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PubMed2000

Stronger association with HLA-Cw6 than with corneodesmosin (S-gene) polymorphisms in Swedish psoriasis patients.

Psoriasis vulgaris is strongly associated with certain human leukocyte antigens, especially in early onset. The purpose of this study was to study the HLA-Cw6 allele and its contribution to disease susceptibility in a set of 104 families with at least two affected siblings. A sequencing method was utilized to examine the two exons that build up the antigen binding site of the C locus receptor. DNA from patients homozygous for Cw6 based on haplotype information were sequenced. The results confirmed the identity of the Cw6 allele in affected individuals with the consensus sequence for Cw*0602. We screened the set of families for psoriasis patients homozygous for Cw6 and found 11 individuals with a mean age at onset of 16.1 years. The corresponding figure for the Cw6 heterozygotes was 18.45 years and for the Cw6-negatives 22.36 years. This is indicative of a gene dose effect. We performed a transmission disequilibrium test (TDT) on the Cw6 allele per se, used as a biallelic marker. The analysis resulted in a P-value of 5.3 x 10(-17) (t167/nt45). This greatly exceeds our previous results of a TDT in the region, including microsatellite markers and single nucleotide polymorphisms (SNPs) in the coding part of the S gene (corneodesmosin), which is a suggested candidate gene in the region. The maximum nonparametric linkage (NPL) value was also reached using HLA-C as a marker. We conclude that Cw6 is the allele which shows the highest degree of association with psoriasis in our set of families and we propose that it directly influences the age at onset of the disease rather than increasing the genetic load in accordance with a polygenic theory.

Alleles↗
PubMed1996

Informed consent: the nurse's dilemma.

The author builds upon the concept of informed consent whereby the patient agrees to undergo experimental medical procedures. Ideally, the doctor will inform the patient fully on the proposed treatment so as to assure the patient's right to participate intelligently and freely in the decisions regarding his treatment. The nurse is drawn into the doctor-patient relationship in cases where the patient seeks her counsel because he feels insufficiently informed by the doctor, or because the nurse becomes aware of inadequacies in the information-giving process. She is then faced by the nurse's dilemma: a conflict between the loyalties she owes to her patient and to her physician team mate. A work sheet is presented which can help the nurse decide upon the proper course of action in solving this dilemma, guided by her personal and professional beliefs and by specific ethical concepts in the Code for Nurses. Solution of the dilemma and attainment of informed consent requires willing cooperation between doctor and nurse. Both can develop the skills for imparting information to the patient under difficult conditions and for verifying its comprehension by the patient. Both must learn to respect the patient's decision and to temper their professional skills with sensitivity, a strong moral sense and a deep respect for their fellow human beings.

Decision Making↗
PubMed2004

Regulatory motif finding by logic regression.

MOTIVATION: Multiple transcription factors coordinately control transcriptional regulation of genes in eukaryotes. Although many computational methods consider the identification of individual transcription factor binding sites (TFBSs), very few focus on the interactions between these sites. We consider finding TFBSs and their context specific interactions using microarray gene expression data. We devise a hybrid approach called LogicMotif composed of a TFBS identification method combined with the new regression methodology logic regression. LogicMotif has two steps: First, potential binding sites are identified from transcription control regions of genes of interest. Various available methods can be used in this step when the genes of interest can be divided into groups such as up-and downregulated. For this step, we also develop a simple univariate regression and extension method MFURE to extract candidate TFBSs from a large number of genes in the availability of microarray gene expression data. MFURE provides an alternative method for this step when partitioning of the genes into disjoint groups is not preferred. This first step aims to identify individual sites within gene groups of interest or sites that are correlated with the gene expression outcome. In the second step, logic regression is used to build a predictive model of outcome of interest (either gene expression or up- and down-regulation) using these potential sites. This 2-fold approach creates a rich diverse set of potential binding sites in the first step and builds regression or classification models in the second step using logic regression that is particularly good at identifying complex interactions. RESULTS: LogicMotif is applied to two publicly available datasets. A genome-wide gene expression data set of Saccharomyces cerevisiae is used for validation. The regression models obtained are interpretable and the biological implications are in agreement with the known resuts. This analysis suggests that LogicMotif provides biologically more reasonable regression models than previous analysis of this dataset with standard linear regression methods. Another dataset of S.cerevisiae illustrates the use of LogicMotif in classification questions by building a model that discriminates between up- and down-regulated genes in iron copper deficiency. LogicMotif identifies an inductive and two repressor motifs in this dataset. The inductive motif matches the binding site of the transcription factor Aft1p that has a key role in regulation of the uptake process. One of the novel repressor sites is highly present in transcription control regions of FeS genes. This site could represent a TFBS for an unknown transcription factor involved in repression of genes encoding FeS proteins in iron deficiency. We establish the robustness of the method to the type of outcome variable used by considering both continuous and binary outcome variables for this dataset. Our results indicate that logic regression used in combination with cluster/group operating binding site identification methods or with our proposed method MFURE is a powerful and flexible alternative to linear regression based motif finding methods. AVAILABILITY: Source code for logic regression is freely available as a package of the R programming language by Ruczinski et al. (2003) and can be downloaded at http://bear.fhcrc.org/~ingor/logic/download/download.html an R package for MFURE is available at http://www.stat.berkeley.edu/~sunduz/software.html

Algorithms↗
PubMed2004

Dynamics of the mammalian nucleus: can microscopic movements help us to understand our genes?

The cell is the basic building block of human life. Each of us has existed as a single cell--the fertilized egg--and each of us is made up of billions of cells specialized in many different ways to form our tissues and organs. The nucleus of the cell, described as far back as 1682, is known to be the site of storage of chromosomes that carry the essential and unique DNA blueprint for life. With the recent publication of the entire human genome, our knowledge of exactly what our genes say has increased immeasurably. This, however, is only a small part of the story. In order for the chromosomal genes to function correctly, a complex cellular machinery must rewrite (or transcribe) the genetic instructions of the DNA into a temporary messenger molecule, messenger RNA (mRNA), rearrange (or splice) this message into a readable format and then produce a protein that accurately represents the DNA code. It is these protein molecules that are the functional result of the genetic information. This whole process is termed 'gene expression'. Both transcription and splicing of the mRNA message are carried out in the nucleus. These events must be performed accurately and efficiently in a minute volume already full of highly packaged DNA. An ever-increasing number of sub-nuclear structures have been described, from the nucleolus (first described in 1835) to newly discovered 'paraspeckles' and 'clastosomes'. In fact, as increasing numbers of molecular probes become available, so the complexity of nuclear structure appears to expand. The functions of some of these structures are currently unknown. Those whose functions are, at least partly, understood play roles in gene expression. Interestingly, alterations in nuclear structure are associated with human diseases such as spinal muscular atrophy and promyelocytic leukaemia, suggesting that the control of nuclear organization may be vital to health. The dynamic nature of the structure of the mammalian nucleus has come under increasing scrutiny over the past few years. This has largely been driven by advances in microscopy as well as the advent of in vivo labelling techniques for sub-nuclear structures. It is now possible, using a protein originally isolated from jellyfish, to visualize sub-nuclear structures in living cultured cells. Together with three-dimensional time-lapse microscopy and an ever-expanding range of photo-bleaching techniques, this technology allows us to ask detailed questions about movements of sub-nuclear structures themselves and of the proteins contained within them. It has recently become clear that sub-nuclear structures are capable of moving within the nucleus and of physically interacting with each other. It is also now known that there is a constant flux of molecules into and out of these mobile structures as well as exchange of molecules between them, rather like passengers travelling on the London Underground. The challenge for the future is to relate dynamic events at the microscopic and molecular levels back to the organism as a whole. Only by understanding how the information encoded on genes is accurately expressed at the right time and in the right place can we really take advantage of the knowledge currently available to us.

Animals↗
PubMed2001

Dynamic wedge versus physical wedge: a Monte Carlo study.

The purpose of this study is to analyze the characteristics of dynamic wedges (DW) and to compare DW to physical wedges (PW) in terms of their differences in affecting beam spectra, energy fluence, angular distribution, contaminated electrons, and dose distributions. The EGS4/BEAM Monte Carlo codes were used to simulate the exact geometry of a 6 MV beam and to calculate 3-D dose distributions in phantom. The DW was simulated in accordance with the segmented treatment tables (STT). The percentage depth dose curves and beam profiles for PW, DW, and open fields were measured and used to verify the Monte Carlo simulations. The Monte Carlo results were found to agree within 2% with the measurements performed using film and ionizing chambers in a water phantom. The present EGS4 calculation reveals that the effects of a DW on beam spectral and angular distributions, as well as electron contamination, are much less significant than those for a PW. For the 6 MV photon beam, a 45 degrees PW can result in a 30% increase in mean photon energy due to the effect of beam hardening. It can also introduce a 5% dose reduction in the build-up region due to the reduction of contaminated electrons by the PW. Neither this mean-energy increase nor such dose reduction is found for a DW. Compared to a DW, a PW alters the photon-beam spectrum significantly. The dosimetric differences between a DW and a PW are significant and clearly affect the clinical use of these beams. The data presented may be useful for DW commissioning.

Electrons↗
PubMed1999

Hidden Markov model approach for identifying the modular framework of the protein backbone.

The hidden Markov model (HMM) was used to identify recurrent short 3D structural building blocks (SBBs) describing protein backbones, independently of any a priori knowledge. Polypeptide chains are decomposed into a series of short segments defined by their inter-alpha-carbon distances. Basically, the model takes into account the sequentiality of the observed segments and assumes that each one corresponds to one of several possible SBBs. Fitting the model to a database of non-redundant proteins allowed us to decode proteins in terms of 12 distinct SBBs with different roles in protein structure. Some SBBs correspond to classical regular secondary structures. Others correspond to a significant subdivision of their bounding regions previously considered to be a single pattern. The major contribution of the HMM is that this model implicitly takes into account the sequential connections between SBBs and thus describes the most probable pathways by which the blocks are connected to form the framework of the protein structures. Validation of the SBBs code was performed by extracting SBB series repeated in recoding proteins and examining their structural similarities. Preliminary results on the sequence specificity of SBBs suggest promising perspectives for the prediction of SBBs or series of SBBs from the protein sequences.

Amino Acid Sequence↗
PubMed1999

Building a mission for quality care.

Clearly, there is a benefit to the group process in helping to establish teamwork. Teamwork and cooperation can assist with promoting effective communication, improving work quality, and building a sense of well-being within the group. With this cooperation, setting goals and looking toward the future can become a reality. Once goals are set, then developing a professional image can begin. Developing a mission statement can be an effective means to help create that professional image. Having the opportunity to develop a mission for a patient care area and articulating it through a mission statement coalesces the values, beliefs, and philosophy of a group of neuroscience staff. The following is the mission statement developed by the neurosciences unit at the University of Wisconsin Hospital and Clinics: We, the staff of UWHC Neuroscience unit embrace a vision of excellence in health care for all. Our mission is to deliver consistent quality patient care, while fostering our own professional growth. As caring healers, teachers and patient advocates in an ever-changing health care environment, we are empowered by the code for nurses. Within our scope of practice, we strive to maintain a balance of basic human respect and dignity for patients and their families in their quest for wellness, adaptation, rehabilitation or comfort care. It is our hope that patients and families will work with the health care team to construct a plan of care that best meets the patient's needs and goals. We are committed to accommodate special communication, religious or cultural needs of patients and their families. Our final acknowledgment is to ourselves, as members of the health care team. We celebrate the dignity of the staff by recognizing each individual as a special person capable of making unique and significant contributions to the unit.

Communication↗
PubMedDate not supplied

Measuring the EMS patient access time interval and the impact of responding to high-rise buildings.

OBJECTIVES: To measure the patient access time interval and characterize its contribution to the total emergency medical services (EMS) response time interval; to compare the patient access time intervals for patients located three or more floors above ground with those less than three floors above or below ground, and specifically in the apartment subgroup; and to identify barriers that significantly impede EMS access to patients in high-rise apartments. METHODS: An observational study of all patients treated by an emergency medical technician paramedics (EMT-P) crew was conducted using a trained independent observer to collect time intervals and identify potential barriers to access. RESULTS: Of 118 observed calls, 25 (21%) originated from patients three or more floors above ground. The overall median and 90th percentile (95% confidence interval) patient access time intervals were 1.61 (1.27, 1.91) and 3.47 (3.08, 4.05) minutes, respectively. The median interval was 2.73 (2.22, 3.03) minutes among calls from patients located three or more stories above ground compared with 1.25 (1.07, 1.55) minutes among those at lower levels. The patient access time interval represented 23.5% of the total EMS response time interval among calls originating less than three floors above or below ground and 32.2% of those located three or more stories above ground. The most frequently encountered barriers to access included security code entry requirements, lack of directional signs, and inability to fit the stretcher into the elevator. CONCLUSIONS: The patient access time interval is significantly long and represents a substantial component of the total EMS response time interval, especially among ambulance calls originating three or more floors above ground. A number of barriers appear to contribute to delayed paramedic access.

Ambulances↗
PubMed2003

Experiences with a generator tool for building clinical application modules.

OBJECTIVES: To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis/OpenMed, which is in widespread use in Germany, Austria, and Switzerland. METHODS: In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system's functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool. RESULTS: The system's functionality is comparable to other commercial products' functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users' work practice. CONCLUSIONS: We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.

Computer Systems↗
PubMed2006

The benefits and challenges of research centers and institutes in academic medicine: findings from six universities and their medical schools.

PURPOSE: To understand the benefits and challenges of using centers and institutes in the academic research enterprise, and to explore institutional strategies that capitalize on the strengths and ameliorate the weaknesses of the center/institute structure. METHOD: Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six institutions, which can produce extrapolations to, but not necessarily findings that are generalizable to, other institutions and settings. RESULTS: Centers and institutes offer a number of benefits to academic institutions. Centers can aid in faculty recruitment and retention, facilitate collaboration in research, secure research resources, offer a sense of community and promote continued learning, afford organizational flexibility, and focus on societal problems and raise funds. Despite their many benefits, centers can also create tensions and present management challenges to institutional leaders. Centers can compete with departments over resources, complicate faculty recruitment, contribute to a fragmented mission, resist effective evaluation, pose governance problems, and impede junior faculty development. CONCLUSIONS: Institutional leaders might capitalize on the strengths of centers through three strategies: (1) reward leaders who embrace a collaborative point of view and develop a culture that frowns upon empire building; (2) distinguish among the many entities that share the "center" or "institute" labels; and (3) acknowledge that departments must maintain their place in the organizational milieu.

Academies and Institutes↗
PubMed2006

Clustering threshold gradient descent regularization: with applications to microarray studies.

MOTIVATION: An important goal of microarray studies is to discover genes that are associated with clinical outcomes, such as disease status and patient survival. While a typical experiment surveys gene expressions on a global scale, there may be only a small number of genes that have significant influence on a clinical outcome. Moreover, expression data have cluster structures and the genes within a cluster have correlated expressions and coordinated functions, but the effects of individual genes in the same cluster may be different. Accordingly, we seek to build statistical models with the following properties. First, the model is sparse in the sense that only a subset of the parameter vector is non-zero. Second, the cluster structures of gene expressions are properly accounted for. RESULTS: For gene expression data without pathway information, we divide genes into clusters using commonly used methods, such as K-means or hierarchical approaches. The optimal number of clusters is determined using the Gap statistic. We propose a clustering threshold gradient descent regularization (CTGDR) method, for simultaneous cluster selection and within cluster gene selection. We apply this method to binary classification and censored survival analysis. Compared to the standard TGDR and other regularization methods, the CTGDR takes into account the cluster structure and carries out feature selection at both the cluster level and within-cluster gene level. We demonstrate the CTGDR on two studies of cancer classification and two studies correlating survival of lymphoma patients with microarray expressions. AVAILABILITY: R code is available upon request. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Algorithms↗
PubMed2001

Characterization of particulate emissions from occupant activities in offices.

This paper characterizes the relationship between occupant activities and indoor air particulate levels in a non-smoking office building. Occupant activities were recorded on video. Particulate concentrations were monitored by three optical particle counters (OPCs) in five size ranges at three heights. Particulate mass concentrations were measured gravimetrically and bioaerosol concentrations were determined by impaction methods. Occupant activities and number concentrations were determined with 1-min resolution over a 1-week period. Occupant activities such as walking past or visiting the monitoring site explained 24-55% of the variation of 1- to 25-micron diameter particle number concentrations. Statistical models associating particulate concentrations with occupant activities depended on the size fraction and included an autocorrelative term. Occupant activities are estimated to contribute up to 10 micrograms m-3 in particulate concentrations per person. Number concentrations of particles smaller than 1 micron had little correlation with indoor activities other than cigarette smoking and were highly correlated with outdoor levels. The method can be used to characterize emissions from activities if rapid measurements can be made and if activities can be coded from the video record.

Activities of Daily Living↗
PubMed2000

Empirically supported treatments in pediatric psychology: constipation and encopresis.

OBJECTIVE: To review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence. METHOD: Sixty-five articles investigating intervention efficacy were identified and reviewed. Twenty-three of the studies were excluded because they were case studies or were less well-controlled single-case designs. The intervention protocol for each study was identified and coded, with studies employing the same interventions matched and evaluated according to the Chambless criteria. RESULTS: From the literature base to date, no well-established interventions have emerged. However, four probably efficacious treatments and three promising interventions were identified. Two different medical interventions plus positive reinforcement fit the criteria for the probably efficacious category (one with fiber recommendation and one without). Three biofeedback plus medical interventions fit efficacy category criteria: one probably efficacious for constipation with abnormal defecation dynamics (full medical intervention plus biofeedback for paradoxical contraction), and two fit the promising intervention criteria for constipation and abnormal defecation dynamics (full medical intervention plus biofeedback for EAS strengthening, correction of paradoxical contraction and home practice; and biofeedback focused on correction of paradoxical contraction, medical intervention without fiber recommendation, and positive reinforcement). Two extensive behavioral interventions plus medical intervention also met efficacy criteria for constipation plus incontinence (medical intervention without laxative maintenance plus positive reinforcement, dietary education, goal setting, and skills building presented in a small-group format fits criteria for a promising intervention; and positive reinforcement and skills building focused on relaxation of the EAS during defecation, but without biofeedback, plus medical intervention meets the probably efficacious criteria). CONCLUSIONS: A discussion of the current weaknesses in this research area follows. Specific recommendations for future research are made including greater clarity in treatment protocol and sample descriptions, reporting cure rates rather than success rates, utilization of adherence checks, and investigation of potential differential outcomes for subgroups of children with constipation and incontinence.

Behavior Therapy↗
PubMed1997

Monte Carlo based phase-space evolution for electron dose calculation.

A system of computer codes based on phase-space evolution is developed and applied to low energy therapeutic electron beams. Monte Carlo (EGS4) is used to pre-calculate the electron transport and dose deposition in a 0.5 cm width cubic voxel. Dose calculations at larger scales are computed from the pre-calculated data using phase-space evolution. This approach has the theoretical accuracy of Monte Carlo with potentially significant speed gains resulting from the pre-calculation. This study demonstrates the accuracy of this technique while providing a preliminary assessment of the calculation time. For a 4.3 MeV electron beam in water with a 0.5 cm thick slab of either water (homogeneous), air, or aluminum at 1 cm depth, we observe differences relative to Monte Carlo of less than 3% along the central axis for a pencil-beam. For a 3.5 cm x 3.5 cm field we observe a maximum difference on the central axis of 4% in the build-up region and less than 0.1 cm in the fall-off region for all three phantoms. Calculation times are disappointing; however, there is high potential for their reduction to values comparable to or better than condensed history Monte Carlo while retaining clinically acceptable accuracy.

Algorithms↗
PubMed2000

A recurrent model of transformation invariance by association.

This paper describes an investigation of a recurrent artificial neural network which uses association to build transform-invariant representations. The simulation implements the analytic model of Parga and Rolls [(1998). Transform-invariant recognition by association in a recurrent network. Neural Computation 10(6), 1507-1525.] which defines multiple (e.g. "view") patterns to be within the basin of attraction of a shared (e.g. "object") representation. First, it was shown that the network could store and correctly retrieve an "object" representation from any one of the views which define that object, with capacity as predicted analytically. Second, new results extended the analysis by showing that correct object retrieval could occur where retrieval cues were distorted; where there was some association between the views of different objects; and where connectivity was diluted, even when this dilution was asymmetric. The simulations also extended the analysis by showing that the system could work well with sparse patterns; and showing how pattern sparseness interacts with the number of views of each object (as a result of the statistical properties of the pattern coding) to give predictable object retrieval performance. The results thus usefully extend a recurrent model of invariant pattern recognition.

Artificial Intelligence↗
PubMed2002

[The SGB IX, book 9 of the German social code, in the development of social security law].

The SGB IX is the legal basis of rehabilitation in Germany since 2001. It is embedded in the codification of the German social code, the Sozialgesetzbuch (SGB). There it has an intermediate function between the general social law and the special laws of the social insurance and social security institutions. Rehabilitation in Germany is working in a system of several different institutions with different legal roots. In special these are compensation of damages caused by employment accident and war and the avoidance of disability benefits by rehabilitation and activation. Inequality of treatment of disabled people according to the cause of their disability and to their employment status are accepted less; common principles of rehabilitation are being searched. Important reforms of rehabilitation law have taken place in 1974 and 1975. Since then problems have become visible in implementation and in the coordination of the complex system. SGB IX is a new effort for a general rehabilitation law. Open questions remain in handling the relations between rehabilitation and sickness treatment, long term care and prevention. Important are the newly defined terms for participation (Teilhabe) and disability (Behinderung), which build the linkage of SGB IX with constitutional law and with the health sciences. A weak point is still the relation of disability and age. Political attempts for unequal benefits in health insurance endanger the now reached level of rehabilitation law.

Disability Evaluation↗
PubMed2005

Construction and 3-D computer modeling of connector arrays with tetragonal to decagonal transition induced by pRNA of phi29 DNA-packaging motor.

The bottom-up assembly of patterned arrays is an exciting and important area in current nanotechnology. Arrays can be engineered to serve as components in chips for a virtually inexhaustible list of applications ranging from disease diagnosis to ultrahigh-density data storage. In attempting to achieve this goal, a number of methods to facilitate array design and production have been developed. Cloning and expression of the gene coding for the connector of the bacterial virus phi29 DNA-packaging motor, overproduction of the gene products, and the in vitro construction of large-scale carpet-like arrays composed of connector are described in this report. The stability of the arrays under various conditions, including varied pH, temperature and ionic strength, was tested. The addition of packaging RNA (pRNA) into the array caused a dramatic shift in array structure, and resulted in the conversion of tetragonal arrays into larger decagonal structures comprised of both protein and RNA. RNase digestion confirmed that the conformational shift was caused by pRNA, and that RNA was present in the decagons. As has been demonstrated in biomotors, conformational shift of motor components can generate force for motor motion. The conformational shift reported here can be utilized as a potential force-generating mechanism for the construction of nanomachines. Three-dimensional computer models of the constructed arrays were also produced using a variety of connector building blocks with or without the N- or C-terminal sequence, which is absent from the current published crystal structures. Both the connector array and the decagon are ideal candidates to be used as templates to build patterned suprastructures in nanotechnology.

Bacillus Phages↗
PubMed2005

Design of a Multi Dimensional Database for the Archimed DataWarehouse.

The Archimed data warehouse project started in 1993 at the Geneva University Hospital. It has progressively integrated seven data marts (or domains of activity) archiving medical data such as Admission/Discharge/Transfer (ADT) data, laboratory results, radiology exams, diagnoses, and procedure codes. The objective of the Archimed data warehouse is to facilitate the access to an integrated and coherent view of patient medical in order to support analytical activities such as medical statistics, clinical studies, retrieval of similar cases and data mining processes. This paper discusses three principal design aspects relative to the conception of the database of the data warehouse: 1) the granularity of the database, which refers to the level of detail or summarization of data, 2) the database model and architecture, describing how data will be presented to end users and how new data is integrated, 3) the life cycle of the database, in order to ensure long term scalability of the environment. Both, the organization of patient medical data using a standardized elementary fact representation and the use of the multi dimensional model have proved to be powerful design tools to integrate data coming from the multiple heterogeneous database systems part of the transactional Hospital Information System (HIS). Concurrently, the building of the data warehouse in an incremental way has helped to control the evolution of the data content. These three design aspects bring clarity and performance regarding data access. They also provide long term scalability to the system and resilience to further changes that may occur in source systems feeding the data warehouse.

Databases, Factual↗