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Summary: In this study, we report that the gender ratio (GR) at death [where GR=(N males/N males + N females)] of those born (and likely conceived) in solar cycle peaks (about a 3-year period occurring on average every ∼11years), is inversely related to mean male age at death; e.g., the higher the GRat death the lower the mean lifespan, while the GRat death of those born in non-peak years has no relation to mean male lifespan. Although changes in the GR are small and may be of little clinical significance, the GR is a sensitive indicator of environmental effects, and therefore is pertinent to epigenetics. This paper supports the hypothesis that solar radiation, probably in the ultraviolet spectrum, by some manner interacts with chromosomal DNA (genes) and produces the genetic variety that not only fosters adaptation, but also produces the diseases that reduce lifespan. This paper also proposes that sunlight is more effective in modifying genomes at the time of conception than later in gestation or infancy. Referring to the work of others, this study also reveals that geographic latitude also affects the GR, suggesting that the variation in light is probably as important as the intensity of light in modifying genomes. This study finds that men sustain more genetic variation, producing 28% more disease than women, as well as a 2% decrease in GR from birth to death, and a shorter life (in Maine) by 7years. [Copyright &y& Elsevier]

We apply pattern-recognizing artificial neural net works (ANNs) to the patients of two psychiatric hospi tals, a private, for-profit hospital (PH) and a state hospital (SH), both serving the southern tier of Maine (approximately two-thirds of the state's population, i.e., 800,000 persons) over a 19-month period. In our data from the PH, N = 837 admissions, and at the SH, N = 834. Unique patient identifiers were assigned to patients so that their individual patterns of care could be incorpo rated into our ANNs. We used a previously reported methodology to measure quality of care (Q), and devel oped a measure of value of service (V) from the patients' perspective for both facilities. A random portion of the demographic and outcome data of patients from each hospital was sequestered as a test set, whereas the re mainder was used to train ANNs with length-of-stay (LOS) as an outcome measure. Q, and V normalized for risk (RR), i.e., V/RR, were calculated for each test set, which included multiple admissions of individual patients to each hospital. The methodology for V accounts for the severity of illness with the calculation of a metric called U/G, for the differences in case-mix by exchanging "vir tual patients" between ANNs, and for entropy in the health care system by using a metric called the risk ratio (RR). Results showed that V/RR was 2.4 times greater at the SH than at the PH. This advantage is likely due to prior knowledge of individual patient patterns of treat ment by the SH's staff. Data sets from each hospital using only single admissions for each patient in the study pe riod (thereby eliminating unique patient patterns of LOS), yielded a V/RR that was only 21% greater at the SH. We hypothesize that this difference is due to the SH's ability to use treatment and discharge based upon pa tient strengths and level of clinical improvement, un fettered by insurance deadlines. Approximately 5% of the admissions to our studied PH went on to our SH, namely, the most severely impaired and indigent patients. The SH not only had twice the value, but also had half the cost of the PH, despite the greater number of treat ment non-responders and non-compliants at the SH. The reasons for this are skilled staff and specialized ancil lary services, staff knowledge of patients' responses to previous therapy, and individualized LOSs. These are fea tures that create a caring environment and better com pliance with treatment. This study emphasizes the value of tertiary care psychiatric facilities in a comprehensive mental health care delivery system. There are few stud ies of the effects of excessive downsizing of SHs on the community, but reports from Massachusetts (in 1995) suggest a 79% increase in suicides when the closing of SH beds exceeded 98% of maximum historical census. Routine use of pattern-recognizing tools such as ANNs would serve to inform the public about the value of men tal health services so that the most vulnerable in our so ciety are not neglected. [ABSTRACT FROM PUBLISHER]

This study uses a new paradigm to calculate the min imum and the optimum number of involuntary psychi atric beds at a state hospital in Maine with 5538 admissions over a 7-year period. The method measures quality of care (Q) based upon the accuracy of predic tion of length-of-stay for the hospital, and of commu nity length-of-stay for the community, each corrected for the severity of illness of the average patient. When Q in the hospital equals Q in the community, there is no net movement of patients from one phase of care to the other, analogous to a zero electromotive force, and the census at that point is the minimum number of beds (22 beds/100,000 population). When patients in the commu nity were least ill, relative to the hospital then hospital bed census is at its optimum (31 beds/100,000) given cur rent resources and technology. In studying specific di agnosis groups with the same methodology the authors found that patients with schizophrenia having the ben efit of clozapine for most of the study period had a Q av eraged over 7 years that was nearly equal in both hospital and community settings. This explains the perception that tertiary psychiatric hospitals comprised mostly of patients with schizophrenia can downsize significantly. However, affective disorders and "borderline" person ality disorders clearly benefit from structured hospital care with specialized experienced staff. We make argu ments for the role of the state hospital as a homeostat for the mental health care delivery system. [ABSTRACT FROM PUBLISHER]

This study investigates a new method of measuring quality of care. Taking place at a tertiary psychiatric hos pital with 5,128 admissions from January 1989 through December 1995, this study uses artificial neural networks (ANNs) to predict hospital length-of-stay (LOS) and uses the standard deviation of LOS in a formula to measure quality of care, Q. ANNs are trained with data using unique patient identifiers and are compared with iden tical ANNs trained without these identifiers. These two types of ANNs make a LOS prediction, P, with a slightly different accuracies, and this fact is exploited in mea suring Q. The authors defined U as the standard devia tion of the difference between the actual and the predicted LOS of the ANNs with unique patient identi fiers, and defined G as the standard deviation of the dif ference between the actual and the predicted LOS of the ANNs without using these unique identifiers. Dividing U, the variation of individual LOS patterns intertwined with systemic LOS patterns, by G, the variation of pre dominately systemic LOS patterns, yields the ratio U/G, in which systemic effects are factored out leaving a mea sure of the average severity of patient illness. Ratios that exceed unity are seen in the patients who are more severely ill. The formula for quality of care, Q, divides the best LOS prediction accuracy, P, which is inversely pro portional to overall variation in the delivery system, by U/G, which is inversely proportional to quality of care, written as: Q = P/(U/G). Q reflects the patients' per spective because LOS is concrete and tangible to patients. The study took place during hospital downsizing (polit ical change), a consent decree (policy change), new administrative and medical personnel (staffing change), and the introduction of clozapine and risperidone for schizophrenia (therapeutic change). These events had a predominantly positive impact on Q. The value of Q cor related well with the Joint Commission on Accreditation of Health Care Organizations (JCAHO) triennial evalu ations. Some conclusions that emerged from this study: 1) System variation, reflected in the standard deviation of LOS, increased with frequent changes in top manage ment. 2) There was a clear-cut beneficial effect of cloza pine, and to a lesser extent of risperidone in schizophrenia, allowing more community placement. 3) With a dedicated professional staff quality of care can pre vail despite increasing variation in LOS (systemic prob lems). 4) The number of hospital employees per Q unit halved when the overall hospital Q ranged from low to high values as a result of policy and staffing improve ments, suggesting an increased efficiency of operation. 5) Q can be an objective outcome measure of quality care from the patients' perspective. [ABSTRACT FROM PUBLISHER]