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The paper is devoted to the analysis of the influence of ambient temperature on the linear free and non-linear harmonic vibrations of laminate plates with viscoelastic layers. The Zener fractional material model is adopted. The plate kinematics is described using the refined zig-zag theory. The formulation of vibrations of the plate is based on the physical law with the separation of deviatoric and volumetric deformation. The temperature influence is included using the frequency-temperature superposition principle. The shift factor applied to modify the damping properties of the viscoelastic material is computed using the Willams-Landel-Ferry formula. The paper contains the results of several analyses of laminate plates with various viscoelastic materials for which the material data were available in the literature. In particular, the analyses focus on determination of the properties characteristic for the plates with Zener fractional model under the influence of the ambient temperature. • Frequency-temperature superposition for temperature influence on plates vibrations • Refined zig-zag theory applied to define the plate kinematics • Fractional Zener material with separated volumetric and deviatoric deformation • Numerous analyses of various viscoelastic materials • Explanation of non-monotonous character of temperature effects on damping [ABSTRACT FROM AUTHOR]

Background: This study empirically evaluates the influence of medical information on patient trust at the physician level, the medical profession, hospitals, and with the payer. Restoring patient trust in a medical setting in Poland appears to be significantly affected due to the COVID-19 pandemic. Patient trust improves results from medical treatment, raises perception of healthcare performance, and smoothens the overall functionality of healthcare systems.Methods: In order to study trust volatility, patients took part in a three-stage experiment designed via: (1) measured level of trust, (2) randomly dividing participants into two groups-control (i.e., re-examination of level of trust) and experimental (i.e., being exposed to a piece of certain manipulative information), and (3) checking whether observational changes were permanent.Results: Results indicate that in the experimental group the increase of trust was noticed in the payer (27.7%, p < 0.001), hospitals (10.9%, p = 0.011), and physicians (decrease of 9.2%, p = 0.036).Conclusion: The study indicated that in Poland medical information is likely to influence patient trust in healthcare while interpersonal and social trust levels may be related to increases of trust in hospitals and in the payer versus decreases in physicians. [ABSTRACT FROM AUTHOR]

Passive damping systems are energy dissipating devices that are used in building constructions to reduce excessive vibration caused by wind or earthquakes. Recently, the use of inerters, devices using the inertia of the rotating mass, as a passive damping system has become more and more popular. Inerter, regardless of the construction, generates a resistance force that is proportional to the relative acceleration at the terminal ends of the device. The purpose of this study is to evaluate the effectiveness of the viscoelastic (VE) dampers in combination with the inerter. For the derived equations of motion of structures with VE dampers and inerters, the Laplace transformation is applied, which leads to a nonlinear eigenproblem. The solution to the eigenproblem is obtained using the continuation method, also known as the homotopy or as the path following method. It was found that for some cases of inerter connection with ve damper, there are some additional solutions in relation to the degrees of freedom of the structure. Furthermore, the dynamic characteristics of the structure associated with the above-mentioned additional eigenvalue are strongly dependent on the equivalent inerter mass. Damping efficiency is tested by determining changes in the system's dynamic characteristics: natural frequencies, non-dimensional damping ratios and displacement transfer functions. The presented approach allows determining the appropriate parameters of the inerter and VE damper and their appropriate location on the structures that correspond to the most effective damping. The obtained numerical results confirm the effectiveness of the proposed approach. [ABSTRACT FROM AUTHOR]

Planar frame structures made of a viscoelastic material are considered in the paper. The technically very important structures made of a homogenous material are contemplated. A family of rheological models (classic and fractional) are used to describe the mechanical properties of the viscoelastic material. In particular, the dynamic characteristics of the structures are of interest. A numerically very efficient method is proposed to determine such characteristics. The method requires the solution to the linear eigenvalue problem for corresponding elastic structures and the solution to a nonlinear, algebraic equation. The presented method is much more efficient than other methods where, very often, the continuation method is used to solve the nonlinear eigenvalue problem. The influence of temperature changes on dynamic characteristics is analyzed using the frequency–temperature principle. The results of several parametric analyses are presented and discussed. For the first time, the influence of temperature on the dynamic characteristics of beams has been studied in detail. [ABSTRACT FROM AUTHOR]

• Harmonic vibrations of VE laminate plates with exponential complex-conjugate solution form and harmonic balance method. • The use of refined zig-zag theory for the description of layered plate kinematics. • Application of fractional Zener material model with separation of volumetric and deviatoric strain. The paper is devoted to the theoretical formulation of the harmonic vibrations problem for laminate plates in the von Kàrmàn geometrically non-linear regime. The plate layers are modelled as viscoelastic using the fractional Zener material with the linear elastic material being a special case. The model of the material is formulated with the separation of the volumetric and deviatoric strain. The laminate plate kinematics is described using the refined zig-zag theory. The vibrations of the plate are formulated using the alternative exponential form with complex-conjugate amplitudes. The harmonic balance method and the time-averaging are applied to derive the amplitude equation of the problem in hand. The efficiency and correctness of the formulation is verified in the continuation paper Part 2 – numerical analysis. [ABSTRACT FROM AUTHOR]

• FE solution of harmonic vibrations for VE layered plates with exponential complex-conjugate form and refined zig-zag theory. • Effective application of the continuation method to solve the discretised amplitude equation. • Numerous analyses of the influence of various plate and formulation parameters on the resonance behaviour of laminate plates. The paper is devoted to the numerical analysis of the harmonic vibrations of laminate plates with viscoelastic layers in the von Kàrmàn geometrically non-linear regime. The amplitude equation derived in the prequel paper Part 1 – theoretical background is discretized using the 8-noded bi-quadratic plate finite elements. The response curves are obtained using the continuation method to solve the discretised amplitude equation treated as the equation with the frequency of vibrations as a parameter. The proposed method of solution is verified by comparing the results with those from available literature. Furthermore, several numerical analyses are performed, including testing of FE mesh density, plate aspect ratio, various VE materials, support conditions and layers layout as well as the possibility of simplification of the complex-valued zig-zag function used in the description of plate kinematics. Several results of practical importance are found and discussed in the conclusions. [ABSTRACT FROM AUTHOR]

A method for analyzing the influence of temperature on the dynamic characteristics of structures with viscoelastic dampers is proposed in this paper. Dampers which are described by so-called fractional rheological models are considered. The temperature-frequency superposition principle is used to describe the influence of temperature on the dynamic characteristics. The concept of continuous dependence of damping on an artificially introduced parameter is adopted for solving, in an approximate way, the nonlinear eigenvalue problem from which dynamic characteristics are determined. The correctness and effectiveness of the method was verified by means of two examples. [ABSTRACT FROM AUTHOR]

This study concerns the structural systems in which additional damping was introduced by means of viscoelastic (VE) dampers modeled with the fractional derivative models. The fractional derivative models have an ability to correctly describe the behavior of VE materials in a wide range of frequency, using a small number of model parameters. However, the governing equation of motion includes fractional derivatives together with ordinary ones. In the proposed approach, after applying the Laplace transform and the inverse transform to the equations of motion, the solution obtained for the system with fractional dampers is equivalent to the modal solution used in the case of proportional damping. In order to validate the proposed approach, the maximum response of the structural system equipped with dampers is determined in the time domain. Thus, the equations of motion with fractional derivatives derived for the considered system are numerically integrated. Moreover, the paper extends the response spectrum concept to structures equipped with fractional viscoelastic dampers. [ABSTRACT FROM AUTHOR]

The paper is devoted to non-linear vibrations of plates, made of the Zener viscoelastic material modelled with the Caputo fractional derivative, and in particular to their response to harmonic excitation. The plate geometric non-linearity is of the von Kármán type. In the formulation shear effects and rotary inertia are considered, too. The problem is solved in the frequency domain. A one-harmonic form of the solution for plate displacements corresponding to the plate formulation is assumed. The amplitude equation is obtained from the time averaged principle of virtual work. The time averaging precedes the use of the harmonic balance method. In the space discretization the finite element method is used involving 8-noded rectangular plate elements with selective-reduced integration. Several numerical examples are analyzed and the response curves are found using a path-following method. The purpose of these analyses is to identify material features of the adopted model of viscoelasticity with the fractional derivative. [ABSTRACT FROM AUTHOR]

The problem of non-linear, steady state vibration of beams, harmonically excited by harmonic forces is investigated in the paper. The viscoelastic material of the beams is described using the Zener rheological model with fractional derivatives. The constitutive equation, which contains derivatives of both stress and strain, significantly complicates the solution to the problem. The von Karman theory is applied to take into account geometric nonlinearities. Amplitude equations are obtained using the finite element method together with the harmonic balance method, and solved using the continuation method. The tangent matrix of the amplitude equations is determined in an explicit form. The stability of the steady-state solution is also examined. A parametric study is carried out to determine the influence of viscoelastic properties of the material on the beam's responses. [ABSTRACT FROM AUTHOR]

The influence of uncertain design parameters on dynamic characteristics and the frequency response function is considered in this paper. A structure with dampers modeled as a shear frame is analyzed. The dampers properties of dampers are described by fractional derivatives. The design parameters of the considered structure change only in a specified range and the interval analysis is taken into account in calculating the lower and upper bounds of dynamic characteristics. Several methods are used to obtain the limit values of objective functions: the vertex method and the method of approximation using the first- and the second-order Taylor series expansion. The vertex method is adopted as a comparative method. Two examples are presented in order to illustrate the considered methods. In the case of large uncertainties, the obtained results differ from those obtained by means of the vertex method. Therefore, a new method using the second-order Taylor series expansion is proposed. The method consists of a sequence of changes of only one parameter and requires much fewer combinations when the number of uncertain design parameters is high. [ABSTRACT FROM AUTHOR]

The problem of geometrically non-linear steady state vibrations of beams excited by harmonic forces is considered in this paper. The beams are made of a viscoelastic material defined by the classic Zener rheological model - the simplest model that takes into account all the basic properties of real viscoelastic materials. The constitutive stress-strain relationship for this type of material is given as a differential equation containing derivatives of both stress and strain. This significantly complicates the solution to the problem. The von Karman theory is applied to describe the effects of geometric nonlinearities of beam deformations. The equations of motions are derived using the finite element methodology. A polynomial approximation of bending moments is used. The order of basis functions is set so as to obtain a coherent approximation of moments and displacements. In the steady-state solution of equations of motion, only one harmonic is taken into account. The matrix equations of amplitudes are derived using the harmonic balance method and the continuation method is applied for solving them. The tangent matrix of equations of amplitudes is determined in an explicit form. The stability of steady-state solution is also examined. The resonance curves for beams supported in a different way are shown and the results of calculation are briefly discussed. [ABSTRACT FROM AUTHOR]

In paper the design sensitivity analysis of dynamic characteristics of structures with viscoelastic (VE) dampers is considered. The dampers are modeled using the classical rheological model and the rheological model with fractional derivatives. The design sensitivity is analyzed by using direct differentiation method and adjoint variables method. The formulae enabling the calculation of sensitivity of the first and the second order with respect to chosen design parameters have been derived. Sensitivity analysis of eigenvalues, eigenvectors and dynamic characteristics such as natural frequencies and non-dimensional damping ratios are presented. The correctness of the presented formulae is illustrated in examples. [ABSTRACT FROM AUTHOR]

This paper concerns the dynamic analysis of composite beams containing elastic and viscoelastic (VE) layers. A method for determination of the dynamic characteristics of multilayered beams with VE layers (i.e., natural frequencies, non-dimensional damping ratios and modes of vibration) is presented. The Euler-Bernoulli beam theory and the Timoshenko theory are used to describe the elastic and VE layers, respectively. To describe the mechanical properties of a VE layer, the four-parameter rheological model with fractional derivative is applied. A number of particular rheological models are particular cases of this general model. The virtual work principle and the finite element method together with the Laplace transform are used to derive the equation of motion in the frequency domain. The dynamic characteristics of a beam with VE layers are obtained as the solution to a properly defined nonlinear eigenvalue problem. The continuation method is adopted for solving the nonlinear eigenproblem. Several conclusions concerning the accuracy of the method and variability of results are presented on the basis of numerical studies. [ABSTRACT FROM AUTHOR]

Background. Some Polish hospitals are in a good financial position but others are not, even though they are of a similar size according to their budgets, the number and structure of specialists and type of society they serve. Furthermore, it is difficult to find the factors responsible for their different financial standing. To investigate deeper the dissimilarities that might exist, the author hypothesizes that one of the most important factors that possibly influences a hospitals financial performance is its control system. Research aims. In these circumstances the research is aimed at identifying different control areas and mechanisms which have been used by hospital managers to ensure delivery of high-quality cost-effective patient care and that concurrently balance the hospital budget. Method. During the study the author investigated the operating core of hospitals in order to develop a deeper understanding of its internal control processes. This qualitative study is based on several in-depth interviews with general directors of two similar hospitals. Key findings. The research indicates that hospitals ought to concentrate on four generic areas of control: input control, legitimacy of medical procedures control, revenue control and overheads control. Thus comparing the studied hospitals according to their activities in the four control areas it is visible that the hospital which has a good financial situation, takes control measures in all four areas, and the top managers are directly involved in supervising most of these activities. While the hospital which is facing financial difficulties, is much less active in the described areas of control and the director does not participate actively in control of the lower levels of his organization nor does he build such extended control mechanisms as the director from the better-off hospital. [ABSTRACT FROM AUTHOR]

Highlights: [•] The dynamic characteristics of structures with viscoelastic dampers are determined. [•] The fractional, rheological model of damper is applied. [•] The proposed approach enables the simultaneous use of a few models of damper. [•] The equations of motion are solved using the continuation method. [•] The problem of existence of real eigenvalues is also discussed. [ABSTRACT FROM AUTHOR]

• Pioneer application of refined zig-zag theory in dynamic analysis of laminate plates. • Separate fractional Zener material description for volumetric and deviatoric strains. • Derivation of efficient finite element formulation leading to the non-linear eigen-value problem. The refined zig-zag theory is used to solve the dynamic problems for composite sandwich plates made from the elastic and the viscoelastic (VE) layers. The linear constitutive relations are used to model physical properties of the VE layers separately for volumetric and deviatoric strains. The fractional Zener model is used in the formulation of VE material. The Laplace transformation and the finite element method are used to derive the discretized nonlinear eigenvalue problem. The required dynamic characteristics of the plates – the frequency and the damping ratio, fundamental in design of structural elements in many fields of engineering, can be obtained using the procedure described in the companion paper Litewka P. Lewandowski R, Wielentejczyk P. Free vibrations of laminate plates with viscoelastic layers using the refined zig-zag theory – Part 2. Numerical analysis. [ABSTRACT FROM AUTHOR]

• Efficient solution procedure for non-linear eigen-value problem based on homotopy and quasi-Newton methods. • Numerical verification of the proposed formulation and testing of various solution variants. • Extensive analyses of results sensitivity to the model parameters. In this paper the numerical procedure to solve the non-linear eigen-value problem describing the free vibrations of the laminate plates with viscoelastic (VE) layers is presented. The derivation of that main equation based on the refined zig-zag theory and using fractional Zener material model to describe VE material is presented in the companion paper Lewandowski R, Litewka P. Wielentejczyk P. Free vibrations of laminate plates with viscoelastic layers using the refined zig-zag theory – Part 1. Theoretical background. The solution obtained using the continuation method provides the required dynamic characteristics of the plates – the frequency and the damping ratio. In the iterative part of each continuation step either the full Newton or the quasi-Newton iterative procedure are used. Several numerical examples are solved to verify accuracy, efficiency and versatility of the proposed formulation. Numerous parametric studies are carried out to determine the influence of various solution variants and combinations of material parameters onto the results describing the damping properties of laminate plates. [ABSTRACT FROM AUTHOR]

Aim of the study: Metastases of non-small cell lung cancer (NSCLC) into pleura disqualify a patient from surgery and present a bad prognostic index. The aim of the study was to find out whether washing out the pleural cavity in such cases and examining obtained washings for presence of cancer cells will help to detect early NSCLC metastases into pleura, and also whether negative results of the cytology determine whether hyper methylation of these genes will increase the sensitivity of this examination. Material and methods: The study consisted of the examination of 76 patients, including 59 operated on for NSCLC and 17 operated on for other reasons. Pleural washing fluid collected during the surgery was subjected to cytological examination as well as examined to determine the presence of promoter region hypermethylation of p16 and MGMT genes. Results: Positive cytological results of pleural lavage were confirmed in 4 persons (7%) with NSCLC. The presence of promoter region hypermethylation of one or both examined genes was found in 3 patients (18%) in the control group and in 47 (80%) in the study group. Sex, occupational exposure, smoking cigarettes, and NSCLC histological type did not have an influence on the presence of cancer cells or hypermethylation in the pleural lavage fluid. Positive cytology results were more frequent at the T4 stage of NSCLC. Hypermethylation was more fre quent in the research group (p < 0.01). Cancer cells and hypermethylation did not occur more frequently in pleural lavage fluid of patients with metastases into pleura. Conclusions: The cytological examination and promoter region hypermethylation assessment of the p16 gene and MGMT gene in pleural lavage cells do not allow one to detect early metastasis of NSCLC into pleura. [ABSTRACT FROM AUTHOR]

Abstract: Frame structures with viscoelastic dampers mounted on them are considered in this paper. Viscoelastic (VE) dampers are modelled using two, three-parameter, fractional rheological models. The structures are treated as elastic linear systems. The equation of motion of the whole system (structure with dampers) is written in terms of state-space variables. The resulting matrix equation of motion is the fractional differential equation. The proposed state space formulation is new and does not require matrices with huge dimensions. The paper is devoted to determine the dynamic properties of the considered structures. The nonlinear eigenvalue problem is formulated from which the dynamic parameters of the system can be determined. The continuation method is used to solve the nonlinear eigenvalue problem. Moreover, results of typical calculations are presented. [ABSTRACT FROM AUTHOR]

Introduction. Methods of financing health care services constantly undergo changes. These changes involve both the allocated financial resources and average prices received for person-day of treating patients in hospital departments of various specialties. Thus, a constant monitoring of financing levels and service pricing in particular types of health care services is indispensable, since these issues are directly associated with the development or stagnation observed in particular branches of medicine. Aim. This paper aimed at verifying the hypothesis that the pricing of person-day in the field of inpatient therapeutic rehabilitation, especially involving children, is under priced in relation to an average value of a person-day received in specialties providing non-invasive hospital treatment, and comparable as regards the costs of services. Materials and methods. An analysis and comparison of costs and incomes for medical units providing health care services in selected areas of inpatient therapeutic rehabilitation for children and non-invasive hospital medical treatment have been attempted. This analysis has been carried out on the basis of data provided by the regional branches of the National Health Fund (NFZ). Generally available information concerning the terms and conditions of contracting services and agreements that NFZ has entered into with service providers has been also used. Results and discussion. A comparison of the conditions for providing services that service providers should meet in order to obtain financing within the framework of NFZ, shows that personnel costs of a department of pulmonary rehabilitation and department of general rehabilitation are lower by approximately 15% than personnel costs of a department of pediatrics, and 9% lower than for a department of pediatric neurology. However, an average pricing of person-day received by rehabilitation departments is about 3-fold lower than that received by departments of pediatrics and pediatric neurology. Departments providing non-invasive medical treatment admit a large variety of patients. This diversification of patients only in part coincides with patients admitted to rehabilitation departments. Thus, additionally average pricings of person-day at departments providing non-invasive medical treatment and departments of general rehabilitation with respect to selected diagnosis related groups of patients who manifest diseases treated in both types of departments, have been compared. The obtained results have confirmed gross under financing of inpatient rehabilitative services. Conclusions. Inpatient rehabilitative services offered for children are particularly undervalued. In this instance, service providers bear higher costs, resulting from, among other considerations, a larger average number of physiotherapists necessary to conduct rehabilitation, the requirement of assuming the full legal responsibility for children which necessitates additional educational care and 24-hours medical care, not only in the case of neurological rehabilitation, as well as providing nutrition adequate for children's ages, including five high-quality meals daily. Consequently, it is necessary to increase the pricing of inpatient rehabilitative services provided for children. [ABSTRACT FROM AUTHOR]

• The subspace iteration method is used to solve nonlinear eigenvalue problem. • The continuation method is used to solve the nonlinear Hermitian eigenproblem. • The method presented allows determination of only a part of eigenvalues. • The method was tested for structures with viscoelastic elements. • The models of VE elements are described with the help of fractional derivatives. The paper presents an extension of the subspace iteration method for application in systems with viscoelastic damping elements, which are described by both classical and fractional models. The presented method enables determination of only a certain number of eigenvalues and associated eigenvectors. This is very useful, especially when the considered problem has many degrees of freedom, in which case it would be very time-consuming or even impossible to determine all the eigenvalues. At the same time, from the engineering point of view, it is not necessary to know all the eigenvalues. In this paper, the subspace iteration method is used for the first time to solve the nonlinear eigenproblems which appear in the dynamic analysis of systems with viscoelastic damping elements. The proposed solution consists of assuming the number of eigenvalues to be determined, taking the initial point of iteration and then solving the nonlinear reduced eigenproblem with Hermitian matrices in each iterative loop. The solution to the reduced eigenproblem is obtained using the continuation method, and it is an additional novelty in the paper. The correctness and effectiveness of the proposed approach are illustrated with numerical examples. [ABSTRACT FROM AUTHOR]

• The refined zig-zag theory is used to solve the dynamic problem for composite beams with viscoelastic layers. • The fractional Zener model is used in analysis. • The dynamic characteristics of multi-layered viscoelastic beams are of interest. • The hierarchical FEM and the Laplace transform are used to derive the nonlinear eigenvalue problem. • The continuation method is adopted to solve the nonlinear eigenvalue problem. In the present paper the displacement based refined zig-zag theory is used, for the first time, to solve dynamic problems of composite and sandwich beams made of both elastic and VE layers. The linear constitutive relations are used to model physical properties of the VE layers. The rheological models can be in the classical or fractional versions, but the main focus is on the fractional Zener model. The dynamic characteristics of considered beams are evaluated. The hierarchical finite element and the Laplace transformation are used to derive the nonlinear eigenvalue problem and its solutions yield the required dynamic characteristics of beams. The continuation method is adopted to solve this problem numerically. Accuracy, effectiveness and efficiency of the proposed method are verified in several examples. The results of the presented calculations are summarized with some conclusions. [ABSTRACT FROM AUTHOR]

• The governing equations of the VE Mindlin plates in the Laplace domain are derived • The simple procedure for dynamic characteristics of VE Mindlin plates is proposed. • The simple method to include the temperature influence is included. • Parametric studies of the dynamic characteristics are carried out. This paper is devoted to geometrically linear free vibrations of viscoelastic (VE) Mindlin plates. The governing equations are derived in the Laplace domain. A simple way to take into account the influence of temperature on the damping properties is included using the frequency-temperature superposition principle. The novel approach to the solution of the non-linear problem of free vibrations of VE plates significantly simplifies the procedure reducing it to a linear eigen-value problem and a simple algebraic non-linear equation with one unknown. Several numerical examples involving varying physical parameters of the model are solved and the results are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of lateral curvatures of the spine ranges from 0.3% to 15.3% in the general population. The aim of the study was to develop and compare three different screening tests for idiopathic scoliosis (IS) with respect to their effectiveness and costs.Material and Methods: The Delphi method was used to assess the efficacy of each screening algorithm in detecting IS in the population. An economic analysis was also performed.Results: Diagnostic Algorithm 1 for IS comprised a screening examination performed by nurses and a general practitioner (GP) with verification by specialists. The unit cost of carrying out diagnostic work-up for IS in Algorithm 1 was €94 per child. The second algorithm involved the use of the moiré computer method, followed by verification by a specialist. The lower unit cost of €86 per child of diagnostic work-up according to Algorithm 2 was due to fewer stages compared to Algorithm 1. The highest effectiveness with the highest costs were found for the third algorithm, with only one stage, a specialist's consultation (cost €153 per child).Conclusions: The number of stages in an algorithm does not correlate positively with its efficacy or cost. The recommended scheme is Algorithm 3, where children are examined by rehabilitation specialists or a physiotherapist using a scoliometer and an inclinometer. The use of the apparently most expensive scheme (Algorithm 3) should result in lowering the costs of treatment of established idiopathic scoliosis and, in the long term, prove to be the most cost-effective solution for the health care system. [ABSTRACT FROM AUTHOR]

Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals. Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources. Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) ‘integrated’ control with high levels of coordination and coherent patterns for cost and quality controls; (2) ‘partly integrated’ control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) ‘fragmented’ control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management. Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of ‘coordination’ of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective. [ABSTRACT FROM AUTHOR]

Introduction. The era of computer testing, measurement and decision-making systems began in the second half of the 20th century. Medical application of such systems manifests itself in digital devices for the observation of the patient's condition, X-ray and laboratory diagnostics. In this article the authors concentrate on the decision-making systems, and, in particular, on decision-making self-learning systems which, as the authors suggest, could be applied in medical diagnostics. Creating the model of the self-learning system based on patients' clinical records for the use of rehabilitation-orthopedic diagnostics is the principal aim of this research. Materials and methods. Pathological entities displayed by 850 patients (at the age of 6-20 years, on average 14.6 years) were classified. All the patients underwent treatment for idiopathic scoliosis (IS) in the Department and Clinic of Rehabilitation and in the Provincial Rehabilitation Hospital for Children in Ameryka near Olsztyn, Poland. The diagnostics imaging technique (X-ray, CT, CT-3D) was focused on identifying characteristic entities, discovered by the image algorithm identification and by the analysis of spectrum obtained out of Fourier transformation and Falk transformation. As regards the IS identification, it was appropriate to use diagnostics imaging techniques, as well as anamnesis to analyze the data. Results and discussion. The research resulted in creating the output vector in the form of anticipated treatment effects. The topology of the classification network was designed on the basis of the artificial neural networks recurrent algorithm. Conclusions. The applied classification procedure proves that defining input data and normalizing reply vector allows researchers to build the artificial neural network for the purpose of anticipating treatment effects on the basis of the acquired knowledge. For a competent medical doctor, the self-learning system can function only as an advisory device, which produces a useful information tool by means of accumulated information. [ABSTRACT FROM AUTHOR]

Background: Hospital governance increasingly combines management and professional self-governance. This article maps the new emergent modes of control in a comparative perspective and aims to better understand the relationship between medicine and management as hybrid and context-dependent. Theoretically, we critically review approaches into the managerialism-professionalism relationship; methodologically, we expand cross-country comparison towards the meso-level of organisations; and empirically, the focus is on processes and actors in a range of European hospitals.Methods: The research is explorative and was carried out as part of the FP7 COST action IS0903 Medicine and Management, Working Group 2. Comprising seven European countries, the focus is on doctors and public hospitals. We use a comparative case study design that primarily draws on expert information and document analysis as well as other secondary sources.Results: The findings reveal that managerial control is not simply an external force but increasingly integrated in medical professionalism. These processes of change are relevant in all countries but shaped by organisational settings, and therefore create different patterns of control: (1) 'integrated' control with high levels of coordination and coherent patterns for cost and quality controls; (2) 'partly integrated' control with diversity of coordination on hospital and department level and between cost and quality controls; and (3) 'fragmented' control with limited coordination and gaps between quality control more strongly dominated by medicine, and cost control by management.Conclusions: Our comparison highlights how organisations matter and brings the crucial relevance of 'coordination' of medicine and management across the levels (hospital/department) and the substance (cost/quality-safety) of control into perspective. Consequently, coordination may serve as a taxonomy of emergent modes of control, thus bringing new directions for cost-efficient and quality-effective hospital governance into perspective. [ABSTRACT FROM AUTHOR]