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Background Because patients can remain colonized with vancomycin-resistant enterococci (VRE) for long periods of time, VRE may spread from one health care facility to another. Methods Using the Regional Healthcare Ecosystem Analyst, an agent-based model of patient flow among all Orange County, California, hospitals and communities, we quantified the degree and speed at which changes in VRE colonization prevalence in a hospital may affect prevalence in other Orange County hospitals. Results A sustained 10% increase in VRE colonization prevalence in any 1 hospital caused a 2.8% (none to 62%) average relative increase in VRE prevalence in all other hospitals. Effects took from 1.5 to >10 years to fully manifest. Larger hospitals tended to have greater affect on other hospitals. Conclusions When monitoring and controlling VRE, decision makers may want to account for regional effects. Knowing a hospital's connections with other health care facilities via patient sharing can help determine which hospitals to include in a surveillance or control program.

Background.Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals.Methods.Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (β), MRSA loss rate, probability of patient transfer or readmission, and time to readmission.Results.Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%).Conclusion.MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.

Production of electricity and propulsion systems involve turbulent combustion. Computational modeling of turbulent combustion can improve the efficiency of these processes. However, large tensor datasets are the result of such simulations; these datasets are difficult to visualize and analyze. In this work we present an unsupervised statistical approach for the segmentation, visualization and potentially the tracking of regions of interest in large tensor data. The approach employs a machine learning clustering algorithm to locate and identify areas of interest based on specified parameters such as strain tensor value. Evaluation on two combustion datasets shows this approach can assist in the visual analysis of the combustion tensor field.

Objective As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare ‘ecosystem’ in infection control. Materials and methods We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. Results To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus . Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Discussion Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. Conclusions A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

Efforts to control life-threatening infections, such as with methicillin-resistant Staphylococcus aureus (MRSA), can be complicated when patients are transferred from one hospital to another. Using a detailed computer simulation model of all hospitals in Orange County, California, we explored the effects when combinations of hospitals tested all patients at admission for MRSA and adopted procedures to limit transmission among patients who tested positive. Called "contact isolation," these procedures specify precautions for health care workers interacting with an infected patient, such as wearing gloves and gowns. Our simulation demonstrated that each hospital's decision to test for MRSA and implement contact isolation procedures could affect the MRSA prevalence in all other hospitals. Thus, our study makes the case that further cooperation among hospitals-which is already reflected in a few limited collaborative infection control efforts under way-could help individual hospitals achieve better infection control than they could achieve on their own. © 2012 Project HOPE-The People-to-People Health Foundation, Inc.

Simulation and modeling of turbulent flow, and of turbulent reacting flow in particular, involves solving for and analyzing time-dependent and spatially dense tensor quantities, such as turbulent stress tensors. The interactive visual exploration of these tensor quantities can effectively steer the computational modeling of combustion systems. In this chapter, we discuss the challenges in dense symmetric-tensor visualization applied to turbulent combustion calculation, and analyze the feasibility of using several established tensor visualization techniques in the context of exploring space-time relationships in computationally-simulated combustion tensor data. To tackle the pervasive problems of occlusion and clutter, we propose a solution combining techniques from information and scientific visualization. Specifically, the proposed solution combines a detailed 3D inspection view based on volume rendering with glyph-based representations—used as 2D probes—while leveraging interactive filtering and flow salience cues to clarify the structure of the tensor datasets. Side-by-side views of multiple timesteps facilitate the analysis of time-space relationships. The resulting prototype enables an analysis style based on the overview first, zoom and filter, then details on demand paradigm originally proposed in information visualization. The result is a visual analysis tool to be utilized in debugging, benchmarking, and verification of models and solutions in turbulent combustion. We demonstrate this analysis tool on three example configurations and report feedback from combustion researchers.

Background Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county. Methods/Principal Findings We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities. Conclusions/Significance This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions.

"Turbulence is the most important unsolved problem of classical physics". That was Richard Feynman decades ago, referring to a century old problem. Today, the situation is no different. Turbulent combustion, which deals with a fluid mixture reacting and mixing under turbulent conditions (as found in rockets, jet engines, power generators, car engines, furnaces,...), is harder still. While a solution that would satisfy a physicist is yet to be found, engineers all over the world are tackling the problem with computational modeling and simulation. There are a plethora of models for turbulence and combustion with a whole wide range of competing characteristics of applicability, accuracy, reliability and computational cost. Nowadays, reliability is the key feature required of such modeling (but, most often than not, sacrificed or oversight) for the design of environment friendly and efficient machines.There exists an unproven (but undeniable) direct correlation between reliability and computational cost. However, the era of sacrificing the former because one cannot overcome and afford the latter for a full scale engineering application is over, thanks to TeraGrid and other resources for open research coupled with relentless efforts of countless developers to provide software that runs faster and better. This project is one sampling of how these resources are utilized to overcome an important research problem. We take on the Filtered Density Function (FDF) for large eddy simulation (LES) of turbulent reacting flow, which is a novel and robust methodology that can provide very accurate predictions for a wide range flow conditions. FDF involves an expensive particle/mesh algorithm where stiff chemical reaction computations cause quite interesting, problem specific, and in most cases extremely imbalanced (a couple of orders of magnitude) computational loads. The authors present the Irregularly Portioned Lagrangian Monte Carlo[?], an advanced implementation of FDF based on a simple and smart parallelization strategy that is implemented via optimized solvers and high-level public domain parallelization libraries (eg. Zoltan[?]). The methodology and a discussion of the implementation is presented along with results and benchmarks on the TeraGrid (NICS/Kraken and PSC/Bigben). Scaling and speed up comparisons demonstrate that a conventional parallelization is unable to scale beyond a 100 processors, whereas the new implementation can efficiently utilize 1000 processors for the same size problem, and has enabled the FDF methodology to tackle ever larger problems.