnak ej miere v oboch priestorových orientaciach, na zaklade coho mozno predpokladat, ze priestorova orienta cia ra mcekoveho gra fu neovplyvnuje mechanizmy usudzovania, ktore vyvolava.Lem, Onghena, Ver scha ffel, and Van Dooren (2013b) recently showed that box plots are misinterpreted frequently and that the incorrect interpretation of the area of the box plot can be assigned to incorrect heuris- tic reasoning. A limitation of this study is, however, that it only used horizontally po- sitioned box plots, while it is also common practice to make use of vertically positioned box plots, particularly when multiple groups are being compared (e.g., McGill, Tukey, Larsen, 1978; Williamson, Parker, Kendrick, 1989). Based on graph design principles (Tversky, 1997), some arguments can be given that make it likely that less interpreta- tion difficulties will occur when the box plot is represented vertically. In the present study, we compared the way horizontally and verti- cally positioned box plots are interpreted, using a dual processing perspective.The Heuristic Misinterpretation of Box PlotsThe misinterpretation, which is the focus in this study, was documented first by Bakker, Biehler, and Konold (2005). They found that the area of the box plot is often perceived by students as displaying the fre- quency or proportion of observations in that interval, instead of the density. Bakker et al. ascribed this misinterpretation to the fact that students link the use of box plots to the use of graphical r epresen tations previously learned in school (e.g., histograms and bar graphs, see also Lem, Onghena, Verschaffel, Van Dooren, 2012). In box plots the area of the box indicates how dense the observa- tions are in that interval: The smaller an area, the higher the density of observations in that interval. This makes box plots very different from other graphical representations, such as bar graphs and histograms, in which a larger area of the bar reflects a higher fre- quency of observations. …

Neuronal representation of number and proportion in the primate brain

Abstract Number symbols have allowed humans to develop superior mathematical skills that are a hallmark of technologically advanced cul­tures. Findings in animal cognition, devel­opmental psychology, and anthropology in­dicate that these numerical skills are rooted in nonlinguistic biological primitives. Recent studies in human and nonhuman primates using a broad range of methodologies pro­vide evidence that numerical information is represented and processed by regions of the prefrontal and posterior parietal lobes, where single neurons are tuned to preferred abso­lute quantities. Until recently, data explor­ing ratios of quantities, as in proportions and fractions, were comparatively sparse. New data derived with complementary methods and from different model systems now shed light on the mechanisms of magnitude ra­tio representations. A coding scheme for pro­portions has emerged that is highly reminis­cent of the representation of absolute num­ber. The magnitude code is automatic, inde­pendent of language and the format of pre­sentation. These findings suggest that the primate brain houses a phylogenetically old network for the representation of quantity that, during the course of human evolution, has been coopted to build our remarkable sense of number.

Inverse proportion : a constructivist view of college students

From the constructivist paradigm, knowing misconceptions of students regarding a particular concept is deemed vital in designing effective instruction. Ausubel (1968) commented that 'The most important single factor influencing learning is what the learner already knows; ascertain this and teach him accordingly'. The symbiosis between science and mathematics is a profound one. Science views mathematics as a significant branch. Science likes to refer mathematics as the Queen, as mathematics nurtures the growth of science especially in the areas such as scientific prediction and manipulation. On the other hand, many concepts of mathematics are invented for the purpose of science such Proportion and Calculus to name a few. Two major ideas in Proportion are the Direct and the Inverse. A good grasp of these mathematical ideas is paramount for students in understanding the fundamental nature of science in its quantitative form. This paper offers a comprehensive description of seven hundred and fifty nine science based students (385 female and 374 male) from a local university in their developmental understanding of this mathematical idea of Inverse Proportion from the six domains i.e., Definition of Inverse Proportion, Graphical Representation of Inverse Proportion, Mathematical Representation of Inverse Proportion, Data Characteristic of Inverse Proportion, Relational Understanding of Inverse Proportion, and Problem Solving in Inverse Proportion. It discusses these six domains from two perspectives i.e., Academic Ability and Gender. The paper is based on a study by Beh et al (2008) anchoring on Constructivism. Among the major findings are: Students irrespective of high or low academic ability generally performed poorly in domains requiring conceptual understanding but showed relatively higher competency for the domain requiring procedural skills. Students of higher level academic ability demonstrate a significant in dept understanding of Inverse Proportion than students of lower level of academic ability; and Male students overall understanding of Inverse is significantly higher than their female counterparts at the 5% level. Since the study is based on Constructivism, it also highlights students' alternative frameworks. Implications for teaching and learning will be discussed.

Commentary: Proportion not the cause of beauty but of health?

Body proportions have come of age in the medical and epidemiological research communities. The article in this issue by Ferrie et al. 1 examines the association between leg length and trunk length to coronary heart disease (CHD) in the latest phase of the Whitehall II study, a prospective survey of the health of British civil servants. This is one of many studies published in the last decade to focus on the length of body segments in relation to health. Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity, and death in adulthood. A concern with body proportion has deep roots in European history. In the 15th Century, Leonardo da Vinci developed canons (rules) for the representation of the human body proportion in art and Albrecht Durer devised technology to draw both the canonical forms and many variations as observed in nature. Edmund Burke, the British statesman and philosopher, published in 1756 the essay, The Philosophical Inquiry into the Origin of Our Ideas on the Sublime and Beautiful. One part of this is titled, ‘Proportion not the Cause of Beauty in the Human Species.’ Burke argued that people with body proportions outside the canon might still be considered beautiful. He held the human leg to be especially handsome, ‘I believe nobody will think the form of a man’s leg so well adapted to running, as those of a horse, a dog, a deer, and several other creatures; at least they have not that appearance: yet, I believe, a well-fashioned human leg will be allowed to far exceed all these in beauty.’ One is left to wonder which human legs are ‘well-fashioned.’ Perhaps Burke meant those that are relatively straight and long—contraindicating rickets, suggesting good health and nutrition in childhood, and predicting fecundity in adult women. Ferrie and colleagues report that leg length is inversely associated with CHD risk factors in middle-aged men and women. The strength of this finding would likely be increased had the authors used the sitting height ratio (SHR), calculated as (sitting height/stature · 100). The SHR provides a better account of body proportion variation standardized against total stature. In our research using data from the United States National Health and Examination Survey (1988–94) we find stronger correlations for SHR than leg length with body mass index and sum of skinfolds. Leitch 4 was, perhaps, the first medical researcher to propose that a ratio of leg length to total stature might be a good indicator of nutritional history and health. Noting the wellknown cephalo-caudal gradient in growth, Leitch (p. 145) wrote, ‘. . . it would be expected on general principles that children continuously underfed would grow into underdeveloped adults . . .with normal or nearly normal size head, moderately retarded trunk and relatively short legs.’ Reviewing the literature available at the time, Leitch found that improved nutrition during infancy and childhood did indeed result in a greater increase in leg length than in total height or weight. Longer-legged children were also less susceptible to bronchitis, which was then a scourge of poorly fed children. A recent spate of research on body proportions and health finds that poor nutrition and health during pregnancy and during the first 6 years of life post-partum result in fetuses, newborns, infants, and children of reduced body length, mostly due to reduced leg length. High risk behaviours, such as smoking during pregnancy, also reduce height and especially leg length of offspring. The alterations in body proportions are likely due to competition between body segments, such as trunk versus limbs, and organs for the limited nutrients during growth. 5

Gene therapy of genetic diseases and cancer.

The scope of gene transfer applications in human therapy has expanded enormously over the last 15 years to include not only several types of genetic diseases but also a variety of genetic approaches to the treatment of cancer. Hematopoietic stem cells have been considered excellent targets for therapeutic gene transfer because of their capacity for self-renewal and for differentiation into multiple cellular lineages. Retrovirus-mediated gene transfer has been tested for treatment of diseases that specifically affect the hematopoietic system, such as adenosine deaminase deficiency and chronic granulomatous disease. Storage disorders such as Gaucher disease, Hurler syndrome and Hunter syndrome, genetic deficiencies that affect a broad range of tissue types, may also be amenable to treatment by gene transfer into hematopoietic cells, owing to the release of enzyme expressed in transduced cells with subsequent uptake by untransduced cells ("metabolic cross-correction"). Hematopoietic stem cells may also be targeted for introduction of drug-resistance genes for the purpose of protecting normal tissues from the toxic side-effects of cancer chemotherapeutic agents, thus allowing more effective antitumor chemotherapy. The danger of introducing drug-resistance function into tumor cells may be dealt with by including sequences specifically designed to reduce expression of oncogenes or to restore expression of tumor suppressor genes. Current limitations on the efficiency of gene transfer into hematopoietic stem cells may be alleviated by the development of new vector systems such as adeno-associated virus or lentivirus vectors, or by advances in cell processing that render hematopoietic cells more susceptible to transduction. Drug-resistance genes may also be applied for in vivo selection to expand the representation of a small proportion of transduced hematopoietic cells. These approaches toward increasing the frequency of hematopoietic cell transduction contribute to the anticipated feasibility of gene therapy for genetic diseases and cancer.

持続音の継時比較における時間錯誤

The purpose was to ascertain the characteristics of the P-and E-functions in the comparison of the temporal length given as the duration of tone (substantial time), where the former function represented the time-error as a function of the length of pause between tones, and the latter indicated that as a function of the length of time under comparison.The changes in the length either of pause (P) (Tables 1 and 2) or of duration (E) (Tables 3 and 4) revealed that both functions were similar in tendency, i.e., the time-error was negative and remarkable at the shorter Ps or Es, but the error gradually decreased its amount and approached zero as P or E became longer. Within a single series, however, the changes in both P and E (Table 5) yielded a disagreement with the preceding results in the amount of error. The disagreement was more remarkable and the individual differences were larger when each combination of P and E constructed a separate series (Table 6). These disagreements are possibly due to the difference in the manner of constructing the stimulus series. A continued experimentation on a single stimulus condition showed no specific transition of error (Table 8). On the other hand, the repetition of a series, which was constructed by various stimulus conditions, increased or decreased the amount of error in that series as a whole (Table 9). The effect of the distribution of variable stimuli was hardly observed within the range of the present experiment (Table 10). The linear representation of the relative proportion of E-P-E did not result in any specific tendency in P- or E-function. By introspective method the following impressions were reported: a rhythm in binary time (R), aggregation of Es into a single unit (A), segregation of Es into pieces (S), a phrasing composed of two bars in binary time (P), and a wave-like image of E or oppressive impression (W) (Table 11). And the reports changed from R, through A, A and P, to W according to the elongation of either P or E. Such a complementary relation between P and E was indicated by the modification of E-function in the order of the length of P, in another detailed experiment (Table 12). If the effects of series construction and repetition were eliminated, E-functions for respective Ps, and P-function for respective Es also, could be brought to coincidence with each other by transformation of coordinate system (Fig. 1).These experimental results suggest that P- and E-functions are divided into three phases. Phase 1: at shorter Ps or Es the amount of error varies largely, though being always negative. Phase 2: at moderate Ps or Es the negative error decreases as P or E gets length, and both functions appear in a similar form. Phase 3: at longer Ps or Es, P-function is horizontal, while E-function descends to the negative side as E increases. The first phase, corresponds to the impression R, the second to A, S and P, and the third to W. Many kinds of factors would be complicated under the phenomena of time-error. Therefore, further analysis of conditions affecting the phenomena would be required rather than the attempt at an integrated explanation.