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Mon, 16 Jul 2012
Set from a beautiful open air party in the hills near Zagreb with some proper floor gems. :)
Mon, 16 Jan 2012
An Nordic/Balearic/Pacific winter expression, from the Fjords of Norway to the Bays of California...
Special thanks to The Beat Broker, Skatebård, Deadstock 33's, Stupid Human and Dany Dorado for Promo tracks... Love Ya..! ;)
Sun, 24 Jul 2011
Warm weather selection for summer chilling & dancing...
Mon, 18 Apr 2011
Modern older/newer selection for the legendary Croatian electronic music site...
Mon, 10 Jan 2011
Wed, 20 Oct 2010
Tue, 19 Oct 2010
Sun, 17 Oct 2010

subset: commoncrawl


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Having an unwholesome mind is not a criminal offence. Nor should it be.
Pressed under cross-examination to explain the sexual content of his work, Couture said "The goal was not to arouse people. It was simply to create horror"
Remy Couture said the horror website he ran, which brought to life a psychopathic killer character he created, is artistic and not pornographic
Our right to watch shows like South Park and Dexter very much depends on Remy Couture's right to produce gory horror films.
The fictional violence inflicted by the artist's "psychopath" – the torture and sexual abuse of naked women – appears so brutal, the Crown is arguing the material is illegal
Remy Couture is charged with corrupting morals through the distribution, possession and production of obscene materials in a case that explores the boundaries of artistic expression
The photos of mutilated bodies Rémy Couture posted online were so realistic an Austrian pathologist who examined them concluded they might be real
A jury trial is under way for a Quebec special-effects artist who faces criminal charges because he produces gory horror films.


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Hey whatsup people, my name is Justin and i really love WRX's. I have a important question. My senior year is approaching and my parents are getting the idea of getting a new car for me. I would like to get a rough idea of how much insurance will be for a 17 year old driver of a 02-03 wrx, i havent been in any wrecks or recieved any tickets. I know there are many other factors to include but based on a clean record, how much would insurance be. My good friend owns a wrx and he says it is considered a sedan so insurance isnt as high. Is he correct.
any help is appreciated!


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|3,900 sq. ft.
|Property type
|Minimum Stay
|7 nights
Vacation at this Westport Island Waterfront Captain's Cottage with spectacular views! Enjoy working lobster boats, colorful sailboats, beautiful sunrises, low-flying osprey, and a deep-water dock that gives access to some of the world's finest Striped Bass fishing around! Enjoy coffee on the open deck in an Adirondack chair and watch the fishermen haul in their catch. Order freshly caught lobsters! Wind down your day with drinks and dinner on the huge screen porch overlooking the water or head downstairs for a game of pool on the slate Olhausen pool table. The kids will enjoy roaming the property's acreage with plenty of woods for exploring. Kayaks can also be rented and kept at the dock for tranquil early morning bird watching or trips to see the seals basking on the rocks just a few hundred yards away. Surrounded by woods and water, framed by roses and perennial gardens, complete privacy is yours at the Captain's Cottage.
Now accepting reservations for the 2017 season! Book early to reserve your summer vacation time at the Captain's Cottage. Call or email me anytime with additional questions concerning the cottage or surrounding area. Additionally, call me to request a discount for multiple weeks or for weeks during the off-season.
Full amenities in a 3-story waterfront cottage. This waterfront 3-story cottage boasts 5 bedrooms, 3 full baths, and a sunny kitchen and family room adjoining the 30x10 foot screened-in porch. In addition, there is a dining room with seating for 8, a living room, sun-room, two decks overlooking the water and a 36x24 ft. fully furnished game room. The decor is pure Maine with exposed beams and a hand-hewn wrought iron staircase. It is exceptionally appointed in antiques, Bar Harbor wicker, four-poster and iron beds and antique oil lamps. The library is fully stocked and there are hundreds of children and young-adult books, too.
When you vacation at the Captain's Cottage you enter into the real deal - a storied Maine cottage owned by the captain and master of the famous fishing vessel Hannah Boden which survived The Perfect Storm during the Halloween gale of 1991.
The Captains Cottage
Our extended family, ranging from age 6 to 72, has found the Captains Cottage to be the perfect Maine getaway. It is a large beautifully appointed cottage and yet casual enough to completely relax. We love the front lawn for games, the lightly screened deck, and the open deck. Both decks have a classic Maine water view. There is room to read by yourself, play pool or cards downstairs or just sit on a couch and look at the view. We love to cook and the well equipped kitchen with an island is always busy. Last, but not least, the dining room has a long table that will hold everyone for meals, including lobster that can be delivered to the dock on the water.
We have just spent a wonderful week at Captain's Cottage celebrating our 5oth Anniversary with our family, which included 6 adults and 4 grandchildren ages 7-16.The house is warm and inviting with lots of interesting art and antiques to look at.Eveyone from age 7 to 73 found a book to read from your extensive collection.The downstairs game room was a perfect diversion for teenagers during the adult cocktail hour. The eating facilities were very good with room on the kitchen island to do a buffet for a casual meal.The 3 mile and 4 mile connecting running /bike routes from the house was great for our exercise enthusiasts.Although the water was too cold for swimming, the dock was a great place to relax and try our luck at fishing. Dusk kayak trips were beautiful and we saw quite a few seals. We practically lived on the screened deck enjoying the view at all hours. Marianne was helpful with information and so pleasant. It was a wonderful vacation and the cottage was absolutely perfect. I would enthusiastically recommend Captain's Cottage to anyone.
We had a wonderful family vacation. There were 15 of us ranging in age from 5 to 69. We even had 6 additional friends come for a day with their 4 children, and though there was a rainstorm, the house easily accommodated 10 children and 16 adults for two meals.
Everyone mentions the screened porch and that is because it is wonderful. It has an excellent view and we all spent as much time as possible there. In the morning, the sun streams in and warms it so that you can use it earlier than you might otherwise if it is chilly. In the afternoon, it is shaded and cool. If you want afternoon sun, you can be on the deck at the other end of the house.
The house has wonderful common areas that work well with a big group. You can find a corner to read or work undisturbed, or talk easily in groups with plenty of space. The children spent a lot of time in the well-equipped game room in the basement. The kitchen had everything we needed in abundance. There were plenty of towels and sheets, and the cleaners came in and did a great job at the height of our stay. The bedrooms are somewhat awkward, depending on the needs of your guests. If all the couples we expected had shown up, we would have had to have them share space with others. As it was, because we are all extended family, it worked out well, and everyone said they wouldn't mind if they had to sleep on air mattresses in with others if they had to, especially since the common areas are so wonderful and you only need the bedrooms for sleep. The property can handle 4 couples and a few children without any awkwardness.
The dock is down more than 75 stairs, so trekking down and back up with kayaks is not easy, but not impossible. There is a small dingy and garden chairs that live at the dock, and the area is very good for canoeing and kayaking. We also bicycled and ran.
The lobster co-op is a wonderful resource, and we even watched a lobster molt! Other day trips that have become a tradition for us included the Cabbage Island Clambakes out of Boothbay Harbor, a day at Ried State Park with a wonderful meal at Five Islands Lobster Co. and a day at the Coastal Maine Botanical Gardens. The pond on the property is lovely - full of butterflies, and dragonflies, etc. The decor is fun and lovely. And the book collection is really special. Oh, and there is a grand piano with a bench full of music!
New to Maine, our New York family of 13 chose Westport Island and the wonderful Captian's Cottage based on numerous recommendations from veteran Maine vacationers we knew, and the kind and incredibly helpful email correspondence from the home's owner, Marianne. With ages in our group ranging from 80 years old to 8, we enthusiastically arrived at the Captian's Cottage, ready to experience everything Maine was known for. Marianne's beautiful home, filled with comfy, New England antiques, didn't disappoint. With room for us all to spread out, we explored the 3 levels of the cottage, chose our favorite beds, (Every room complete with clean bedding, towels and old Maine charm) and gazed out from the expansive, screened in porch in awe- peaceful, waterfront scenery, complete with a lobster boat or two, as far as the eye can see.
Situated on 6 sunny acres, we had all of the privacy a crowd like us could ask for. We did, however, take advantage of Marianne's recommendation and had a
local Maine chef come to the cottage and cook us all an authentic Maine dinner, not only once, but twice during our week stay! Even the younger children in our group enjoyed tasting all of chef Kathie's wonderful appetizers and dishes- she was just a pleasure as we all gathered in the kitchen asking "touristy" questions and watching her whip up her specialties. Her meals were just out of this world. Marianne's lobster fisherman recommendation, Mike, was another special event at the cottage. He delivered 30 lobsters (Caught not far from our waterfront) to our door one evening and even helped us prepare them! He was just great and our lobster fest will be one of our favorite memories of Maine.
Although we loved relaxing at the cottage, kayaking off our very own boat dock, we did often venture out to explore. Not far from the cottage (15 minute drive or so) was a nice big supermarket (Shaws) to help stock up our kitchen. A little further down was the quaint town of Wiscasset- great for antiquing or an afternoon lobster roll. A little further on, and you'll find Boothbay Harbor- a fun and busy harbor town great for fishing trips, various boat rides- including one to nearby Cabbage Island for a humongous clambake- shops, homemade ice cream and restaurants for all. The very best part for us, though, was coming back to the Captain's Cottage, where in such a short time, it felt like our second home. A big thanks to Marianne for sharing this very special place- Recommended for all!
We can't say enough about how wonderful our week at the Captain's Cottage was! Marianne is a most gracious hostess - she has thought of everything and she was just a phone call away if we needed anything! We had four generations ranging in age from 9 to 78 and everyone enjoyed. My Mother enjoyed reading in the sunroom, the youngsters loved feeding the horses and playing in the treehouse. Everyone else enjoyed the wonderful walkout basement with lots of windows and lots of entertainment - pool, ping pong, poker table, and tons of games. The number of books is amazing and we all found just what we wanted. I was worried at first because there are so many beautiful antiques and decorations around the house and I was worried about something being destroyed. But, not to worry, the house is just so homey and friendly and the kids were fascinated with everything, but didn't destroy anything!! We all spent the majority of time on the huge screened porch where we rocked while watching the lobster boats and where we ate all of our meals. The BEST part of the trip was the lobsters that were delivered right to the dock! We had so much fun cooking what turned out to be the best lobster any of us had ever tasted! It is a steep, long walk down to the dock so my Mother didn't attempt that. Also, it was nice that there was a bedroom on the first floor, so Mom was very content there. We had fun exploring the house because it just seems to keep going on and on from one room to another - in fact there were times I would forget how to get somewhere! The kids enjoyed figuring out which bed they wanted to sleep in each night! It was so private and so quiet and just what we wanted to get away from it all. Thanks so very much, Marianne, for making us so comfortable and for sharing your beautiful home with us!
We are a small group of friends who have been renting vacation houses for an annual summer and winter get away for over 30 years so I feel our opinion is based on some real life experiences. Many of the homes we have rented talk about the decor, "fine antiques" or, "deep, rich upholstery" and to be honest with you that's never mattered much to us but at the Captain's Cottage there was little mention of interior furnishings and there should have been! While the main seating areas, living room, dining room and porch, (There will be MUCH more on the porch later!) were exceedingly comfortable all throughout the house were interesting wall hangings, pieces of furniture, (A clockmakers tool chest?), photographs and various other small details that were both fun and interesting to look at while not making you want to tie the kids hands so they wouldn't break anything.
Now to the important stuff, the aforementioned porch! We spent almost all the time we were at the house on the screened porch or the open deck on the end of the house or the dock on the water, each one a slice of paradise. The screened porch was perfect for the end of the day into the evening for conversation, dining or having a cocktail. The open deck was great during the day for hanging around, playing games or having a cocktail while the dock was where all our sun worshippers congregated, also where we launched our kayaks from and where we had sunset cocktails, (You may sense a pattern here!).
One other part of the house that deserves mention is the game room, we were lucky enough to have seven days of sunshine so while it didn't get much use by us, if anyone had rainy days in Maine this room could fill many many hours with good fun. We used it mainly at night to unwind and test our pool or table tenns skills while having a cocktail. (Oops, there's that cocktail word again!)
In summation, the house is spacious enough for everyone to not bump into one another with large enough areas for everyone to gather, the bedrooms are all very comfortable and there are plenty of bathrooms. The kitchen was large enough to feed 12 hungry adults easily with everything you could possibly need and the area the house is in is very conducive to walks and cycling which we did a lot of. Lastly, and most importantly, the home owner is gracious, friendly, helpful and DELIVERS LOBSTER RIGHT TO YOUR DOCK!! It just doesn't get any better than a week in Maine at the Captain's Cottage.
It is an amazing house. Lobsters are delivered to the dock. The kayaking is outstanding and you share the river with the seals. This was a wonderful base for our summer vacation. The owner is great and provides wonderful advice. The house was very kid friendly. We loved the decks. The room were well decorated and very tidy. We would highly recommend this location to anyone.
The location is very near a number of sites to visit.
New for kids of all ages! Monkey C Monkey Do: Family Adventure Park with zip lines, swings, and an ice skating rink! Plus, Boothbay Harbor lies 20 minutes away via boat. Wiscasset, with its antique shops, wonderful restaurants, and gourmet wine, cheese and bread shop is 15 minutes away via boat or automobile. Reid State Park, Damariscotta Lake, Thomaston Point Beach, Freeport's L.L. Bean and the Maine State Theatre at Bowdoin College are all less than a half-hour to an hour's driving distance away. Enjoy the numerous festivals mid-coast Maine has to offer including the Lobster Festival, the Hot Air Balloon Festival, the Folk Music Festival, the Jazz Festival, the Fishermans Festival and the Arts Festival. Fun family entertainment at its best! In addition, attend one of the many weekly antique auctions held locally at Foster's or the Thomaston House Gallery and take home a real Maine treasure. Oriental rugs, oil lamps, pine cupboards, and estate jewelry can all be picked up at a fraction of the price charged in stores. Bring your fishing gear for some great striped bass, mackerel and cod fishing.
|Rate Period
|Weekend Night
Jun 3 2017 - Sep 9 2017
7 night minimum stay
|Pet Fee
|Refundable damage deposit
|Tax Rate
$3950 from June through Labor Day weekend
$2950 May and after Labor Day weekend until mid October
No winter rentals available


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Shrimp scampi is easy and elegant and just perfect for entertaining. Made of shrimp sautéed in butter and olive oil, garlic, and gently tossed with red onion and parsley, it is a classic.
Shrimp scampi makes a quick and delicious meal that is ready in less than 15 minutes!
It is perfect for super easy entertaining, too. In just a few minutes you've got a beautiful plate of shrimp scampi that you can serve as an appetizer or even over a plate of pasta as the main course. I call that versatile!
Of course, you can always add a pinch of red pepper flakes to your shrimp scampi, if you choose.
And wonderful for those evenings when I want a quick, yet delicious supper without a whole lot of fuss, I know this is a recipe that I can turn to time and again.
It just never gets old.
Here's my favorite shrimp scampi recipe. I think you should make it soon!
- 1 pound shrimp, peeled and deveined
- 3 tablespoons butter
- 3 tablespoons olive oil
- 3 cloves garlic, minced
- 4 tablespoons chopped red onion
- ¼ cup chicken stock or white wine
- juice of ½ lemon
- ½ teaspoon salt
- 4 tablespoons chopped fresh parsley
- Rinse shrimp and set aside to drain. Melt butter in a large skillet with olive oil over medium heat. Saute garlic and red onion. Add in shrimp and cook for about 2-3 minutes until the shrimp turns pink. Remove the shrimp and pour in chicken stock and lemon juice. Increase heat to medium-high heat until the stock comes to a boil. Remove from heat and stir in shrimp, salt and fresh parsley. Lightly toss shrimp to make sure it is well coated.
- Serve immediately.
Robyn xo


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Teachers guide and lesson plans for for grades K-3, 4-5 and 8-12 based on work in the exhibition An Invitation To An Infiltration.
Are you a teacher looking to further educate your class about one of our exhibitions? Or, maybe you are planning a field trip and would like some further guidance.
Teachers' Guides support educators who wish to visit the CAG with their students or who wish to carry out lessons related to CAG exhibitions in their classrooms. They include artist biographies, thematic exhibition overviews, suggested points of discussion, as well as recommended readings and references.
Lesson Plans are designed to bring the resources of contemporary art and artists to diverse classrooms. It is our goal to introduce students of all ages to the richness that engaging with contemporary art brings. Such breadth and diversity show that it can be used as a meaningful springboard in teaching a variety of subjects. Please feel free to adapt lessons to suit the specific needs of your class and curriculum.
An ideal context for an examination of the competitive nature of group exhibitions was during the 2010 Winter Olympic Games. In order to take stock of the current state of artistic interventions in the physical space or institutional workings of a gallery, guest curator Eric Fredericksen brought together an international roster of artists for An Invitation to An Infiltration.
On Saturday we launched our latest publication An Invitation to An Infiltration. Contributing artists Holly Ward and Jonathan Middleton came out for the event and Jonathan was signing fictional dedications in the catalogues. The guests eagerly passed around the books to read his interventions.MORE
This publication was produced from the exhibition An Invitation to An Infiltration, held at the Contemporary Art Gallery as part of the Cultural Olympiad Vancouver 2010, January 21 - February 28, 2010. The publication was assembled by Dexter Sinister. Contributions are included by Fia Backstrom, Lucy Clout, Hadley+Maxwell, Jonathan Middleton, Dexter Sinister, Holly Ward and Jordan Wolfson. The exhibition was curated by Eric Fredericksen. The publication includes the essay: Contemporary Art Versus Its Envelope by Thomas Crow.
The publication was edited by Jenifer Papararo, proofread by Snowden Snowden, variously designed by the exhibition's participants, assembled by Dexter Sinister, and coordinated by them together with Jeff Khonsary who printed the monochrome pages on Pacon Sulphite Paper using a RISO 3750 stencil printer at the Fillip offices in Vancouver, and who outsourced the lithographic colour pages to B & L Printworks, then collated and bound the lot in-house with Erin Marranca.
The covers are cut from strips of the screen printed wallpaper Bronzé by Dexter Sinister (2010) displayed in the gallery windows during the exhibition An Invitation to An Infiltration. The pattern of linked rings extends the extant range of heraldic cross-hatching, a medieval system for representing colour in black and white.
The half-title page is cut from one of three different colour variations of the poster produced for, and exhibited within, the exhibition by Jonathan Middleton as part of the work, Strange, the first time I've known of a Piano with Four legs. (Hey! I keep fallin' Down). The publication also includes an audio CD of the work GAME-SET-MATCH by Fia Backstrom. Photography by Aquiles Ascencion and Scott Massey.
The exhibition was co-presented by Contemporary Art Gallery and VANOC and was sponsored by the British Columbia Arts Council under the Unique Opportunities program.


text:
Team preview: Pennsylvania
Blue Ribbon Illustrated previews the 2004-05 college basketball season, exclusively on Insider.
In mid-August, for more than a week, Penn players, administration and fans alike held their collective breath as La Salle courted longtime Quakers coach Fran Dunphy.
On Aug. 18, Dunphy made his decision, announcing that he would decline the offer from his alma mater and return for a 16th season at Penn.
"It was a very difficult choice for me, especially because La Salle, my alma mater, was calling on you," Dunphy said. "It was a tough decision that took a long time to make and I told La Salle that I would still like to help them any way I can.
"I was going to turn my back on one of my schools either way."
With the ordeal behind him, Dunphy is again solely focused on winning his ninth Ivy League title at Penn. The task will not be easy, as the Quakers return just two of their top five scorers from a season ago, when they finished 10-4 in the Ivy League and won 17 games overall. Not a bad campaign, especially considering most thought of 2003-04 as a rebuilding year, but for Penn, anything short of a league crown falls short of its own expectations.
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- Look at the teams. This Final Four just feels big.
First look »
- Coaches: Badgers have great shot vs. UK
- Coaches: Duke will end Michigan State run
- Goodman: Grading every D-I coaching hire
- Recruiting: Eliminated teams' chances in '16
- Transfer List: Top 10 transfers, complete list


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Turkey, in many respects, is a model for Middle Eastern Muslim nations because it allows free reign to secular minded people as well as ensuring the nation retains its Islamic foundation. But, for some strange reason, its leaders fear "words" more than they fear "actions." Nagehan Alci is a young Turkish journalist who writes a column for a major newspaper and frequently appears on television. Last week she made a comment that has aroused fury among millions of her countrymen. She made note that Turkey's founder, Ataturk ruled in a dictatorial manner. From 192 until his death in 1938 he initiated a one party system and banned all opposition parties.
The above is a statement of fact, not opinion. My statement in no way offers an interpretation of his effectiveness as leader of Turkey. It simply states, as did Ms.Alci, that Ataturk was an authoritarian ruler. There are cries Ms.Alci is guilty of blasphemy because she described reality. One wonders as to why in so many Islamic states there are blasphemy laws which prevent expressions that run counter to majority views.
If the Muslim religion is really the correct way to live one's life, then it should bve able to handle words of difference.


text:
Megaman ZX (GN 1 of 2)
Title: Megaman ZX
Volume: GN 1 / 2
Pages: 192
Distributor: Udon Entertainment
Release date: 2010-05-31
Suggested retail price: $12.95
Age rating: ALL
Enter an exciting new future with Mega Man ZX! Hundreds of years in the future, humans are able to merge with living 'biometals', transforming into Mega Men! But are even the combined powers of the Model Z and Model X biometals enough to take down the sinister Slither corporation? It's been years since the wars between humans and Reploids. They now coexist peacefully, with humans using new Biometal technology to give them Reploid-like powers and Reploids giving up their immortality. When a mysterious group attacks a team of couriers delivering Model X and Model Z Biometals, they respond by fusing themselves with the Biometals, creating Model ZX! With powerful abilities at their disposal, they must discover who their enemies are and what they are after.
Story and art by Shin Ogino.
(added on 2010-06-18, modified on 2011-12-16)
- Encyclopedia information about Megaman ZX (manga)


text: The Gates Millennium Scholarship Program (GMS) is a nationally recognized scholarship funded by a grant from the Bill & Melinda Gates Foundation and administered by the United Negro College Fund. The University of Miami has one of the largest contingents of Gates Millennium Scholarship recipients in Florida. The goal of GMS is to promote academic excellence and provide an opportunity for outstanding African American, American Indian/Alaska Native, Asian and Pacific Islander American, or Hispanic American students with significant financial need to reach their highest potential by reducing financial barriers and providing scholars with seamless support from undergraduate through doctoral programs.


text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 1, 2009
|Filing date
|Jul 8, 2008
|Priority date
|Mar 10, 1999
|Fee status
|Also published as
|Publication number
|Anthony J. Schaeffer, Ophir Frieder
|Original Assignee
|Illinois Institute Of Technology, Northwestern University
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (20), Referenced by (21), Classifications (16), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a Continuation of U.S. patent application Ser. No. 09/972,762, filed on 5 Oct. 2001 now U.S. Pat. No. 7,418,399, which is a Continuation-In-Part of U.S. patent application Ser. No. 09/266,131, filed Mar. 10, 1999 now abandoned. The co-pending parent application is hereby incorporated by reference herein in its entirety and is made a part hereof, including but not limited to those portions which specifically appear hereinafter.
The present invention relates to the management of diagnosis and treatment of infections prior to or in the absence of culturing the pathogen prior to commencing treatment.
Epidemiology is the branch of medicine that deals with the study of the causes, incidence, distribution, and control of disease in populations or the sum of factors controlling the presence or absence of a disease or pathogen. "Epidemiology" and forms thereof will be used herein in the broadest sense of all pathogenic, personal, and demographic factors that may be tracked according to the dictates of the present invention.
Symptomatic urinary tract infections (UTIs) are among the most common bacterial infections accounting for more than 7 million outpatient visits to physicians' offices and well over one million hospital admissions in the United States annually. In ambulatory patients alone, the national health care cost of uncomplicated lower UTIs is estimated to approach $1 billion. At a time when controlling spiraling health care costs is a national priority, improvements in the management of UTI is imperative.
Currently, when a patient pays an office visit to the doctor complaining of the symptoms of UTI, a presumptive diagnosis is made by examining the urine microscopically for microorganisms or by performing an indirect dipstick test that measures a microbial metabolite. Although these tests may reveal the presence of a microbial infection, they do not identify the type of bacterium present or indicate the drug sensitivity of the bacterium. Moreover, a urine culture is not typically performed if the patient appears to have an uncomplicated UTI; rather, a short course of empirical antimicrobial therapy is given. No follow-up visit or bacterial culture after therapy is necessary unless symptoms persist or recur. If any clinical features or other factors suggest a complicated infection, a bacterial culture is indicated and should be performed before therapy is started. Mitigating factors that would necessitate a culture include diabetes, symptoms for greater than seven days, recent UTI or antimicrobial use, use of a diaphragm, age less than thirteen or greater than sixty-five, and pregnancy.
In principle, the most appropriate antimicrobial to treat an infection could be determined by a clinical microbiology laboratory. That is, the infectious microorganism may be cultured, identified, and tested for drug sensitivity. In practice, this is rarely done because of the expense and because the demand for relief from the symptoms of UTI is too urgent to wait for results of such prolonged testing. As a result of the urgency for prompt treatment, antibiotics are generally prescribed empirically and with variable success.
This empirical method of treating patients without cultures or documentation has significant potential for complications and needless treatment of patients who do not have infections. Approximately ninety-five percent of patients with UTI have no serious risk of complications and empirical treatment is sufficient; however, about five percent have significant risk for complications which can be costly to treat and which can even be life threatening. For instance, if a patient is treated with empirically prescribed antimicrobials for a presumptive infection when in fact she has another more serious condition such as bladder cancer (which often has the same symptoms as UTI), obvious adverse results can ensue from a delay in diagnosis. However, the alternative of requiring repeated physician visits and cultures of all women who present with the symptoms of UTI is clearly inconvenient to the patient and physician and is unnecessarily expensive in the majority of cases. Therefore, there is an acute need for a method of treating routine UTI in an appropriate patient population that conserves health care resources while providing proper treatment to patients with more complicated conditions.
The diagnosis of UTI is complicated by the fact that there is a 48 to 72 hour lead time to obtain information from a urine culture on the type of pathogen and its antimicrobial susceptibility profile. The uncertainty about the proper course of treatment during this period can be reduced if comprehensive up-to-date data are available for the type of patient, regional location of the patient, and the timing of the infection.
Another aspect of increasing concern in UTI management is the growing microbial resistance to existing antibiotics. While there are other infectious diseases such as tuberculosis for which resistance is a serious problem, UTI is unique because of the large number of individuals affected and the difficulty of tracking resistance since cultures are generally not performed under the current treatment scheme. Since patients are generally treated on an outpatient basis, non-responsiveness to drug therapy could be due to drug resistance or to other factors such as non-compliance or misdiagnosis. Furthermore, drug resistant microbial strains can arise and spread very rapidly, but they are often localized within narrow geographical areas of socio-economic groups. Thus, even if there were more historical information available it may have little relevance to the current context due to rapid changes in drug resistance. Thus, drug resistance in any disease must be taken very seriously, but it cannot be monitored without a mechanism of collecting information, e.g., urine cultures.
UTIs are complicated diseases to diagnose and treat because the pathogens involved in causing similar symptoms may vary widely based on region, type of patient, and time. Put another way, UTIs are a heterogeneous disease. The heterogeneous nature arises from two main characteristics of UTIs: 1) there is an inherently variable nature of the pathogen, and 2) different patients may respond differently to the same pathogen and to the same therapeutic regimen. Resistance of the various UTI pathogens to antimicrobials may change due to any of the above, or other, specific factors. Therefore, there is an often unpredictable response of the pathogen to therapy. This is unlike a disease such as hypertension where cause and treatment are relatively predictable and static over time and geography. In the treatment of UTIs neither the cause nor the treatment is predictable unless a great deal of individual data are gathered and great deal is known about the most current state of UTI epidemiology in a particular locality. Current diagnostic practice, record keeping, and reporting of UTI epidemiology are limited relative to the scope of the changing nature of the disease. Further, only fragmented and dated information is gathered, and these data are not linked to relevant clinical data such as the type of patient, infection, or outcome of therapy. Thus, there is no current, comprehensive database, or records, system that would be considered adequate for providing predictable and efficacious treatment.
Additionally, there are other prevalent infections in humans that consume vast amounts of our health care resources besides UTIs. Similarly to UTI, several of these infections are characterized by multiple causative pathogens that cause the same or similar symptoms and the rapid development of drug resistance, which hamper effective diagnosis and antimicrobial therapy. These infections, which include, for example, throat infections and intestinal tract infections, also afflict large numbers of patients and cause large numbers of outpatient and hospital visits each year thereby taking an enormous toll on health care resources. Thus, cost effective and efficacious treatment of infections, including, but not limited to, urinary tract infections, throat infections, and intestinal tract infections, is of paramount importance in this era of spiraling health care costs.
As presented in the above-identified related application, a doctor-directed and controlled, patient processed, "Self-Start" treatment process utilizes a searchable medical record system that is created according to data entered by the patients or diagnostic laboratories or both. Using this medical record system, a medical practitioner is more accurately able to assess the type of bacterium, or pathogen, causing the infection in a previously undiagnosed, i.e., new, patient based on the collected data of previous patients. The practitioner can then further prescribe an empirically effective course of treatment for the infection in the absence of a diagnostic test performed on the new patient.
Specifically, the related application presented methods consist of: collecting information concerning persons previously presenting symptoms; organizing the collected patient information in an electronic medical record system; analyzing the organized information to identify one or more particular pathogens which caused the infection in one or more of the persons from whom the information was collected; for each pathogen identified, identifying personal and/or demographic information common to the persons who developed an infection from the particular pathogen; and identifying one or more antimicrobials which were effective or ineffective in treating the infections developed from the particular pathogen.
The related application also presented methods of establishing a searchable medical record system for assisting a medical practitioner in more accurately predicting a type of pathogen which has caused an infection in a previously undiagnosed human patient and prescribing an effective course of treatment for the infection prior to or in the absence of performing a diagnostic test on a sample from the human patient.
There is a great need in the treatment of UTIs and similar infections to provide timely information on a broad range of specific patient data and treatment efficacy that is readily available to the health care practitioner. Such information must be current and comprehensive to take into account the changing nature of UTI pathogens. Only an integrated system of information gathering, and knowledge retrieval from this information, on the pathogens and their treatment will yield viable results. This integrated system should be done as economically as possible.
While the previously presented systems of the related application, including the searchable medical record system as defined therein, provide a great help to the health care practitioner and to the public health system, all interaction with the data is either data entry initiated by a patient or a laboratory or a query issuance by the physician. Any self-organization or self-discovery processing of the database on its own is presented only as a passing aside. Rather than obtaining all knowledge by direct inquiries from the medical practitioner, it would further be desirable to apply database and knowledge and information discovery techniques to the collected data in an effort to improve public health.
In sum, there is a need for a medical records, or database, system that accurately collects relevant and current clinical data and analyzes the data to predict the causative pathogens and their rapidly changing drug sensitivity for heterogeneous diseases such as UTIs so as to provide effective therapy for infections while minimizing health care costs and the development of drug resistance.
Embodiments of the present invention provide medical records systems including methods and apparatus for more accurately predicting the causative pathogens and the antimicrobial sensitivity thereof for diagnosis and management of infections. More particularly, the present invention may provide components of a medical records system including kits for the collection of epidemiological information from the individuals of a population exhibiting symptoms of a particular class of disease. Preferably, the kit will include information gathering means whereby information may be gathered about the individual, the disease and the treatment at each stage of the medical process from before clinical diagnosis, through diagnosis and treatment, to after-treatment follow ups. The kits, besides providing personal and demographic information gathering tools, may also include diagnostic tests for identifying a pathogen, and treatments for the pathogen. Preferably the kits are constructed and arranged to require minimal input from the health care practitioners when used in conjunction with a medical records database suitably arranged to accept and structure the collected data and derive useful knowledge from the collected data, especially after a sufficiently large sample of patient data is acquired to render the database conclusions valid. Interaction of the database with the health care practitioner's input is, of course, provided for.
In one aspect of the present invention, the kit may include one or more diagnostic tests for indirect testing or direct testing of pathogen presence. In another aspect, a self-administered kit is provided to each patient to obtain at least a portion of the patient information. Further, the kit may include a first diagnostic test for the person to obtain the first sample to identify the pathogen, and a second diagnostic test for the person to obtain the second sample to determine the efficacy of treatment. The kit may further include a prescribed dose of an antimicrobial or other medicine used to treat the suspected or confirmed pathogen.
In yet another aspect, the kit may include a means for gathering the personal, demographic and other epidemiological information of the person having the symptoms, e.g., a form of some type. The form may be selected from the group consisting of a form for the person to provide the epidemiological information before commencing a course of treatment, a form for the person to provide the results of the diagnostic test before or after commencing a course of treatment, and a form for the person to provide the results of the completed course of treatment. The information collected may concern the success of, failure of, or any adverse reaction to, treatments used by the person.
In addition, the kit may include a prescription fulfillment report card to be filled out by a pharmacist or physician dispensing said kit to be returned to an entity collecting the information and instructional material for using the kit.
It will be appreciated that the kit may be provided in many alternative forms and further may be provided to, and designed for, any link in the health care chain from patient to trained health care practitioner to the medical records management entity, in any combination.
Ultimately as the database becomes valid, the invention can provide means of diagnosing and treating an infection in a previously undiagnosed patient without first performing a diagnostic test on a sample from the patient. An exemplary embodiment of the medical records system may comprise:
a) providing a kit to each of a plurality of members of a population presenting symptoms associated with a particular disease, the kit having means for collecting prior epidemiological information of members of the population previously having symptoms similar to those of the patient;
b) entering and storing the collected epidemiological information in an electronic database;
c) creating an automated knowledge discovery system including organizing the prior epidemiological information in the electronic database to make the epidemiological information amenable to data mining;
d) providing a similar kit to the patient for collecting epidemiological information of the patient;
e) entering at least some of the patient information into a query function of said database;
f) data mining the organized epidemiological information to predict a pathogen infecting the patient based on similarities of the patient information with the organized epidemiological information; and
g) prescribing a course of treatment to the patient based on the prediction of the data mining;
h) whereby the patient with symptoms of an infection may be diagnosed or treated or both before testing for the presence of specific pathogens which may be infecting the patient.
Thus, the present invention includes means for establishing a searchable medical record system for assisting a medical practitioner in more accurately predicting the type of pathogen, which has caused an infection in a previously undiagnosed human patient, and in more accurately prescribing an effective course of treatment prior to performing a diagnostic test on a sample from the patient.
The present invention further includes various techniques for constructing and utilizing a database for the searchable medical record system. Once the collected data are stored in a searchable medical record system, the present invention provides for knowledge discovery operations to continuously execute on those data. These knowledge discovery operations derive suggestions, e.g., treatment patterns or guidance procedures, that can be presented to the physician. These suggestions are self generated within the database operations and provide knowledge to the physician through learning based on the data stored and past decisions made. Eventually, the doctor may examine the knowledge provided by the systems of the present invention and will then be able to comment on the degree of validity or value of the given suggestions, and then further return doctor comments back to the knowledge discovery system.
The knowledge discovery system, may, in turn process the newly obtained guidance, e.g., doctor comments, and store this information in the database. Based on this information, various manipulation routines can execute and potentially new therapeutic guidelines can be derived. Whenever new suggestions are derived by the knowledge discovery system, the suggestions are either saved for later processing or are directly forwarded to the physician. The present invention enhances the functionality of the originally described diagnostic system by providing additional functionality that derives timely, up-to-date, treatment guidance for the physician in addition to the previously disclosed query processing capability.
The knowledge discovery system of the present invention can utilize various data mining techniques to further enhance the efficacy of the previously disclosed diagnostic system. There are many data mining approaches, and new approaches are being continually developed, which may be known to the person having ordinary skill in the art of information technologies. Thus, the systems and methods described herein are intended simply to serve as representative algorithms and the present invention is not intended to be limited to the examples set forth herein. The present invention teaches the use of data mining approaches to better predict the pathogen encountered and to provide better medical practitioner guidance with respect to the undiagnosed patient. This is particularly crucial within this application since susceptibilities and tolerance to pathogen mutations and their treatment rapidly change.
The discovery of knowledge from the data can follow a process comprising iterative refinement of the following steps: data cleaning with the potential integration of data from several sources, data transformation to a common format, data mining, and pattern evaluation and knowledge representation.
Generally, "data cleaning" involves the review of the data set, potentially removing or correcting erroneous data; "data transformation" involves the transformation of the data to a common format that supports data mining; and "data mining" detects patterns found in the data, derives knowledge from the patterns, and represents the knowledge to the appropriate persons. Validation and evaluation of the detected patterns and the representation of knowledge are the last of the iterative steps in the knowledge discovery process.
By practice of the techniques according to the present invention, data may be made available to the health practitioners in preanalyzed formats and suggested courses of practice without, or in addition to, the previously taught system of data extraction by direct query from the health practitioner. Knowledge discovery processing, including the above data mining techniques, as set forth herein can be applied to continuously changing data. Data changes may arise from such causes as additional patient data entered in to the system or the discovery of new bacterial resistance. Best practice guidelines for the physician can be derived according to the techniques herein. Potential epidemic threat detection and warning can be accomplished by the present invention through data related to group diagnostic patterns and derived information potentially based on geographic regions, age, weight, profession, etc. Predictive treatment outcome generation via a "virtual patient" can be supported to develop answers to hypothetical scenarios by automatically mining the data to derive potential treatment patterns. Experimentation on a virtual patient or class of groups of patients is supported. Further, given the cleansing process involved in knowledge discovery, error detection, with potential for suggestive correction, is supported.
For the purpose of illustrating the invention, there are shown in the drawings embodiment(s) that are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown. In the drawings:
The present invention provides medical records systems including means and methods for obtaining and comparing epidemiological, e.g., demographic, personal, and medical data concerning persons previously diagnosed and treated for infections with the same or similar data from a particular, previously undiagnosed, patient presenting with, i.e., having, the same or similar symptoms of infection. The present invention thus allows prediction, or diagnosis, for the particular patient, of the most likely pathogen to the causative agent of the infection and prediction, or prescribing, of an effective treatment for the infection. The diagnosis and prescription may preferably be done for the patient prior to, or in the absence of, obtaining a sample, and analyzing the sample, from the particular patient. For simplicity, the phrase "prior to" will be understood to include "in the absence of" hereinafter unless otherwise indicated.
An exemplary embodiment of the present invention comprises an integrated, multi-component method and system designed to lower the cost of treatment, for example, of bacterial urinary tract infections (UTIs) while simultaneously improving the quality of patient care. It also provides a systematic method for the collection of data that will enable vigilant monitoring of the host and bacterial factors associated with bacterial infections. The components of the medical records system may include (1) a "self-start" kit for home diagnosis, sample gathering mechanisms, and data collection, and (2) a database for storing the collected data and applying data mining tools to the data for automated knowledge discovery.
Although a detailed illustrative embodiment of the present invention is disclosed herein, specific communications systems, information storage formats, health data processing structures, and so on, may be embodied in a wide variety of alternatives, some of which may be quite different from those of the disclosed embodiment. Consequently, the specific structural and functional details disclosed herein are merely representative; yet in that regard, they are deemed to afford the best embodiment for purposes of disclosure and to provide a basis for the claims herein, which define the scope of the present invention.
The exemplary embodiment includes a method of establishing a medical record system providing automated knowledge discovery in predicting a type of bacterium which has caused a bacterial infection in a previously undiagnosed human patient and predicting an effective course of treatment for the bacterial infection prior to performing a diagnostic test on a sample from the human patient.
The method comprises (1) initially collecting epidemiological information concerning persons presenting with symptoms typical of bacterial infections from a variety of sources. The information concerning such persons may include, but is not limited to: sex, age, race, ethnic background, address, weight, height, place of employment, type of work performed, income, median annual family income, social history, along with a multitude of additional information including such parameters as habits, health and conditions of the individuals including medical history and such parameters as blood pressure, urine culture, stool culture, throat culture, history of antimicrobial use, history of any known drug allergies, and a history of past and present infections (i.e., persistent, chronic, recurrent, date of last infection, and the like). For each such past infection, information may be gathered on: the effectiveness of antimicrobials in treating past infections, the type of bacterium causing it, the type, dose and duration of antimicrobial treatment, the outcomes of such antimicrobial treatment, and whether there were any adverse effects to the antimicrobial treatment. The information may also include any known risk factors for various types of bacterial infections such as, for example, whether the person is a diabetic, pregnant, immunosuppressed, catheterized, and the like.
The subject information for such persons may be obtained from several sources, e.g., medical providers' offices, laboratories, hospitals, wellness centers, and the individual patients themselves, via forms filled out and collected in any of a variety of ways or means of communication.
Ultimately the epidemiological information is received by an information collecting, or database, entity where the information may be categorized, stored, processed and conveniently retrieved. However, data storage and processing do not necessarily have to be performed by the same entity but may be accomplished by one or more persons or entities. Further, if there is more than one information storage center, the information center need not be physically located in any one particular geographic location; instead, various information storage centers may be connected to one another such that data may be shared or exchanged by one or more centers such that all or some portion of the information may be accessible for data analysis by one or more centers. However, each information center may also stand alone and may function individually in collecting, organizing, searching and analyzing information.
In addition to collecting the above-stated information, the invention may encompass obtaining a first sample from each person prior to the initiation of treatment for the bacterial infection. "Sample", as used herein, means any fluid or tissue from a patient.
Upon obtaining a sample from each person, a diagnostic test can be performed. "Diagnostic test", as used herein, means any method by which the presence and/or identity of a bacterium is determined in a sample or by which the susceptibility of a bacterium to an antimicrobial is determined. In one embodiment, the diagnostic test is a direct diagnostic test. "Direct diagnostic test", as used herein, means a test performed to directly detect the bacterium in the sample. Alternatively, an indirect diagnostic test may be used to identify the bacterium that caused the bacterial infection. "Indirect diagnostic test," as used herein, means any test that detects the absence or presence of bacterial metabolites or some other substance that provides immediate evidence, without directly detecting the bacterium, that the bacterium may be present in the sample.
However, the invention is not limited to requiring that the sample be obtained prior to initiation of treatment. Instead, the invention should also be construed to encompass situations where the sample is obtained at any time before the symptoms of the bacterial infection are resolved or at any time wherein detectable amounts of bacteria would be present in the sample. Further, the persons may obtain the sample or a medical practitioner or some other person or entity may obtain it.
In one embodiment, the information provided by the individual or by another source such as a pharmacy or the prescribing entity, includes the identity of an antimicrobial taken by the person. The information provided might include the type of antimicrobial taken for a urinary tract infection, and the name of the pharmacy that filled the prescription, the name and address of the prescribing entity, and the amount, dosage, and duration of the antimicrobial treatment.
Further, in another aspect of the present invention, a second sample can be obtained after the course of treatment is completed to determine the effectiveness of the prescribed antimicrobial in treating the bacterial infection. That is, the sample is tested to determine whether any detectable evidence of bacteria that caused the infection is present in the sample. The presence or absence of the bacterium and/or bacterial products following the course of treatment is an indicator that the antimicrobial is or is not effective in treating the bacterial infection. This information is also collected and input into the medical record system of the invention.
If the identity of the antimicrobial is provided, then the person's outcome at the completion of the course of treatment also identifies whether the antimicrobial is effective for treating the identified bacterium. That is, whether the symptoms are resolved by completion of the course of antimicrobial treatment is an indicator as to whether the antimicrobial taken is effective in treating the bacterial infection.
All epidemiological information collected is then organized in a searchable medical record system. The term "searchable medical record system", as used herein, means any data storage system wherein the information concerning individuals previously treated or currently being treated for bacterial infection may be stored; and from which the information may be accessed, processed, analyzed, compared across several parameters, or retrieved so as to allow the information concerning a particular patient to be compared to similar information from other persons; and to identify other persons besides the particular patient having presented with similar symptoms and having demographic and/or other medical and personal data similar to the particular patient. Such systems may be as described in, for example, Goldman and Greenberg (U.S. Pat. No. 5,542,420). In this way, as more fully discussed elsewhere herein, the information stored in the system may be compared so as to produce a profile of the particular patient which may be compared to the profiles of the other persons whose information is stored in the record system to determine those previously diagnosed and treated individuals which are most similar to the particular patient. Such data comparison may be performed as described by Schneiderman (U.S. Pat. No. 5,508,912). The data can be analyzed and reprioritized based on current outcomes to determine which data are more predictive of the causative pathogen and/or effective antimicrobial.
In addition, the information concerning each particular patient is input into the system so as to continually add to the information concerning bacterial infections and the susceptibility of bacteria to antimicrobials; thereby providing an on-going system for predicting causative bacteria and effective antimicrobials in a patient population. One skilled in the art will appreciate that such a database should be self-perpetuating and should take into account any change in the prevalence of a particular bacterium at a particular time, in a particular geographic area, or the like, and would also account for any development of resistance to antimicrobials for each such bacterium as may be seen over time.
"Organizing", as used herein, means that the information in the searchable medical record system is input and processed such that virtually any set, subset, or type of individual patient information may be compared with information from other patients to identify common information amongst the patients and be analyzed to identify one or more individuals who have certain information in common.
The organized information is then analyzed to identify one or more particular bacterium that caused the bacterial infection in one or more persons from whom the information was collected. Thus, the information is analyzed to identify each bacterium that caused an infection in one or more persons previously presenting with symptoms of bacterial infections thereby linking each bacterium with the symptoms and demographic and other information for each person whose information is stored in the record system.
For each bacterium which caused an infection, the information is also analyzed to identify one or more antimicrobials which were effective and/or ineffective in treating the bacterial infection in each person whose infection was caused by the bacterium as identified in the record system. That is, the information is analyzed such that each bacterium is cross-matched with the antimicrobial used to treat it and the information is further analyzed to identify which antimicrobials were effective or ineffective for each bacterium identified in the record system.
It will be appreciated that the accuracy of the prediction will depend on various factors including the number of matching characteristics between the undiagnosed patient and the previous persons, the number of patients whose information is present in the record system, the number of persons in the record system which were afflicted with symptoms similar to those of the undiagnosed patient, the number of persons in the record system whose personal and demographic information match that of the undiagnosed patient, and, of those persons, the number which were infected with any particular bacterium, and the number treated with any particular antimicrobial having a successful or unsuccessful treatment outcome.
The present invention may also include a self-administered kit to be provided to each person whose information is to be input into the medical record system. It is noted, however, that pertinent data might be acquired by means other than the use of the self-administered kit. The kit can be provided to, at least in part, obtain the personal and demographic information for the person. The kit is valuable in efficiently and economically obtaining the patient information needed to establish and maintain the medical records system.
The kit may further include a first diagnostic test for the person to obtain a first sample to identify pathogens, and a second diagnostic test for the person to obtain a second sample to determine the efficacy of a prescribed antimicrobial. The first sample is preferably obtained prior to the commencement of treatment while the second diagnostic test to obtain the second sample is to be performed after completion of the antimicrobial course of treatment. Further, the patient may perform the first diagnostic test or it may be sent to a medical practitioner or other entity for evaluation. The first diagnostic test, which is used to obtain a sample prior to initiating antimicrobial treatment, may be used to identify the bacterium present in the sample. The sample may also be used to perform in vitro testing of the effectiveness of various antimicrobials in treating the bacterial infection to identify one or more antimicrobials likely to be effective in treating the bacterial infection caused by the identified bacterium.
Therefore, a person of ordinary skill in the art would appreciate, based on the disclosure provided herein, that the identity of the bacterium and the identity of an antimicrobial likely to be effective in treating an infection caused thereby may be ascertained by obtaining a single sample from a patient without need of further sampling. As stated previously, the effectiveness of the antimicrobial may be further confirmed based on the patient outcome at the end of the course of treatment.
All of this information may be collected and organized into the medical record system to maintain the currency of the information as new antimicrobials are developed and as bacterial resistance to antimicrobials develops over time. In this way, the record system is updated regularly to aid in the diagnosis and treatment for an undiagnosed patient without first obtaining a sample from the undiagnosed patient and avoiding the costs and inconvenience of an office visit for the patient while providing effective patient care.
In one embodiment, the self-administered kit includes a prescribed dose of an antimicrobial predicted by the database applications to be effective in treating the infection in a previously undiagnosed patient based on the fact that the antimicrobial successfully treated previous persons having similar symptoms and similar personal and demographic information to the undiagnosed patient. However, the present invention should not be construed to require that the antimicrobial be included with the self-administered kit. Rather, the antimicrobial may be prescribed any time before or after the self-administered kit is provided to the previously undiagnosed patient, and may be provided separately from the kit.
The kit may also comprise a form provided to the person for the purpose of documenting his or her personal and demographic information. The information may be provided to the medical practitioner providing the kit. The information may be submitted to an entity collecting information for creating and maintaining a medical record system or an entity associated therewith. The information may be provided either in person or by other means of communication. Alternatively, the information may be provided directly by the patient to the medical record system such as, for example, by direct connection to the database such as through the Internet, facsimile device, telephone, or other device for transmitting data.
The invention may include various means or forms for the person to provide a sample or the results of the diagnostic test prior to commencing a course of treatment; and means or forms for submitting a sample or diagnostic test results after completing a course of treatment. The information requested by the form need not be submitted as a form. Rather, the information concerning personal and demographic data may be provided to a medical practitioner or to an entity collecting such information for a medical record system in person, by telephone, or by any other method of communication now known or to be developed. The information requested by the form regarding personal and demographic information should be provided before an antimicrobial is prescribed to the previously undiagnosed patient. This information is the basis to determine the identity of the most likely bacterium and an appropriate antimicrobial via a comparison of the information to the information of other persons in the record system.
The kit may further comprise a prescription fulfillment card to be returned by the pharmacy dispensing the self-administering kit and instructional material for the use of the kit. The prescription fulfillment card can be returned either to the prescribing entity or to an information-collecting center. In this manner, the patients to whom the kit is prescribed are identified and their names and information are entered into the medical record system. Means, either human or electronic, to authenticate the patient's identity and data might likewise be used. This provides a manner of following up with those persons who have symptoms indicative of a bacterial infection so that they may be contacted and their information can be obtained and entered into the record system. The instructional material describes the use of the kit and its various components.
The automated and enhanced discovery of knowledge for treatment of disease according to the present invention can be accomplished from the gathered data 37 by following a process comprising iterative refinement of one or more of the following steps:
data cleaning with the potential integration of data from several sources; data transformation to a common format; data mining; and pattern evaluation and knowledge representation.
"Data cleaning", within the context of the present invention, generally involves the review of the data set, potentially removing or correcting erroneous data. The correction or removal of erroneous data may follow either predefined rules as can be developed for the specific purposes of a particular medical records application, or may follow some heuristic processing pattern such as known in or adapted from the art. This process, or processes, may involve the integration of data that are obtained from multiple sources. The final goal of the data cleaning process is the availability of a single source of correct data.
"Data transformation" involves the transformation of the data to a common format that supports data mining. Such processing can include the conversion of the data to a common measure of units. For example, all temperature readings should be in Celsius as opposed to some in Fahrenheit and others in Celsius. Other data transformation processing can include generalization, namely, all temperatures (in Celsius) in the range of less than 10 degrees, 10 to 25 degrees, and over 25 degrees are grouped as cold, moderate, and hot, respectively. Such generalization is often necessary for some data mining approaches.
"Data mining" approaches, as further described below, have common features in that they detect patterns found in the data from which knowledge is derived and represented. Basically, a working definition of "data mining" is the extraction of knowledge previously unknown. The validation and evaluation of the detected patterns and the representation of knowledge is the last of the iterative steps in the knowledge discovery process.
Four sample data mining techniques are set forth herein by way of exemplifying means of detecting patterns and deriving knowledge from the stored data. The four techniques are: Discrimination, Association Rules (Analysis), Classification (Decision Trees), and Clustering. The person having ordinary skill in the art will note that there are many other common data mining techniques which are not overviewed herein, but which may be relevant within certain contexts of the present invention, such as those on neural networks and Na�ve-Bayesian approaches.
For example, one criterion for the determination of the degree of complication of a UTI is gender. As shown, the database consists of ten patient entries with five attributes per entry. Clearly, the patient identification attribute (NAME) does not contribute to the resulting type determination (TYPE of UTI). Thus, the discrimination algorithm sifting through the data recorded in the remaining three attributes (GENDER, AGE, and NUMBER of OCCURRENCE) will determine, for example, that all male patients are diagnosed as having a complicated UTI. Thus, if a new male patient is treated, the system will predict that his diagnosis is a complicated UTI and should thus be treated accordingly.
In the second data mining technique, Association Rules based approaches derive conditional probability measures to determine a degree of support, or confidence, for the validity of a conclusion. That is, probabilities are derived to determine the level of support (designated in terms of a ratio) that given a certain condition, a subsequent condition exits. Furthermore, the probability that the first condition ever occurs is likewise determined. This probability is used to predict how prevalent a condition actually is. For example, if all patients are female then the support of male and complicated is less significant than in the current example. Returning to the data in our sample database, the degree of support of: given that the patient is a male, the type of UTI is complicated, is:
Thus, with a probability of 1, if a patient is a male then it is concluded that the type of UTI is complicated. The probability of the patient being male is 3 out of 10 or 30%.
In the fourth data mining technique, Clustering approaches, at times referred to as unsupervised classification, the database entries are partitioned into clusters, or sets, of related elements. Using a similarity measure of the attribute values, related entries are grouped and a central value, often called a centroid, is computed. Each derived cluster represents a possible related scenario, e.g., type of antimicrobial used, related demographic information, gender, age, etc. In the present invention, each cluster might likewise have a potential treatment guidance associated with it. Given the database 35 shown in
Cluster 1:
Centroid Representing:
Not complicated:
Key Attribute Features:
Female, First UTI, Age between 30 and 46
{Sara Klein, Jody Stark, Mary Smith,
Kelly Jones, Tammy Green}
Cluster 2:
Centroid Representing:
Complicated, Male
Key Attribute Features:
{Tom Gross, Fred Schwartz, David Gold}
Cluster 3:
Centroid Representing:
Complicated, Female, Repetitive
Key Attribute Features:
Female, Recurrent UTIs
{Sally Weiss}
Cluster 4:
Centroid Representing:
Complicated, Female, Young
Key Attribute Features:
Female, Age 11
{Susan Brown}
Given a new patient experiencing a UTI, the new patient attributes are evaluated and compared against the key attribute features of the cluster. Those clusters whose key attribute features are similar to the new patient's features are considered related. A diagnosis (as represented above in the first listed centroid for each cluster) corresponding to those clusters is made and the associated potential treatment guidance of the clusters is prescribed.
Obviously, in each of the data mining techniques the identified pathogens and treatments as discussed above will be factored into the comparison and conclusions as a major form of data. Pattern evaluation to determine confidence level in the data and knowledge representation to the health care practitioners can be accomplished via a variety of techniques known in the art.
The system software is designed such that an information collecting staff person or other appropriately trained individual (such as a medical practitioner) can retrieve and sort data by means of a standard search program. Additional levels of complexity can be added to allow the data processing device such as a computer itself to scan the database, analyze data, and generate reports. The reports can be based on pre-defined statistical parameters established by the medical practitioner affiliated with the service center.
In addition to aiding medical practitioners in predicting which bacterium has caused an infection in a patient and which antimicrobials are useful in treating the infection, the present invention offers many advantages to the health care community. For example, prior to launching new drugs on the market, pharmaceutical manufacturers perform extensive clinical testing and collect data on effectiveness of their drugs and on adverse reactions associated with them. Once the drug is launched, relatively little information is accessible. In the case of infectious diseases such as UTI where antibiotic resistance is a documented problem, pharmaceutical companies could greatly benefit from this type of continuous, broad-based collection of information on their products. A narrowly confined outbreak of resistance may indicate a need for closer observation or suggest that a drug is counter-indicated for a segment of the population. Alternatively, a growing resistance may have serious implications for the future of the product and for strategic planning for new products.
A managed care organization may use the database to establish prescription guidelines or to monitor physician performance. Since the database will contain information relating specific drugs to patient outcomes, the managed care organization may determine that most UTIs in most locations are successfully treated with a low cost antibiotic and that more expensive drugs are unnecessary. The managed care organization could then provide guidelines to participating physicians that the lower cost drug should be prescribed unless certain mitigating factors are present.
Additionally, a computer is programmed to analyze the data and to recommend a course of action to the medical practitioner and/or patient. As an example, a woman has recurrent symptoms of UTI but test results repeatedly indicate no evidence of infection. The woman is advised via report generated by the medical record system data processing device that she must see a urologist for evaluation of other causes for the symptoms. A medical practitioner receives a report informing them that the drugs he/she is prescribing for a certain type of infections are no longer effective and that an alternative should be tried. Moreover, a data processing device, based on the information present in the record system, may generate reports for pharmaceutical companies concerning, for example, the utilization patterns and patient outcomes for a specific drug. These reports could be compiled and the information communicated to a subscribing pharmaceutical company on a pre-determined schedule.
By practice of the techniques according to the present invention, data may be made available to the health practitioners in preanalyzed formats and suggested courses of practice without, or in addition to, the previously taught system of data extraction by direct query from the health practitioner. Knowledge discovery processing, including the above data mining techniques, as set forth herein can be applied to continuously changing data. Data changes may arise from such causes as additional patient data entered in to the system or the discovery of new bacterial resistance. Best practice guidelines for the physician can be derived according to the techniques herein. Potential epidemic threat detection and warning can be accomplished by the present invention through data related to group diagnostic patterns and derived information potentially based on geographic regions, age, weight, profession, etc. Predictive treatment outcome generation via a "virtual patient" can be supported to develop answers to hypothetical scenarios by automatically mining the data to derive potential treatment patterns. Experimentation on a virtual patient or class of groups of patients is supported. Further, given the cleansing process involved in knowledge discovery, error detection, with potential for suggestive correction, is supported.
While the invention has been disclosed with reference to specific embodiments, it is apparent that other embodiments and variations of this invention may be devised by others skilled in the art without departing from the spirit and scope of the invention. Thus, the present invention is intended to be limited only by the appended claims.
|Cited Patent
|Filing date
|Publication date
|Sep 18, 1975
|May 17, 1977
|Griffith Donald P
|Method and composition for treating urinary tract infections
|Nov 7, 1986
|Aug 23, 1988
|General Computer Corporation
|System and software for pharmaceutical prescription compliance
|Jun 25, 1990
|Apr 16, 1996
|Barry Schneiderman
|Clinical database of classified out-patients for tracking primary care outcome
|Apr 29, 1994
|Aug 6, 1996
|Goldman; Arnold J.
|Personalized method and system for storage, communication, analysis, and processing of health-related data
|Jan 29, 1996
|Jul 1, 1997
|Methods for identifying human hereditary disease patterns
|Dec 31, 1996
|Jul 21, 1998
|Integration Concepts, Inc.
|System and method for the rationalization of physician data
|Jan 15, 1997
|Jan 19, 1999
|Chiron Corporation
|Method and apparatus for predicting therapeutic outcomes
|Oct 14, 1997
|Jun 8, 1999
|Lucent Technologies Inc.
|Method using central epidemiological database
|Mar 17, 1997
|Aug 17, 1999
|The Board Of Regents Of The University Of Oklahoma
|Digital disease management system
|Aug 22, 1997
|Dec 14, 1999
|Power Med Incorporated
|Method of improving drug treatment
|Feb 9, 1998
|Feb 29, 2000
|International Business Machines Corporation
|Dimension reduction for data mining application
|Jul 24, 1992
|Jun 27, 2000
|Seres Laboratories, Inc.
|Method of treating a viral condition by inhibiting membrane fusion
|Oct 31, 1994
|Jun 5, 2001
|Opt-E-Scrip, Inc.
|Method and kit for treating illnesses
|Jun 3, 1998
|Sep 4, 2001
|The Trustees Of Columbia University In The City Of New York
|System and method for remotely monitoring asthma severity
|Nov 24, 1999
|Nov 26, 2002
|International Business Machines Corporation
|Data mining techniques for enhancing medical evaluation
|Oct 18, 1999
|Mar 25, 2003
|Centro Nacional De Investigaciones
|Equipment, kit and method for microbiological diagnosis
|Jun 8, 2000
|Jun 6, 2006
|Virco Bvba
|Method and system for predicting resistance of a disease to a therapeutic agent using a neural network
|Feb 1, 1999
|May 23, 2002
|Michael Weiss
|Agent-based data mining and warehousing
|May 21, 2001
|Jun 27, 2002
|Institut Pasteur
|Methods for detecting and identifying a gram positive bacteria in a sample
|Jan 4, 2001
|Sep 12, 2002
|Leveque Joseph A.
|Collecting and managing clinical information
|Citing Patent
|Filing date
|Publication date
|Feb 21, 2008
|Apr 20, 2010
|Aureon Laboratories, Inc.
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|Mar 13, 2013
|Dec 9, 2014
|Palantir Technologies, Inc.
|Document-based workflows
|Apr 16, 2014
|Jan 13, 2015
|Palantir Technologies Inc.
|Determining and extracting changed data from a data source
|Jun 13, 2014
|Aug 11, 2015
|Palantir Technologies Inc.
|Aggregating data from a plurality of data sources
|Aug 23, 2012
|Feb 9, 2016
|International Business Machines Corporation
|Evaluating candidate answers to questions in a target knowledge domain
|Jul 17, 2014
|Mar 1, 2016
|Palantir Technologies, Inc.
|Managing disconnected investigations
|Nov 24, 2014
|Mar 15, 2016
|Palantir Technologies Inc.
|Computer-implemented systems and methods for comparing and associating objects
|Dec 23, 2014
|Mar 22, 2016
|Palantir Technologies Inc.
|Determining and extracting changed data from a data source
|Sep 9, 2009
|May 24, 2016
|Palantir Technologies, Inc.
|Sharing objects that rely on local resources with outside servers
|Oct 22, 2012
|May 24, 2016
|Palantir Technologies Inc.
|System and method for batch evaluation programs
|Mar 2, 2012
|Jun 28, 2016
|Palantir Technologies, Inc.
|System and method for accessing data objects via remote references
|Oct 26, 2015
|Jul 12, 2016
|Palantir Technologies Inc.
|Systems and methods for identifying information related to payment card breaches
|Mar 10, 2016
|Sep 20, 2016
|Palantir Technologies Inc.
|Determining and extracting changed data from a data source
|Oct 22, 2012
|Oct 18, 2016
|Palantir Technologies, Inc.
|System and method for stack-based batch evaluation of program instructions
|Dec 15, 2014
|Nov 1, 2016
|Palantir Technologies Inc.
|System and method for associating related records to common entities across multiple lists
|Oct 28, 2014
|Nov 15, 2016
|Palantir Technologies Inc.
|Method and system for generating a parser and parsing complex data
|Aug 29, 2013
|Nov 22, 2016
|Palantir Technologies, Inc.
|Resolving database entity information
|Apr 7, 2016
|Dec 6, 2016
|Palantir Technologies Inc.
|Systems and methods for importing data from electronic data files
|Apr 1, 2016
|Dec 6, 2016
|Palantir Technologies Inc.
|Systems and methods for identifying and categorizing electronic documents through machine learning
|May 23, 2016
|Apr 11, 2017
|Palantir Technologies, Inc.
|System and method for accessing data objects via remote references
|Feb 21, 2008
|Dec 11, 2008
|Aureon Laboratories, Inc.
|Methods and systems for predicting occurrence of an event
|U.S. Classification
|705/2, 705/3, 600/300
|International Classification
|Cooperative Classification
|European Classification


text:
Spin wave confinement
- Responsibility
- edited by Sergej O. Demokritov.
- Language
- English.
- Imprint
- Singapore : Pan Stanford Pub. ; Singapore ; Hackensack, NJ : Distributed by World Scientific Pub. Co., c2009.
- Physical description
- ix, 229 p. : ill. (some col. ) ; 24 cm.
Available online
- marc.crcnetbase.com CRCnetBASE
SAL3 (off-campus storage)
Stacks Request
|Call number
More options
- Contributor
- Demokritov, Sergej O.
- Bibliography
- Includes bibliographical references and index.
- Contents
- Spin Waves in the Inhomogeneous Internal Field of Nanostructured Magnets (D Grundler et al.)-- Non-Uniform Magnetization Dynamics in Ultra-Small Ferromagnetic Planar Elements (V V Kruglyak et al.)-- Mode Structure of Ferromagnetic Squares (M Bailleul & C Back)-- Localized Spin Wave Modes Excited by Spin-Polarized Current (A N Slavin & V S Tiberkevich)-- Brillouin Light Scattering Study of Spin Dynamics in Patterned Nano-Elements: From Single-Layer to Multilayered Structures (G Gubbiotti et al.)-- Spin Wave Quantization, Localization, and Tunnelling in Magnetic Systems (S O Demokritov & V E Demidov).
- (source: Nielsen Book Data)9789814241069 20160528
- Publisher's Summary
- This book presents recent scientific achievements in the investigation of magnetization dynamics in confined magnetic systems. Introduced by Bloch as plane waves of magnetization in unconfined ferromagnets, spin waves currently play an important role for description of very small magnetic systems ranging from microelements, building the basis for magnetic sensors, down to magnetic nano-contacts. Spin wave confinement effect was experimentally discovered in the 1990s in permalloy microstripes. The diversity of systems where this effect is observed has been steadily growing since then, most of which will be addressed in this book.The book includes six chapters which originate from different groups of experimentalists and theoreticians dominating the field since the discovery of the effect. Different chapters of the book reflect different facets of spin wave confinement, providing a comprehensive description of the effect and its place in modern magnetism. It will be of value for scientists and engineers working on magnetic storage elements and magnetic logic, and is also suitable as an advanced textbook for graduate students.
(source: Nielsen Book Data)9789814241069 20160528
- Subject
- Spin waves.
- Electronagnetism.
Bibliographic information
- Publication date
- 2009
- 9814241067 (cloth)
- 9789814241069 (cloth)
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text:
Subasi, Munevver Mine, Subasi, Ersoy, Anthony, Martin and Hammer, Peter L. (2012) A new imputation method for incomplete binary data. In: International Symposium on Artificial Intelligence and Mathematics, 9th-11th January 2012, Fort Lauderdale.
|Item Type:
|Conference or Workshop Item (Paper)
|Official URL:
|Additional Information:
|© 2012 The Authors
|Library of Congress subject classification:
|Q Science > QA Mathematics
|Departments > Mathematics
|Date Deposited:
|11 Jul 2012 10:39
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Insider Blog
Photo: Terra Hall
Mistura 2014: The 7 Strangest Foods at South America's Largest Food Fair
For the last seven years, food lovers have flocked to South America's most grandiose food festival – Mistura – and this year is no different (save for a few details). With the Pacific Ocean on one side and the Costa Verde on the other, Mistura stretches 37 acres in Lima's Magdalena del Mar district. It is there that chefs and restaurants from every corner of Peru cook up their most-loved dishes. For 10 days each September locals and foreigners, travelers and foodies walk through Mistura's gates and into a new world, or as 2014 would have it 12 new 'worlds.'
Photo: Bridget Gleeson
Buenos Aires Food Week is Back
The fourth edition of the quickly growing biannual food event benefits the Buenos Aires food bank – and features fifteen new participating restaurants, Campari aperitifs, and a creative banana split with cognac that everyone's talking about.
More than 40 restaurants are onboard for the current edition of Buenos Aires Food Week, running now through September 14th. The three-course menus run AR$140 for lunch and only AR$220 for dinner, not including tip or drinks – unless, of course, you're counting the complimentary aperitifs offered at many restaurants. Cocktails aside, Food Week is a convenient opportunity to sample the cuisine at some of the city's more prestigious dining venues. I talked to Anne Reynolds, co-founder of the event, about highlights of this year's line-up.
Photo: Eileen Smith
Carlo Cocina: Chilean Food in Small Portions
Traipsing through your local mall does not always yield the best food options, but there's a mall in Santiago that may turn your thinking around. And even more so with the newly-opened Carlo Cocina, a restaurant showcasing the best Chilean food in small portions, so you can custom build your own meal out of what you like best.
Photo: stu_spivack
Top 5 Places: Ceviche in Cartagena
Though ceviche originated (and may have been perfected, depending on who you ask) in Peru, Colombia's Atlantic coast has put its own distinctive spin on it – camarones en salsa rosada, anyone?
Cartagena's diverse and excellent food scene has the challenge of trying to cater to locals and international tourists alike, which has led restaurants to try to outdo each other when it comes to this coastal favorite. Each place – and each resident — has an individual interpretation of what makes a good ceviche, and the possibilities, from Asian fusion to traditional corvina, are almost as colorful as the city's famous architecture. These are some of the best places in the city to go to get a taste of the full spectrum of flavors.
Photo: Mani
Helena Rizzo: World's Best Female Chef
While the S. Pellegrino World's 50 Best Restaurants list continues to climb in status among foodies the world over – some give it more clout than Michelin these days – so does Brazilian cuisine, which in the 2014 awards not only maintained another top 10 placement (D.O.M. in São Paulo at No. 7), but trumped the world over for one of the side awards, the Veuve Cliquot World's Best Female Chef.


text:
Cat adoption saves lives. Adopt a cat and you'll have a friend for life! Contact us, or contact another local humane society, animal shelter or SPCA.
Underdog Cat Rescue was founded in dedication to homeless cats struggling to survive. We help those who are lost, abandoned, or feral to ensure their immediate safety and health, followed by assessment of their rehabilitative needs (if any), and/or socialization. We commit to accommodating these needs in foster until ready for placement into safe and loving homes.
We support humane TNR initiatives (Trap/Neuter/Release) for maintaining cat colony populations; but Underdog Cat Rescue takes it to the next level... Trap/Neuter/REHAB (and adopt). Despite myths about feral cats, they are grateful to be rescued from harsh circumstances and develop strong bonds with loving owners.
Since 2009, Underdog Cat Rescue has developed a protocol for successfully socializing feral cats. It is an individualized process in which we gain trust, establish a bond, build confidence, and develop their personality. Meanwhile, we provide the best in high quality nutrition and veterinary care. The result is a healthy, loving companion that brings joy to the home of some lucky person/family who adopts.
We do NOT take in surrendered pets. We are a foster-based organization whose mission is dedicated to urgent rescue and safety from outside. You may contact us if you know of a cat that is urgent. Our ability to intake is subject to space, which is very limited. We can offer information on helping homeless animals in your community.
Fostering saves lives! If you can foster a cat who is ready and waiting for adoption, please contact us! Each one that is fostered or adopted makes room for another to be saved. Check our 'adoptable' list and support our mission by ADOPTING an ~underdog~ cat! Meow.
Why should you adopt?
Dog adoption and cat adoption saves lives. Adopt a dog or adopt a cat and you'll have a friend for life! What is the difference between adopting a cat or kitten versus getting cats for sale or kittens for sale from a cat breeder? When someone is breeding kittens, they are creating new cats who need homes. Some people are interested in a very specific breed of cat or kitten and they think the only way to find that specific breed is to buy a cat for sale from a kitten breeder. Yet animal shelters are filled with cats who must find homes. So rather than buying a cat or kitten for sale from a cat breeder, we encourage people to adopt a cat or adopt a kitten at their local animal shelter, SPCA, humane society or pet rescue group.


text:
Rose Perla Koran
June 21, 2013
Rose Perla Koran, 90, passed away peacefully June 19, 2013, in Price.
She was born June 30, 1922, in Aspen to John and Amelia Miljavec Perla. She married Joseph Koran on Feb. 14, 1942, in Helper, Utah. He died Nov. 8, 1942.
Rose is survived by her children, Tom (Barbara) Koran, Michael (DD) Koran and Stephen (Frieda) Koran, all of Colorado, Kathryn Koran, of Carbonville, David Koran, of Colorado, and Patricia (Scott) Olsen, of Price; daughter in law Alfreda Koran, of Colorado; 31 grandchildren; and 36 great-grandchildren.
She was preceded in death by her husband, Joe; brothers John, Frank and Joe; sisters Mary, Molly, Annie and Eva; and four grandchildren.
A funeral Mass is at 10 a.m. June 25, 2013, at Notre Dame de Lourdes Catholic Church. A vigil service is at 7 p.m. June 24, 2013, at Notre Dame de Lourdes Catholic Church. Family will receive friends Monday and Tuesday one hour prior to services. Committal will be at Price City Cemetery.
Arrangements are entrusted to Mitchell Funeral Home, of Price. Friends may share memories of Rose online at http://www.mitchellfuneralhome.net.


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