Developing a method for specifying the components of behavior change interventions in practice: the example of smoking cessation.

PubMed

Lorencatto, Fabiana; West, Robert; Seymour, Natalie; Michie, Susan

2013-06-01

There is a difference between interventions as planned and as delivered in practice. Unless we know what was actually delivered, we cannot understand "what worked" in effective interventions. This study aimed to (a) assess whether an established taxonomy of 53 smoking cessation behavior change techniques (BCTs) may be applied or adapted as a method for reliably specifying the content of smoking cessation behavioral support consultations and (b) develop an effective method for training researchers and practitioners in the reliable application of the taxonomy. Fifteen transcripts of audio-recorded consultations delivered by England's Stop Smoking Services were coded into component BCTs using the taxonomy. Interrater reliability and potential adaptations to the taxonomy to improve coding were discussed following 3 coding waves. A coding training manual was developed through expert consensus and piloted on 10 trainees, assessing coding reliability and self-perceived competence before and after training. An average of 33 BCTs from the taxonomy were identified at least once across sessions and coding waves. Consultations contained on average 12 BCTs (range = 8-31). Average interrater reliability was high (88% agreement). The taxonomy was adapted to simplify coding by merging co-occurring BCTs and refining BCT definitions. Coding reliability and self-perceived competence significantly improved posttraining for all trainees. It is possible to apply a taxonomy to reliably identify and classify BCTs in smoking cessation behavioral support delivered in practice, and train inexperienced coders to do so reliably. This method can be used to investigate variability in provision of behavioral support across services, monitor fidelity of delivery, and identify training needs.

Comparing the coding of complications in Queensland and Victorian admitted patient data.

PubMed

Michel, Jude L; Cheng, Diana; Jackson, Terri J

2011-08-01

To examine differences between Queensland and Victorian coding of hospital-acquired conditions and suggest ways to improve the usefulness of these data in the monitoring of patient safety events. Secondary analysis of admitted patient episode data collected in Queensland and Victoria. Comparison of depth of coding, and patterns in the coding of ten commonly coded complications of five elective procedures. Comparison of the mean complication codes assigned per episode revealed Victoria assigns more valid codes than Queensland for all procedures, with the difference between the states being significantly different in all cases. The proportion of the codes flagged as complications was consistently lower for Queensland when comparing 10 common complications for each of the five selected elective procedures. The estimated complication rates for the five procedures showed Victoria to have an apparently higher complication rate than Queensland for 35 of the 50 complications examined. Our findings demonstrate that the coding of complications is more comprehensive in Victoria than in Queensland. It is known that inconsistencies exist between states in routine hospital data quality. Comparative use of patient safety indicators should be viewed with caution until standards are improved across Australia. More exploration of data quality issues is needed to identify areas for improvement.

Effect Coding as a Mechanism for Improving the Accuracy of Measuring Students Who Self-Identify with More than One Race

ERIC Educational Resources Information Center

Mayhew, Matthew J.; Simonoff, Jeffrey S.

2015-01-01

The purpose of this paper is to describe effect coding as an alternative quantitative practice for analyzing and interpreting categorical, multi-raced independent variables in higher education research. Not only may effect coding enable researchers to get closer to respondents' original intentions, it allows for more accurate analyses of all race…

Validation of Case Finding Algorithms for Hepatocellular Cancer from Administrative Data and Electronic Health Records using Natural Language Processing

PubMed Central

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2013-01-01

Background Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC ICD-9 codes, and evaluated whether natural language processing (NLP) by the Automated Retrieval Console (ARC) for document classification improves HCC identification. Methods We identified a cohort of patients with ICD-9 codes for HCC during 2005–2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared to manual classification. PPV, sensitivity, and specificity of ARC were calculated. Results 1138 patients with HCC were identified by ICD-9 codes. Based on manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. Conclusion A combined approach of ICD-9 codes and NLP of pathology and radiology reports improves HCC case identification in automated data. PMID:23929403

Validation of Case Finding Algorithms for Hepatocellular Cancer From Administrative Data and Electronic Health Records Using Natural Language Processing.

PubMed

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2016-02-01

Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

PubMed

Peterson, Rachel; Gundlapalli, Adi V; Metraux, Stephen; Carter, Marjorie E; Palmer, Miland; Redd, Andrew; Samore, Matthew H; Fargo, Jamison D

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

PubMed Central

Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

A Comprehensive Approach to Convert a Radiology Department From Coding Based on International Classification of Diseases, Ninth Revision, to Coding Based on International Classification of Diseases, Tenth Revision.

PubMed

McBee, Morgan P; Laor, Tal; Pryor, Rebecca M; Smith, Rachel; Hardin, Judy; Ulland, Lisa; May, Sally; Zhang, Bin; Towbin, Alexander J

2018-02-01

The purpose of this study was to adapt our radiology reports to provide the documentation required for specific International Classification of Diseases, tenth rev (ICD-10) diagnosis coding. Baseline data were analyzed to identify the reports with the greatest number of unspecified ICD-10 codes assigned by computer-assisted coding software. A two-part quality improvement initiative was subsequently implemented. The first component involved improving clinical histories by utilizing technologists to obtain information directly from the patients or caregivers, which was then imported into the radiologist's report within the speech recognition software. The second component involved standardization of report terminology and creation of four different structured report templates to determine which yielded the fewest reports with an unspecified ICD-10 code assigned by an automated coding engine. In all, 12,077 reports were included in the baseline analysis. Of these, 5,151 (43%) had an unspecified ICD-10 code. The majority of deficient reports were for radiographs (n = 3,197; 62%). Inadequacies included insufficient clinical history provided and lack of detailed fracture descriptions. Therefore, the focus was standardizing terminology and testing different structured reports for radiographs obtained for fractures. At baseline, 58% of radiography reports contained a complete clinical history with improvement to >95% 8 months later. The total number of reports that contained an unspecified ICD-10 code improved from 43% at baseline to 27% at completion of this study (P < .0001). The number of radiology studies with a specific ICD-10 code can be improved through quality improvement methodology, specifically through the use of technologist-acquired clinical histories and structured reporting. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Laser direct marking applied to rasterizing miniature Data Matrix Code on aluminum alloy

NASA Astrophysics Data System (ADS)

Li, Xia-Shuang; He, Wei-Ping; Lei, Lei; Wang, Jian; Guo, Gai-Fang; Zhang, Teng-Yun; Yue, Ting

2016-03-01

Precise miniaturization of 2D Data Matrix (DM) Codes on Aluminum alloy formed by raster mode laser direct part marking is demonstrated. The characteristic edge over-burn effects, which render vector mode laser direct part marking inadequate for producing precise and readable miniature codes, are minimized with raster mode laser marking. To obtain the control mechanism for the contrast and print growth of miniature DM code by raster laser marking process, the temperature field model of long pulse laser interaction with material is established. From the experimental results, laser average power and Q frequency have an important effect on the contrast and print growth of miniature DM code, and the threshold of laser average power and Q frequency for an identifiable miniature DM code are respectively 3.6 W and 110 kHz, which matches the model well within normal operating conditions. In addition, the empirical model of correlation occurring between laser marking parameters and module size is also obtained, and the optimal processing parameter values for an identifiable miniature DM code of different but certain data size are given. It is also found that an increase of the repeat scanning number effectively improves the surface finish of bore, the appearance consistency of modules, which has benefit to reading. The reading quality of miniature DM code is greatly improved using ultrasonic cleaning in water by avoiding the interference of color speckles surrounding modules.

Improving the sensitivity and specificity of the abbreviated injury scale coding system.

PubMed Central

Kramer, C F; Barancik, J I; Thode, H C

1990-01-01

The Abbreviated Injury Scale with Epidemiologic Modifications (AIS 85-EM) was developed to make it possible to code information about anatomic injury types and locations that, although generally available from medical records, is not codable under the standard Abbreviated Injury Scale, published by the American Association for Automotive Medicine in 1985 (AIS 85). In a population-based sample of 3,223 motor vehicle trauma cases, 68 percent of the patients had one or more injuries that were coded to the AIS 85 body region nonspecific category external. When the same patients' injuries were coded using the AIS 85-EM coding procedure, only 15 percent of the patients had injuries that could not be coded to a specific body region. With AIS 85-EM, the proportion of codable head injury cases increased from 16 percent to 37 percent, thereby improving the potential for identifying cases with head and threshold brain injury. The data suggest that body region coding of all injuries is necessary to draw valid and reliable conclusions about changes in injury patterns and their sequelae. The increased specificity of body region coding improves assessments of the efficacy of injury intervention strategies and countermeasure programs using epidemiologic methodology. PMID:2116633

CFD Code Survey for Thrust Chamber Application

NASA Technical Reports Server (NTRS)

Gross, Klaus W.

1990-01-01

In the quest fo find analytical reference codes, responses from a questionnaire are presented which portray the current computational fluid dynamics (CFD) program status and capability at various organizations, characterizing liquid rocket thrust chamber flow fields. Sample cases are identified to examine the ability, operational condition, and accuracy of the codes. To select the best suited programs for accelerated improvements, evaluation criteria are being proposed.

A multicenter collaborative approach to reducing pediatric codes outside the ICU.

PubMed

Hayes, Leslie W; Dobyns, Emily L; DiGiovine, Bruno; Brown, Ann-Marie; Jacobson, Sharon; Randall, Kelly H; Wathen, Beth; Richard, Heather; Schwab, Carolyn; Duncan, Kathy D; Thrasher, Jodi; Logsdon, Tina R; Hall, Matthew; Markovitz, Barry

2012-03-01

The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores. Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%. A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.

Use of diagnosis codes for detection of clinically significant opioid poisoning in the emergency department: A retrospective analysis of a surveillance case definition.

PubMed

Reardon, Joseph M; Harmon, Katherine J; Schult, Genevieve C; Staton, Catherine A; Waller, Anna E

2016-02-08

Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965.00, 965.01, 965.02 and 965.09 (poisoning by opiates and related narcotics) and/or an external cause of injury code of E850.0-E850.2 (accidental poisoning by opiates and related narcotics), and developed a novel case definition to determine in which cases opioid poisoning prompted the ED visit. We calculated the percentage of visits coded for opioid poisoning that were clinically significant and compared it to the percentage of visits coded for poisoning by non-opioid agents in which there was actually poisoning by an opioid agent. We created a multivariate regression model to determine if other collected triage data can improve the positive predictive value of diagnosis codes alone for detecting clinically significant opioid poisoning. 70.1 % of visits (Standard Error 2.4 %) coded for opioid poisoning were primarily prompted by opioid poisoning. The remainder of visits represented opioid exposure in the setting of other primary diseases. Among non-opioid poisoning codes reviewed, up to 36 % were reclassified as an opioid poisoning. In multivariate analysis, only naloxone use improved the positive predictive value of ICD-9-CM codes for identifying clinically significant opioid poisoning, but was associated with a high false negative rate. This surveillance mechanism identifies many clinically significant opioid overdoses with a high positive predictive value. With further validation, it may help target control measures such as prescriber education and pharmacy monitoring.

An international survey of building energy codes and their implementation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Evans, Meredydd; Roshchanka, Volha; Graham, Peter

Buildings are key to low-carbon development everywhere, and many countries have introduced building energy codes to improve energy efficiency in buildings. Yet, building energy codes can only deliver results when the codes are implemented. For this reason, studies of building energy codes need to consider implementation of building energy codes in a consistent and comprehensive way. This research identifies elements and practices in implementing building energy codes, covering codes in 22 countries that account for 70% of global energy demand from buildings. Access to benefits of building energy codes depends on comprehensive coverage of buildings by type, age, size, andmore » geographic location; an implementation framework that involves a certified agency to inspect construction at critical stages; and independently tested, rated, and labeled building energy materials. Training and supporting tools are another element of successful code implementation, and their role is growing in importance, given the increasing flexibility and complexity of building energy codes. Some countries have also introduced compliance evaluation and compliance checking protocols to improve implementation. This article provides examples of practices that countries have adopted to assist with implementation of building energy codes.« less

Validation of The Health Improvement Network (THIN) Database for Epidemiologic Studies of Chronic Kidney Disease

PubMed Central

Denburg, Michelle R.; Haynes, Kevin; Shults, Justine; Lewis, James D.; Leonard, Mary B.

2011-01-01

Purpose Chronic kidney disease (CKD) is a prevalent and important outcome and covariate in pharmacoepidemiology. The Health Improvement Network (THIN) in the U.K. represents a unique resource for population-based studies of CKD. We compiled a valid list of Read codes to identify subjects with moderate to advanced CKD. Methods A cross-sectional validation study was performed to identify codes that best define CKD stages 3–5. All subjects with at least one non-zero measure of serum creatinine after 1-Jan-2002 were included. Estimated glomerular filtration rate (eGFR) was calculated according to the Schwartz formula for subjects <18 years and the Modification of Diet in Renal Disease formula for subjects ≥18 years of age. CKD was defined as an eGFR <60 ml/min/1.73m2 on at least two occasions, more than 90 days apart. Results The laboratory definition identified 230,426 subjects with CKD, for a period prevalence in 2008 of 4.56% (95% CI: 4.54, 4.58). A list of 45 Read codes was compiled which yielded a positive predictive value of 88.9% (95% CI: 88.7, 89.1), sensitivity of 48.8%, negative predictive value of 86.5%, and specificity of 98.2%. Of the 11.1% of subjects with a code who did not meet the laboratory definition, 83.6% had at least one eGFR <60. The most commonly used code was for CKD stage 3. Conclusions The proposed list of codes can be used to accurately identify CKD when serum creatinine data are limited. The most sensitive approach for the detection of CKD is to use this list to supplement creatinine measures. PMID:22020900

Validation of The Health Improvement Network (THIN) database for epidemiologic studies of chronic kidney disease.

PubMed

Denburg, Michelle R; Haynes, Kevin; Shults, Justine; Lewis, James D; Leonard, Mary B

2011-11-01

Chronic kidney disease (CKD) is a prevalent and important outcome and covariate in pharmacoepidemiology. The Health Improvement Network (THIN) in the UK represents a unique resource for population-based studies of CKD. We compiled a valid list of Read codes to identify subjects with moderate to advanced CKD. A cross-sectional validation study was performed to identify codes that best define CKD Stages 3-5. All subjects with at least one non-zero measure of serum creatinine after 1 January 2002 were included. Estimated glomerular filtration rate (eGFR) was calculated according to the Schwartz formula for subjects aged < 18 years and the Modification of Diet in Renal Disease formula for subjects aged ≥ 18 years. CKD was defined as an eGFR <60 mL/minute/1.73 m² on at least two occasions, more than 90 days apart. The laboratory definition identified 230,426 subjects with CKD, for a period prevalence in 2008 of 4.56% (95%CI, 4.54-4.58). A list of 45 Read codes was compiled, which yielded a positive predictive value of 88.9% (95%CI, 88.7-89.1), sensitivity of 48.8%, negative predictive value of 86.5%, and specificity of 98.2%. Of the 11.1% of subjects with a code who did not meet the laboratory definition, 83.6% had at least one eGFR <60. The most commonly used code was for CKD Stage 3. The proposed list of codes can be used to accurately identify CKD when serum creatinine data are limited. The most sensitive approach for the detection of CKD is to use this list to supplement creatinine measures. Copyright © 2011 John Wiley & Sons, Ltd.

Space Applications of the FLUKA Monte-Carlo Code: Lunar and Planetary Exploration

NASA Technical Reports Server (NTRS)

Anderson, V.; Ballarini, F.; Battistoni, G.; Campanella, M.; Carboni, M.; Cerutti, F.; Elkhayari, N.; Empl, A.; Fasso, A.; Ferrari, A.;

Additional Research Needs to Support the GENII Biosphere Models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Napier, Bruce A.; Snyder, Sandra F.; Arimescu, Carmen

In the course of evaluating the current parameter needs for the GENII Version 2 code (Snyder et al. 2013), areas of possible improvement for both the data and the underlying models have been identified. As the data review was implemented, PNNL staff identified areas where the models can be improved both to accommodate the locally significant pathways identified and also to incorporate newer models. The areas are general data needs for the existing models and improved formulations for the pathway models.

Improved numerical methods for turbulent viscous recirculating flows

NASA Technical Reports Server (NTRS)

Turan, A.

1985-01-01

The hybrid-upwind finite difference schemes employed in generally available combustor codes possess excessive numerical diffusion errors which preclude accurate quantative calculations. The present study has as its primary objective the identification and assessment of an improved solution algorithm as well as discretization schemes applicable to analysis of turbulent viscous recirculating flows. The assessment is carried out primarily in two dimensional/axisymetric geometries with a view to identifying an appropriate technique to be incorporated in a three-dimensional code.

Accuracy of Administrative Billing Codes to Detect Urinary Tract Infection Hospitalizations

PubMed Central

Hall, Matthew; Auger, Katherine A.; Hain, Paul D.; Jerardi, Karen E.; Myers, Angela L.; Rahman, Suraiya S.; Williams, Derek J.; Shah, Samir S.

2011-01-01

BACKGROUND: Hospital billing data are frequently used for quality measures and research, but the accuracy of the use of discharge codes to identify urinary tract infections (UTIs) is unknown. OBJECTIVE: To determine the accuracy of International Classification of Diseases, 9th revision (ICD-9) discharge codes to identify children hospitalized with UTIs. METHODS: This multicenter study conducted in 5 children's hospitals included children aged 3 days to 18 years who had been admitted to the hospital, undergone a urinalysis or urine culture, and discharged from the hospital. Data were obtained from the pediatric health information system database and medical record review. With the use of 2 gold-standard methods, the positive predictive value (PPV) was calculated for individual and combined UTI codes and for common UTI identification strategies. PPV was measured for all groupings for which the UTI code was the principal discharge diagnosis. RESULTS: There were 833 patients in the study. The PPV was 50.3% with the use of the gold standard of laboratory-confirmed UTIs but increased to 85% with provider confirmation. Restriction of the study cohort to patients with a principle diagnosis of UTI improved the PPV for laboratory-confirmed UTI (61.2%) and provider-confirmed UTI (93.2%), as well as the ability to benchmark performance. Other common identification strategies did not markedly affect the PPV. CONCLUSIONS: ICD-9 codes can be used to identify patients with UTIs but are most accurate when UTI is the principal discharge diagnosis. The identification strategies reported in this study can be used to improve the accuracy and applicability of benchmarking measures. PMID:21768320

Predictive value of the present-on-admission indicator for hospital-acquired venous thromboembolism.

PubMed

Khanna, Raman R; Kim, Sharon B; Jenkins, Ian; El-Kareh, Robert; Afsarmanesh, Nasim; Amin, Alpesh; Sand, Heather; Auerbach, Andrew; Chia, Catherine Y; Maynard, Gregory; Romano, Patrick S; White, Richard H

2015-04-01

Hospital-acquired venous thromboembolic (HA-VTE) events are an important, preventable cause of morbidity and death, but accurately identifying HA-VTE events requires labor-intensive chart review. Administrative diagnosis codes and their associated "present-on-admission" (POA) indicator might allow automated identification of HA-VTE events, but only if VTE codes are accurately flagged "not present-on-admission" (POA=N). New codes were introduced in 2009 to improve accuracy. We identified all medical patients with at least 1 VTE "other" discharge diagnosis code from 5 academic medical centers over a 24-month period. We then sampled, within each center, patients with VTE codes flagged POA=N or POA=U (insufficient documentation) and POA=Y or POA=W (timing clinically uncertain) and abstracted each chart to clarify VTE timing. All events that were not clearly POA were classified as HA-VTE. We then calculated predictive values of the POA=N/U flags for HA-VTE and the POA=Y/W flags for non-HA-VTE. Among 2070 cases with at least 1 "other" VTE code, we found 339 codes flagged POA=N/U and 1941 flagged POA=Y/W. Among 275 POA=N/U abstracted codes, 75.6% (95% CI, 70.1%-80.6%) were HA-VTE; among 291 POA=Y/W abstracted events, 73.5% (95% CI, 68.0%-78.5%) were non-HA-VTE. Extrapolating from this sample, we estimated that 59% of actual HA-VTE codes were incorrectly flagged POA=Y/W. POA indicator predictive values did not improve after new codes were introduced in 2009. The predictive value of VTE events flagged POA=N/U for HA-VTE was 75%. However, sole reliance on this flag may substantially underestimate the incidence of HA-VTE.

Optimizing the performance and structure of the D0 Collie confidence limit evaluator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fishchler, Mark; /Fermilab

2010-07-01

D0 Collie is a program used to perform limit calculations based on ensembles of pseudo-experiments ('PEs'). Since the application of this program to the crucial Higgs mass limit is quite CPU intensive, it has been deemed important to carefully review this program, with an eye toward identifying and implementing potential performance improvements. At the same time, we identify any coding errors or opportunities for potential structural (or algorithm) improvement discovered in the course of gaining sufficient understanding of the workings of Collie to sensibly explore for optimizations. Based on a careful analysis of the program, a series of code changesmore » with potential for improving performance has been identified. The implementation and evaluation of the most important parts of this series has been done, with gratifying speedup results. The bottom line: We have identified and implemented changes leading to a factor of 2.19 speedup in the example program provided, and expected to translate to a factor of roughly 4 speedup in typical realistic usage.« less

Computer-based coding of free-text job descriptions to efficiently identify occupations in epidemiological studies

PubMed Central

Russ, Daniel E.; Ho, Kwan-Yuet; Colt, Joanne S.; Armenti, Karla R.; Baris, Dalsu; Chow, Wong-Ho; Davis, Faith; Johnson, Alison; Purdue, Mark P.; Karagas, Margaret R.; Schwartz, Kendra; Schwenn, Molly; Silverman, Debra T.; Johnson, Calvin A.; Friesen, Melissa C.

2016-01-01

Background Mapping job titles to standardized occupation classification (SOC) codes is an important step in identifying occupational risk factors in epidemiologic studies. Because manual coding is time-consuming and has moderate reliability, we developed an algorithm called SOCcer (Standardized Occupation Coding for Computer-assisted Epidemiologic Research) to assign SOC-2010 codes based on free-text job description components. Methods Job title and task-based classifiers were developed by comparing job descriptions to multiple sources linking job and task descriptions to SOC codes. An industry-based classifier was developed based on the SOC prevalence within an industry. These classifiers were used in a logistic model trained using 14,983 jobs with expert-assigned SOC codes to obtain empirical weights for an algorithm that scored each SOC/job description. We assigned the highest scoring SOC code to each job. SOCcer was validated in two occupational data sources by comparing SOC codes obtained from SOCcer to expert assigned SOC codes and lead exposure estimates obtained by linking SOC codes to a job-exposure matrix. Results For 11,991 case-control study jobs, SOCcer-assigned codes agreed with 44.5% and 76.3% of manually assigned codes at the 6- and 2-digit level, respectively. Agreement increased with the score, providing a mechanism to identify assignments needing review. Good agreement was observed between lead estimates based on SOCcer and manual SOC assignments (kappa: 0.6–0.8). Poorer performance was observed for inspection job descriptions, which included abbreviations and worksite-specific terminology. Conclusions Although some manual coding will remain necessary, using SOCcer may improve the efficiency of incorporating occupation into large-scale epidemiologic studies. PMID:27102331

Accuracy of ICD-10 Coding System for Identifying Comorbidities and Infectious Conditions Using Data from a Thai University Hospital Administrative Database.

PubMed

Rattanaumpawan, Pinyo; Wongkamhla, Thanyarak; Thamlikitkul, Visanu

2016-04-01

To determine the accuracy of International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system in identifying comorbidities and infectious conditions using data from a Thai university hospital administrative database. A retrospective cross-sectional study was conducted among patients hospitalized in six general medicine wards at Siriraj Hospital. ICD-10 code data was identified and retrieved directly from the hospital administrative database. Patient comorbidities were captured using the ICD-10 coding algorithm for the Charlson comorbidity index. Infectious conditions were captured using the groups of ICD-10 diagnostic codes that were carefully prepared by two independent infectious disease specialists. Accuracy of ICD-10 codes combined with microbiological dataf or diagnosis of urinary tract infection (UTI) and bloodstream infection (BSI) was evaluated. Clinical data gathered from chart review was considered the gold standard in this study. Between February 1 and May 31, 2013, a chart review of 546 hospitalization records was conducted. The mean age of hospitalized patients was 62.8 ± 17.8 years and 65.9% of patients were female. Median length of stay [range] was 10.0 [1.0-353.0] days and hospital mortality was 21.8%. Conditions with ICD-10 codes that had good sensitivity (90% or higher) were diabetes mellitus and HIV infection. Conditions with ICD-10 codes that had good specificity (90% or higher) were cerebrovascular disease, chronic lung disease, diabetes mellitus, cancer HIV infection, and all infectious conditions. By combining ICD-10 codes with microbiological results, sensitivity increased from 49.5 to 66%for UTI and from 78.3 to 92.8%for BS. The ICD-10 coding algorithm is reliable only in some selected conditions, including underlying diabetes mellitus and HIV infection. Combining microbiological results with ICD-10 codes increased sensitivity of ICD-10 codes for identifying BSI. Future research is needed to improve the accuracy of hospital administrative coding system in Thailand.

Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

PubMed

Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

2016-08-27

The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

Performance and limitations of administrative data in the identification of AKI.

PubMed

Grams, Morgan E; Waikar, Sushrut S; MacMahon, Blaithin; Whelton, Seamus; Ballew, Shoshana H; Coresh, Josef

2014-04-01

Billing codes are frequently used to identify AKI events in epidemiologic research. The goals of this study were to validate billing code-identified AKI against the current AKI consensus definition and to ascertain whether sensitivity and specificity vary by patient characteristic or over time. The study population included 10,056 Atherosclerosis Risk in Communities study participants hospitalized between 1996 and 2008. Billing code-identified AKI was compared with the 2012 Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria (AKIcr) and an approximation of the 2012 KDIGO creatinine- and urine output-based criteria (AKIcr_uop) in a subset with available outpatient data. Sensitivity and specificity of billing code-identified AKI were evaluated over time and according to patient age, race, sex, diabetes status, and CKD status in 546 charts selected for review, with estimates adjusted for sampling technique. A total of 34,179 hospitalizations were identified; 1353 had a billing code for AKI. The sensitivity of billing code-identified AKI was 17.2% (95% confidence interval [95% CI], 13.2% to 21.2%) compared with AKIcr (n=1970 hospitalizations) and 11.7% (95% CI, 8.8% to 14.5%) compared with AKIcr_uop (n=1839 hospitalizations). Specificity was >98% in both cases. Sensitivity was significantly higher in the more recent time period (2002-2008) and among participants aged 65 years and older. Billing code-identified AKI captured a more severe spectrum of disease than did AKIcr and AKIcr_uop, with a larger proportion of patients with stage 3 AKI (34.9%, 19.7%, and 11.5%, respectively) and higher in-hospital mortality (41.2%, 18.7%, and 12.8%, respectively). The use of billing codes to identify AKI has low sensitivity compared with the current KDIGO consensus definition, especially when the urine output criterion is included, and results in the identification of a more severe phenotype. Epidemiologic studies using billing codes may benefit from a high specificity, but the variation in sensitivity may result in bias, particularly when trends over time are the outcome of interest.

Overview of NASA Multi-dimensional Stirling Convertor Code Development and Validation Effort

NASA Technical Reports Server (NTRS)

Tew, Roy C.; Cairelli, James E.; Ibrahim, Mounir B.; Simon, Terrence W.; Gedeon, David

2002-01-01

A NASA grant has been awarded to Cleveland State University (CSU) to develop a multi-dimensional (multi-D) Stirling computer code with the goals of improving loss predictions and identifying component areas for improvements. The University of Minnesota (UMN) and Gedeon Associates are teamed with CSU. Development of test rigs at UMN and CSU and validation of the code against test data are part of the effort. The one-dimensional (1-D) Stirling codes used for design and performance prediction do not rigorously model regions of the working space where abrupt changes in flow area occur (such as manifolds and other transitions between components). Certain hardware experiences have demonstrated large performance gains by varying manifolds and heat exchanger designs to improve flow distributions in the heat exchangers. 1-D codes were not able to predict these performance gains. An accurate multi-D code should improve understanding of the effects of area changes along the main flow axis, sensitivity of performance to slight changes in internal geometry, and, in general, the understanding of various internal thermodynamic losses. The commercial CFD-ACE code has been chosen for development of the multi-D code. This 2-D/3-D code has highly developed pre- and post-processors, and moving boundary capability. Preliminary attempts at validation of CFD-ACE models of MIT gas spring and "two space" test rigs were encouraging. Also, CSU's simulations of the UMN oscillating-flow fig compare well with flow visualization results from UMN. A complementary Department of Energy (DOE) Regenerator Research effort is aiding in development of regenerator matrix models that will be used in the multi-D Stirling code. This paper reports on the progress and challenges of this

Users Manual for the NASA Lewis Ice Accretion Prediction Code (LEWICE)

NASA Technical Reports Server (NTRS)

Ruff, Gary A.; Berkowitz, Brian M.

1990-01-01

LEWICE is an ice accretion prediction code that applies a time-stepping procedure to calculate the shape of an ice accretion. The potential flow field is calculated in LEWICE using the Douglas Hess-Smith 2-D panel code (S24Y). This potential flow field is then used to calculate the trajectories of particles and the impingement points on the body. These calculations are performed to determine the distribution of liquid water impinging on the body, which then serves as input to the icing thermodynamic code. The icing thermodynamic model is based on the work of Messinger, but contains several major modifications and improvements. This model is used to calculate the ice growth rate at each point on the surface of the geometry. By specifying an icing time increment, the ice growth rate can be interpreted as an ice thickness which is added to the body, resulting in the generation of new coordinates. This procedure is repeated, beginning with the potential flow calculations, until the desired icing time is reached. The operation of LEWICE is illustrated through the use of five examples. These examples are representative of the types of applications expected for LEWICE. All input and output is discussed, along with many of the diagnostic messages contained in the code. Several error conditions that may occur in the code for certain icing conditions are identified, and a course of action is recommended. LEWICE has been used to calculate a variety of ice shapes, but should still be considered a research code. The code should be exercised further to identify any shortcomings and inadequacies. Any modifications identified as a result of these cases, or of additional experimental results, should be incorporated into the model. Using it as a test bed for improvements to the ice accretion model is one important application of LEWICE.

Identification of novel mRNAs and lncRNAs associated with mouse experimental colitis and human inflammatory bowel disease.

PubMed

Rankin, Carl Robert; Theodorou, Evangelos; Law, Ivy Ka Man; Rowe, Lorraine; Kokkotou, Efi; Pekow, Joel; Wang, Jiafang; Martin, Martin G; Pothoulakis, Charalabos; Padua, David Miguel

2018-06-28

Inflammatory bowel disease (IBD) is a complex disorder that is associated with significant morbidity. While many recent advances have been made with new diagnostic and therapeutic tools, a deeper understanding of its basic pathophysiology is needed to continue this trend towards improving treatments. By utilizing an unbiased, high-throughput transcriptomic analysis of two well-established mouse models of colitis, we set out to uncover novel coding and non-coding RNAs that are differentially expressed in the setting of colonic inflammation. RNA-seq analysis was performed using colonic tissue from two mouse models of colitis, a dextran sodium sulfate induced model and a genetic-induced model in mice lacking IL-10. We identified 81 coding RNAs that were commonly altered in both experimental models. Of these coding RNAs, 12 of the human orthologs were differentially expressed in a transcriptomic analysis of IBD patients. Interestingly, 5 of the 12 of human differentially expressed genes have not been previously identified as IBD-associated genes, including ubiquitin D. Our analysis also identified 15 non-coding RNAs that were differentially expressed in either mouse model. Surprisingly, only three non-coding RNAs were commonly dysregulated in both of these models. The discovery of these new coding and non-coding RNAs expands our transcriptional knowledge of mouse models of IBD and offers additional targets to deepen our understanding of the pathophysiology of IBD.

The identification of incident cancers in UK primary care databases: a systematic review.

PubMed

Rañopa, Michael; Douglas, Ian; van Staa, Tjeerd; Smeeth, Liam; Klungel, Olaf; Reynolds, Robert; Bhaskaran, Krishnan

2015-01-01

UK primary care databases are frequently used in observational studies with cancer outcomes. We aimed to systematically review methods used by such studies to identify and validate incident cancers of the breast, colorectum, and prostate. Medline and Embase (1980-2013) were searched for UK primary care database studies with incident breast, colorectal, or prostate cancer outcomes. Data on the methods used for case ascertainment were extracted and summarised. Questionnaires were sent to corresponding authors to obtain details about case ascertainment. Eighty-four studies of breast (n = 51), colorectal (n = 54), and prostate cancer (n = 31) were identified; 30 examined >1 cancer type. Among the 84 studies, 57 defined cancers using only diagnosis codes, while 27 required further evidence such as chemotherapy. Few studies described methods used to create cancer code lists (n = 5); or made lists available directly (n = 5). Twenty-eight code lists were received on request from study authors. All included malignant neoplasm diagnosis codes, but there was considerable variation in the specific codes included which was not explained by coding dictionary changes. Code lists also varied in terms of other types of codes included, such as in-situ, cancer morphology, history of cancer, and secondary/suspected/borderline cancer codes. In UK primary care database studies, methods for identifying breast, colorectal, and prostate cancers were often unclear. Code lists were often unavailable, and where provided, we observed variation in the individual codes and types of codes included. Clearer reporting of methods and publication of code lists would improve transparency and reproducibility of studies. Copyright © 2014 John Wiley & Sons, Ltd.

Systemic inaccuracies in the National Surgical Quality Improvement Program database: Implications for accuracy and validity for neurosurgery outcomes research.

PubMed

Rolston, John D; Han, Seunggu J; Chang, Edward F

2017-03-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) provides a rich database of North American surgical procedures and their complications. Yet no external source has validated the accuracy of the information within this database. Using records from the 2006 to 2013 NSQIP database, we used two methods to identify errors: (1) mismatches between the Current Procedural Terminology (CPT) code that was used to identify the surgical procedure, and the International Classification of Diseases (ICD-9) post-operative diagnosis: i.e., a diagnosis that is incompatible with a certain procedure. (2) Primary anesthetic and CPT code mismatching: i.e., anesthesia not indicated for a particular procedure. Analyzing data for movement disorders, epilepsy, and tumor resection, we found evidence of CPT code and postoperative diagnosis mismatches in 0.4-100% of cases, depending on the CPT code examined. When analyzing anesthetic data from brain tumor, epilepsy, trauma, and spine surgery, we found evidence of miscoded anesthesia in 0.1-0.8% of cases. National databases like NSQIP are an important tool for quality improvement. Yet all databases are subject to errors, and measures of internal consistency show that errors affect up to 100% of case records for certain procedures in NSQIP. Steps should be taken to improve data collection on the frontend of NSQIP, and also to ensure that future studies with NSQIP take steps to exclude erroneous cases from analysis. Copyright © 2016 Elsevier Ltd. All rights reserved.

An Object-Oriented Computer Code for Aircraft Engine Weight Estimation

NASA Technical Reports Server (NTRS)

Tong, Michael T.; Naylor, Bret A.

2009-01-01

Reliable engine-weight estimation at the conceptual design stage is critical to the development of new aircraft engines. It helps to identify the best engine concept amongst several candidates. At NASA Glenn Research Center (GRC), the Weight Analysis of Turbine Engines (WATE) computer code, originally developed by Boeing Aircraft, has been used to estimate the engine weight of various conceptual engine designs. The code, written in FORTRAN, was originally developed for NASA in 1979. Since then, substantial improvements have been made to the code to improve the weight calculations for most of the engine components. Most recently, to improve the maintainability and extensibility of WATE, the FORTRAN code has been converted into an object-oriented version. The conversion was done within the NASA's NPSS (Numerical Propulsion System Simulation) framework. This enables WATE to interact seamlessly with the thermodynamic cycle model which provides component flow data such as airflows, temperatures, and pressures, etc., that are required for sizing the components and weight calculations. The tighter integration between the NPSS and WATE would greatly enhance system-level analysis and optimization capabilities. It also would facilitate the enhancement of the WATE code for next-generation aircraft and space propulsion systems. In this paper, the architecture of the object-oriented WATE code (or WATE++) is described. Both the FORTRAN and object-oriented versions of the code are employed to compute the dimensions and weight of a 300-passenger aircraft engine (GE90 class). Both versions of the code produce essentially identical results as should be the case.

Cohort-specific imputation of gene expression improves prediction of warfarin dose for African Americans.

PubMed

Gottlieb, Assaf; Daneshjou, Roxana; DeGorter, Marianne; Bourgeois, Stephane; Svensson, Peter J; Wadelius, Mia; Deloukas, Panos; Montgomery, Stephen B; Altman, Russ B

2017-11-24

Genome-wide association studies are useful for discovering genotype-phenotype associations but are limited because they require large cohorts to identify a signal, which can be population-specific. Mapping genetic variation to genes improves power and allows the effects of both protein-coding variation as well as variation in expression to be combined into "gene level" effects. Previous work has shown that warfarin dose can be predicted using information from genetic variation that affects protein-coding regions. Here, we introduce a method that improves dose prediction by integrating tissue-specific gene expression. In particular, we use drug pathways and expression quantitative trait loci knowledge to impute gene expression-on the assumption that differential expression of key pathway genes may impact dose requirement. We focus on 116 genes from the pharmacokinetic and pharmacodynamic pathways of warfarin within training and validation sets comprising both European and African-descent individuals. We build gene-tissue signatures associated with warfarin dose in a cohort-specific manner and identify a signature of 11 gene-tissue pairs that significantly augments the International Warfarin Pharmacogenetics Consortium dosage-prediction algorithm in both populations. Our results demonstrate that imputed expression can improve dose prediction and bridge population-specific compositions. MATLAB code is available at https://github.com/assafgo/warfarin-cohort.

Superdense coding interleaved with forward error correction

DOE PAGES

Humble, Travis S.; Sadlier, Ronald J.

2016-05-12

Superdense coding promises increased classical capacity and communication security but this advantage may be undermined by noise in the quantum channel. We present a numerical study of how forward error correction (FEC) applied to the encoded classical message can be used to mitigate against quantum channel noise. By studying the bit error rate under different FEC codes, we identify the unique role that burst errors play in superdense coding, and we show how these can be mitigated against by interleaving the FEC codewords prior to transmission. As a result, we conclude that classical FEC with interleaving is a useful methodmore » to improve the performance in near-term demonstrations of superdense coding.« less

Prevalence of Pulsatile Tinnitus Among Patients With Migraine.

PubMed

Weinreich, Heather M; Carey, John P

2016-03-01

To examine the prevalence of pulsatile tinnitus (PT) among patients with a diagnosis of migraine and to determine if treatment of migraine improves symptoms. Single-institution retrospective patient review. Academic tertiary referral center. Billing data capturing ICD-9 codes 346.xx and 388.3x was used to identify patients with history of migraine and tinnitus. Patients were excluded if the symptom of PT could be attributed to an alternate diagnosis. Data were extracted from the patients' electronic medical records. Therapeutic patients were prescribed a strict migraine diet with or without migraine medication. Subjective improvement in tinnitus as documented in electronic medical records. One thousand two hundred four patients were identified with an ICD-9 code for migraine and of those patients, 12% (n = 145) had an ICD-9 code for tinnitus. After ruling out alternative causes, the prevalence of PT among all patients with migraine was 1.9%. Of migrainers with PT who underwent migraine treatment, 11 out of 16 reported resolution or improvement of their PT. PT can be observed in the context of migraine. Migraine treatment with avoidance of dietary triggers with or without medication can possibly lead to resolution of PT.

Use of a Respondent-Generated Personal Code for Matching Anonymous Adolescent Surveys in Longitudinal Studies.

PubMed

Ripper, Lisa; Ciaravino, Samantha; Jones, Kelley; Jaime, Maria Catrina D; Miller, Elizabeth

2017-06-01

Research on sensitive and private topics relies heavily on self-reported responses. Social desirability bias may reduce the accuracy and reliability of self-reported responses. Anonymous surveys appear to improve the likelihood of honest responses. A challenge with prospective research is maintaining anonymity while linking individual surveys over time. We have tested a secret code method in which participants create their own code based on eight questions that are not expected to change. In an ongoing middle school trial, 95.7% of follow-up surveys are matched to a baseline survey after changing up to two-code variables. The percentage matched improves by allowing up to four changes (99.7%). The use of a secret code as an anonymous identifier for linking baseline and follow-up surveys is feasible for use with adolescents. While developed for violence prevention research, this method may be useful with other sensitive health behavior research. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Improving the genome annotation of the acarbose producer Actinoplanes sp. SE50/110 by sequencing enriched 5'-ends of primary transcripts.

PubMed

Schwientek, Patrick; Neshat, Armin; Kalinowski, Jörn; Klein, Andreas; Rückert, Christian; Schneiker-Bekel, Susanne; Wendler, Sergej; Stoye, Jens; Pühler, Alfred

2014-11-20

Actinoplanes sp. SE50/110 is the producer of the alpha-glucosidase inhibitor acarbose, which is an economically relevant and potent drug in the treatment of type-2 diabetes mellitus. In this study, we present the detection of transcription start sites on this genome by sequencing enriched 5'-ends of primary transcripts. Altogether, 1427 putative transcription start sites were initially identified. With help of the annotated genome sequence, 661 transcription start sites were found to belong to the leader region of protein-coding genes with the surprising result that roughly 20% of these genes rank among the class of leaderless transcripts. Next, conserved promoter motifs were identified for protein-coding genes with and without leader sequences. The mapped transcription start sites were finally used to improve the annotation of the Actinoplanes sp. SE50/110 genome sequence. Concerning protein-coding genes, 41 translation start sites were corrected and 9 novel protein-coding genes could be identified. In addition to this, 122 previously undetermined non-coding RNA (ncRNA) genes of Actinoplanes sp. SE50/110 were defined. Focusing on antisense transcription start sites located within coding genes or their leader sequences, it was discovered that 96 of those ncRNA genes belong to the class of antisense RNA (asRNA) genes. The remaining 26 ncRNA genes were found outside of known protein-coding genes. Four chosen examples of prominent ncRNA genes, namely the transfer messenger RNA gene ssrA, the ribonuclease P class A RNA gene rnpB, the cobalamin riboswitch RNA gene cobRS, and the selenocysteine-specific tRNA gene selC, are presented in more detail. This study demonstrates that sequencing of enriched 5'-ends of primary transcripts and the identification of transcription start sites are valuable tools for advanced genome annotation of Actinoplanes sp. SE50/110 and most probably also for other bacteria. Copyright © 2014 Elsevier B.V. All rights reserved.

The reliability of information on work-related injuries available from hospitalisation data in Australia.

PubMed

McKenzie, Kirsten; Mitchell, Rebecca; Scott, Deborah Anne; Harrison, James Edward; McClure, Roderick John

2009-08-01

To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. A random sample of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across four states in Australia. From this sample, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder; (ii) an independent auditor, blinded to the original code; or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. Of the 4,373 cases sampled, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. The best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries.

Can social media be used as a hospital quality improvement tool?

PubMed

Lagu, Tara; Goff, Sarah L; Craft, Ben; Calcasola, Stephanie; Benjamin, Evan M; Priya, Aruna; Lindenauer, Peter K

2016-01-01

Many hospitals wish to improve their patients' experience of care. To learn whether social media could be used as a tool to engage patients and to identify opportunities for hospital quality improvement (QI), we solicited patients' narrative feedback on the Baystate Medical Center Facebook page during a 3-week period in 2014. Two investigators used directed qualitative content analysis to code comments and descriptive statistics to assess the frequency of selected codes and themes. We identified common themes, including: (1) comments about staff (17/37 respondents, 45.9%); (2) comments about specific departments (22/37, 59.5%); (3) comments on technical aspects of care, including perceived errors and inattention to pain control (9/37, 24.3%); and (4) comments describing the hospital physical plant, parking, and amenities (9/37, 24.3%). A small number (n = 3) of patients repeatedly responded, accounting for 30% (45/148) of narratives. Although patient feedback on social media could help to drive hospital QI efforts, any potential benefits must be weighed against the reputational risks, the lack of representativeness among respondents, and the volume of responses needed to identify areas of improvement. © 2015 Society of Hospital Medicine.

Searching hospital discharge records for snow sport injury: no easy run?

PubMed

Smartt, Pamela F M; Chalmers, David J

2012-01-01

When using hospital discharge data to shape sports injury prevention policy, it is important to correctly identify cases. The objectives of this study were to examine the ease with which snow-skiing and snowboarding injury cases could be identified from national hospital discharge data and to assess the suitability of the information obtained for shaping policy. Hospital discharges for 2000-2004 were linked to compensated claims and searched sequentially using coded and narrative information. One thousand three hundred seventy-six eligible cases were identified, with 717 classified as snowboarding and 659 as snow-skiing. For the most part, cases could not be identified and distinguished using simple searches of coded data; keyword searches of narratives played a key role in case identification but not in describing the mechanism of injury. Identification and characterisation of snow sport injury from in-patient discharge records is problematic due to inadequacies in the coding systems and/or their implementation. Narrative reporting could be improved.

Computer-based coding of free-text job descriptions to efficiently identify occupations in epidemiological studies.

PubMed

Russ, Daniel E; Ho, Kwan-Yuet; Colt, Joanne S; Armenti, Karla R; Baris, Dalsu; Chow, Wong-Ho; Davis, Faith; Johnson, Alison; Purdue, Mark P; Karagas, Margaret R; Schwartz, Kendra; Schwenn, Molly; Silverman, Debra T; Johnson, Calvin A; Friesen, Melissa C

2016-06-01

Mapping job titles to standardised occupation classification (SOC) codes is an important step in identifying occupational risk factors in epidemiological studies. Because manual coding is time-consuming and has moderate reliability, we developed an algorithm called SOCcer (Standardized Occupation Coding for Computer-assisted Epidemiologic Research) to assign SOC-2010 codes based on free-text job description components. Job title and task-based classifiers were developed by comparing job descriptions to multiple sources linking job and task descriptions to SOC codes. An industry-based classifier was developed based on the SOC prevalence within an industry. These classifiers were used in a logistic model trained using 14 983 jobs with expert-assigned SOC codes to obtain empirical weights for an algorithm that scored each SOC/job description. We assigned the highest scoring SOC code to each job. SOCcer was validated in 2 occupational data sources by comparing SOC codes obtained from SOCcer to expert assigned SOC codes and lead exposure estimates obtained by linking SOC codes to a job-exposure matrix. For 11 991 case-control study jobs, SOCcer-assigned codes agreed with 44.5% and 76.3% of manually assigned codes at the 6-digit and 2-digit level, respectively. Agreement increased with the score, providing a mechanism to identify assignments needing review. Good agreement was observed between lead estimates based on SOCcer and manual SOC assignments (κ 0.6-0.8). Poorer performance was observed for inspection job descriptions, which included abbreviations and worksite-specific terminology. Although some manual coding will remain necessary, using SOCcer may improve the efficiency of incorporating occupation into large-scale epidemiological studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

An Object-oriented Computer Code for Aircraft Engine Weight Estimation

NASA Technical Reports Server (NTRS)

Tong, Michael T.; Naylor, Bret A.

2008-01-01

Reliable engine-weight estimation at the conceptual design stage is critical to the development of new aircraft engines. It helps to identify the best engine concept amongst several candidates. At NASA Glenn (GRC), the Weight Analysis of Turbine Engines (WATE) computer code, originally developed by Boeing Aircraft, has been used to estimate the engine weight of various conceptual engine designs. The code, written in FORTRAN, was originally developed for NASA in 1979. Since then, substantial improvements have been made to the code to improve the weight calculations for most of the engine components. Most recently, to improve the maintainability and extensibility of WATE, the FORTRAN code has been converted into an object-oriented version. The conversion was done within the NASA s NPSS (Numerical Propulsion System Simulation) framework. This enables WATE to interact seamlessly with the thermodynamic cycle model which provides component flow data such as airflows, temperatures, and pressures, etc. that are required for sizing the components and weight calculations. The tighter integration between the NPSS and WATE would greatly enhance system-level analysis and optimization capabilities. It also would facilitate the enhancement of the WATE code for next-generation aircraft and space propulsion systems. In this paper, the architecture of the object-oriented WATE code (or WATE++) is described. Both the FORTRAN and object-oriented versions of the code are employed to compute the dimensions and weight of a 300- passenger aircraft engine (GE90 class). Both versions of the code produce essentially identical results as should be the case. Keywords: NASA, aircraft engine, weight, object-oriented

Evaluation of the Components of the North Carolina Syndromic Surveillance System Heat Syndrome Case Definition.

PubMed

Harduar Morano, Laurel; Waller, Anna E

To improve heat-related illness surveillance, we evaluated and refined North Carolina's heat syndrome case definition. We analyzed North Carolina emergency department (ED) visits during 2012-2014. We evaluated the current heat syndrome case definition (ie, keywords in chief complaint/triage notes or International Classification of Diseases, Ninth Revision, Clinical Modification [ ICD-9-CM] codes) and additional heat-related inclusion and exclusion keywords. We calculated the positive predictive value and sensitivity of keyword-identified ED visits and manually reviewed ED visits to identify true positives and false positives. The current heat syndrome case definition identified 8928 ED visits; additional inclusion keywords identified another 598 ED visits. Of 4006 keyword-identified ED visits, 3216 (80.3%) were captured by 4 phrases: "heat ex" (n = 1674, 41.8%), "overheat" (n = 646, 16.1%), "too hot" (n = 594, 14.8%), and "heatstroke" (n = 302, 7.5%). Among the 267 ED visits identified by keyword only, a burn diagnosis or the following keywords resulted in a false-positive rate >95%: "burn," "grease," "liquid," "oil," "radiator," "antifreeze," "hot tub," "hot spring," and "sauna." After applying the revised inclusion and exclusion criteria, we identified 9132 heat-related ED visits: 2157 by keyword only, 5493 by ICD-9-CM code only, and 1482 by both (sensitivity = 27.0%, positive predictive value = 40.7%). Cases identified by keywords were strongly correlated with cases identified by ICD-9-CM codes (rho = .94, P < .001). Revising the heat syndrome case definition through the use of additional inclusion and exclusion criteria substantially improved the accuracy of the surveillance system. Other jurisdictions may benefit from refining their heat syndrome case definition.

LDPC-based iterative joint source-channel decoding for JPEG2000.

PubMed

Pu, Lingling; Wu, Zhenyu; Bilgin, Ali; Marcellin, Michael W; Vasic, Bane

2007-02-01

A framework is proposed for iterative joint source-channel decoding of JPEG2000 codestreams. At the encoder, JPEG2000 is used to perform source coding with certain error-resilience (ER) modes, and LDPC codes are used to perform channel coding. During decoding, the source decoder uses the ER modes to identify corrupt sections of the codestream and provides this information to the channel decoder. Decoding is carried out jointly in an iterative fashion. Experimental results indicate that the proposed method requires fewer iterations and improves overall system performance.

Perinatal Experiences of Women With Physical Disabilities and Their Recommendations for Clinicians

PubMed Central

Smeltzer, Suzanne C.; Mitra, Monika; Iezzoni, Lisa I.; Long-Bellil, Linda; Smith, Lauren D.

2016-01-01

Objective To explore the perinatal experiences of women with physical disabilities (WWPD) and their associated recommendations for maternity care clinicians to improve care. Design A mixed-method study was conducted using a semi-structured interview guide to identify the experiences of WWPD. This qualitative descriptive study is part of a larger study and was conducted to examine the perceptions of WWPD about their interactions with maternity care clinicians and their recommendations for maternity care clinicians to improve care. Participants Twenty-five women with physical disabilities who gave birth within the last 10 years and were 21–55 years of age were recruited and agreed to participate in the study. Methods Participants were asked about their interactions with clinicians during pregnancy and their recommendations for clinicians to improve perinatal care for women with physical disabilities. Transcribed interviews were analyzed using content analysis. Themes that emerged from analysis of the interviews were identified and coded. Kurasaski’s coding was used to establish the reliability of the coding. Results Three themes emerged from analysis of the interview data: clinicians’ lack of knowledge about pregnancy-related needs of WWPD; clinicians’ failure to consider knowledge, experience, and expertise of women about their own disabilities; and clinicians’ lack of awareness of reproductive concerns of WWPD. Women provided recommendations that warrant attention by clinicians who provide perinatal care for women who live with physical disabilities. Conclusion Participants experienced problematic interactions with clinicians related to pregnancy and identified recommendations for maternity care clinicians to address those problems with the goal of improving perinatal health care for WWPD. PMID:27619410

Simulation of halo particles with Simpsons

NASA Astrophysics Data System (ADS)

Machida, Shinji

2003-12-01

Recent code improvements and some simulation results of halo particles with Simpsons will be presented. We tried to identify resonance behavior of halo particles by looking at tune evolution of individual macro particle.

A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment-by-results.

PubMed

Nouraei, S A R; O'Hanlon, S; Butler, C R; Hadovsky, A; Donald, E; Benjamin, E; Sandhu, G S

2009-02-01

To audit the accuracy of otolaryngology clinical coding and identify ways of improving it. Prospective multidisciplinary audit, using the 'national standard clinical coding audit' methodology supplemented by 'double-reading and arbitration'. Teaching-hospital otolaryngology and clinical coding departments. Otolaryngology inpatient and day-surgery cases. Concordance between initial coding performed by a coder (first cycle) and final coding by a clinician-coder multidisciplinary team (MDT; second cycle) for primary and secondary diagnoses and procedures, and Health Resource Groupings (HRG) assignment. 1250 randomly-selected cases were studied. Coding errors occurred in 24.1% of cases (301/1250). The clinician-coder MDT reassigned 48 primary diagnoses and 186 primary procedures and identified a further 209 initially-missed secondary diagnoses and procedures. In 203 cases, patient's initial HRG changed. Incorrect coding caused an average revenue loss of 174.90 pounds per patient (14.7%) of which 60% of the total income variance was due to miscoding of a eight highly-complex head and neck cancer cases. The 'HRG drift' created the appearance of disproportionate resource utilisation when treating 'simple' cases. At our institution the total cost of maintaining a clinician-coder MDT was 4.8 times lower than the income regained through the double-reading process. This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.

Improving accuracy of clinical coding in surgery: collaboration is key.

PubMed

Heywood, Nick A; Gill, Michael D; Charlwood, Natasha; Brindle, Rachel; Kirwan, Cliona C

2016-08-01

Clinical coding data provide the basis for Hospital Episode Statistics and Healthcare Resource Group codes. High accuracy of this information is required for payment by results, allocation of health and research resources, and public health data and planning. We sought to identify the level of accuracy of clinical coding in general surgical admissions across hospitals in the Northwest of England. Clinical coding departments identified a total of 208 emergency general surgical patients discharged between 1st March and 15th August 2013 from seven hospital trusts (median = 20, range = 16-60). Blinded re-coding was performed by a senior clinical coder and clinician, with results compared with the original coding outcome. Recorded codes were generated from OPCS-4 & ICD-10. Of all cases, 194 of 208 (93.3%) had at least one coding error and 9 of 208 (4.3%) had errors in both primary diagnosis and primary procedure. Errors were found in 64 of 208 (30.8%) of primary diagnoses and 30 of 137 (21.9%) of primary procedure codes. Median tariff using original codes was £1411.50 (range, £409-9138). Re-calculation using updated clinical codes showed a median tariff of £1387.50, P = 0.997 (range, £406-10,102). The most frequent reasons for incorrect coding were "coder error" and a requirement for "clinical interpretation of notes". Errors in clinical coding are multifactorial and have significant impact on primary diagnosis, potentially affecting the accuracy of Hospital Episode Statistics data and in turn the allocation of health care resources and public health planning. As we move toward surgeon specific outcomes, surgeons should increase collaboration with coding departments to ensure the system is robust. Copyright © 2016 Elsevier Inc. All rights reserved.

ICD-10 procedure codes produce transition challenges.

PubMed

Boyd, Andrew D; Li, Jianrong 'John'; Kenost, Colleen; Zaim, Samir Rachid; Krive, Jacob; Mittal, Manish; Satava, Richard A; Burton, Michael; Smith, Jacob; Lussier, Yves A

2018-01-01

The transition of procedure coding from ICD-9-CM-Vol-3 to ICD-10-PCS has generated problems for the medical community at large resulting from the lack of clarity required to integrate two non-congruent coding systems. We hypothesized that quantifying these issues with network topology analyses offers a better understanding of the issues, and therefore we developed solutions (online tools) to empower hospital administrators and researchers to address these challenges. Five topologies were identified: "identity"(I), "class-to-subclass"(C2S), "subclass-toclass"(S2C), "convoluted(C)", and "no mapping"(NM). The procedure codes in the 2010 Illinois Medicaid dataset (3,290 patients, 116 institutions) were categorized as C=55%, C2S=40%, I=3%, NM=2%, and S2C=1%. Majority of the problematic and ambiguous mappings (convoluted) pertained to operations in ophthalmology cardiology, urology, gyneco-obstetrics, and dermatology. Finally, the algorithms were expanded into a user-friendly tool to identify problematic topologies and specify lists of procedural codes utilized by medical professionals and researchers for mitigating error-prone translations, simplifying research, and improving quality.http://www.lussiergroup.org/transition-to-ICD10PCS.

Coding and Billing in Surgical Education: A Systems-Based Practice Education Program.

PubMed

Ghaderi, Kimeya F; Schmidt, Scott T; Drolet, Brian C

Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters. We identified knowledge gaps and barriers to documentation and coding in the outpatient setting. We implemented a series of educational and workflow interventions with a group of 12 residents in a surgical clinic at a tertiary care center. To measure the effect of this program, we compared billing codes for 1 year before intervention (FY2012) to prospectively collected data from the postintervention period (FY2013). All related documentation and coding were verified by study-blinded auditors. Interventions took place at the outpatient surgical clinic at Rhode Island Hospital, a tertiary-care center. A cohort of 12 plastic surgery residents ranging from postgraduate year 2 through postgraduate year 6 participated in the interventional sequence. A total of 1285 patient encounters in the preintervention group were compared with 1170 encounters in the postintervention group. Using evaluation and management codes (E&M) as a measure of documentation and coding, we demonstrated a significant and durable increase in billing with supporting clinical documentation after the intervention. For established patient visits, the monthly average E&M code level increased from 2.14 to 3.05 (p < 0.01); for new patients the monthly average E&M level increased from 2.61 to 3.19 (p < 0.01). This study describes a series of educational and workflow interventions, which improved resident coding and billing of outpatient clinic encounters. Using externally audited coding data, we demonstrate significantly increased rates of higher complexity E&M coding in a stable patient population based on improved documentation and billing awareness by the residents. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Proof of Concept Coded Aperture Miniature Mass Spectrometer Using a Cycloidal Sector Mass Analyzer, a Carbon Nanotube (CNT) Field Emission Electron Ionization Source, and an Array Detector.

PubMed

Amsden, Jason J; Herr, Philip J; Landry, David M W; Kim, William; Vyas, Raul; Parker, Charles B; Kirley, Matthew P; Keil, Adam D; Gilchrist, Kristin H; Radauscher, Erich J; Hall, Stephen D; Carlson, James B; Baldasaro, Nicholas; Stokes, David; Di Dona, Shane T; Russell, Zachary E; Grego, Sonia; Edwards, Steven J; Sperline, Roger P; Denton, M Bonner; Stoner, Brian R; Gehm, Michael E; Glass, Jeffrey T

2018-02-01

Despite many potential applications, miniature mass spectrometers have had limited adoption in the field due to the tradeoff between throughput and resolution that limits their performance relative to laboratory instruments. Recently, a solution to this tradeoff has been demonstrated by using spatially coded apertures in magnetic sector mass spectrometers, enabling throughput and signal-to-background improvements of greater than an order of magnitude with no loss of resolution. This paper describes a proof of concept demonstration of a cycloidal coded aperture miniature mass spectrometer (C-CAMMS) demonstrating use of spatially coded apertures in a cycloidal sector mass analyzer for the first time. C-CAMMS also incorporates a miniature carbon nanotube (CNT) field emission electron ionization source and a capacitive transimpedance amplifier (CTIA) ion array detector. Results confirm the cycloidal mass analyzer's compatibility with aperture coding. A >10× increase in throughput was achieved without loss of resolution compared with a single slit instrument. Several areas where additional improvement can be realized are identified. Graphical Abstract ᅟ.

Proof of Concept Coded Aperture Miniature Mass Spectrometer Using a Cycloidal Sector Mass Analyzer, a Carbon Nanotube (CNT) Field Emission Electron Ionization Source, and an Array Detector

NASA Astrophysics Data System (ADS)

Amsden, Jason J.; Herr, Philip J.; Landry, David M. W.; Kim, William; Vyas, Raul; Parker, Charles B.; Kirley, Matthew P.; Keil, Adam D.; Gilchrist, Kristin H.; Radauscher, Erich J.; Hall, Stephen D.; Carlson, James B.; Baldasaro, Nicholas; Stokes, David; Di Dona, Shane T.; Russell, Zachary E.; Grego, Sonia; Edwards, Steven J.; Sperline, Roger P.; Denton, M. Bonner; Stoner, Brian R.; Gehm, Michael E.; Glass, Jeffrey T.

2018-02-01

Despite many potential applications, miniature mass spectrometers have had limited adoption in the field due to the tradeoff between throughput and resolution that limits their performance relative to laboratory instruments. Recently, a solution to this tradeoff has been demonstrated by using spatially coded apertures in magnetic sector mass spectrometers, enabling throughput and signal-to-background improvements of greater than an order of magnitude with no loss of resolution. This paper describes a proof of concept demonstration of a cycloidal coded aperture miniature mass spectrometer (C-CAMMS) demonstrating use of spatially coded apertures in a cycloidal sector mass analyzer for the first time. C-CAMMS also incorporates a miniature carbon nanotube (CNT) field emission electron ionization source and a capacitive transimpedance amplifier (CTIA) ion array detector. Results confirm the cycloidal mass analyzer's compatibility with aperture coding. A >10× increase in throughput was achieved without loss of resolution compared with a single slit instrument. Several areas where additional improvement can be realized are identified.

Audit of accuracy of clinical coding in oral surgery.

PubMed

Naran, S; Hudovsky, A; Antscherl, J; Howells, S; Nouraei, S A R

2014-10-01

We aimed to study the accuracy of clinical coding within oral surgery and to identify ways in which it can be improved. We undertook did a multidisciplinary audit of a sample of 646 day case patients who had had oral surgery procedures between 2011 and 2012. We compared the codes given with their case notes and amended any discrepancies. The accuracy of coding was assessed for primary and secondary diagnoses and procedures, and for health resource groupings (HRGs). The financial impact of coding Subjectivity, Variability and Error (SVE) was assessed by reference to national tariffs. The audit resulted in 122 (19%) changes to primary diagnoses. The codes for primary procedures changed in 224 (35%) cases; 310 (48%) morbidities and complications had been missed, and 266 (41%) secondary procedures had been missed or were incorrect. This led to at least one change of coding in 496 (77%) patients, and to the HRG changes in 348 (54%) patients. The financial impact of this was £114 in lost revenue per patient. There is a high incidence of coding errors in oral surgery because of the large number of day cases, a lack of awareness by clinicians of coding issues, and because clinical coders are not always familiar with the large number of highly specialised abbreviations used. Accuracy of coding can be improved through the use of a well-designed proforma, and standards can be maintained by the use of an ongoing data quality assurance programme. Copyright © 2014. Published by Elsevier Ltd.

Optimizing administrative datasets to examine acute kidney injury in the era of big data: workgroup statement from the 15(th) ADQI Consensus Conference.

PubMed

Siew, Edward D; Basu, Rajit K; Wunsch, Hannah; Shaw, Andrew D; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

2016-01-01

The purpose of this review is to report how administrative data have been used to study AKI, identify current limitations, and suggest how these data sources might be enhanced to address knowledge gaps in the field. 1) To review the existing evidence-base on how AKI is coded across administrative datasets, 2) To identify limitations, gaps in knowledge, and major barriers to scientific progress in AKI related to coding in administrative data, 3) To discuss how administrative data for AKI might be enhanced to enable "communication" and "translation" within and across administrative jurisdictions, and 4) To suggest how administrative databases might be configured to inform 'registry-based' pragmatic studies. Literature review of English language articles through PubMed search for relevant AKI literature focusing on the validation of AKI in administrative data or used administrative data to describe the epidemiology of AKI. Acute Dialysis Quality Initiative (ADQI) Consensus Conference September 6-7(th), 2015, Banff, Canada. Hospitalized patients with AKI. The coding structure for AKI in many administrative datasets limits understanding of true disease burden (especially less severe AKI), its temporal trends, and clinical phenotyping. Important opportunities exist to improve the quality and coding of AKI data to better address critical knowledge gaps in AKI and improve care. A modified Delphi consensus building process consisting of review of the literature and summary statements were developed through a series of alternating breakout and plenary sessions. Administrative codes for AKI are limited by poor sensitivity, lack of standardization to classify severity, and poor contextual phenotyping. These limitations are further hampered by reduced awareness of AKI among providers and the subjective nature of reporting. While an idealized definition of AKI may be difficult to implement, improving standardization of reporting by using laboratory-based definitions and providing complementary information on the context in which AKI occurs are possible. Administrative databases may also help enhance the conduct of and inform clinical or registry-based pragmatic studies. Data sources largely restricted to North American and Europe. Administrative data are rapidly growing and evolving, and represent an unprecedented opportunity to address knowledge gaps in AKI. Progress will require continued efforts to improve awareness of the impact of AKI on public health, engage key stakeholders, and develop tangible strategies to reconfigure infrastructure to improve the reporting and phenotyping of AKI. WHY IS THIS REVIEW IMPORTANT?: Rapid growth in the size and availability of administrative data has enhanced the clinical study of acute kidney injury (AKI). However, significant limitations exist in coding that hinder our ability to better understand its epidemiology and address knowledge gaps. The following consensus-based review discusses how administrative data have been used to study AKI, identify current limitations, and suggest how these data sources might be enhanced to improve the future study of this disease. WHAT ARE THE KEY MESSAGES?: The current coding structure of administrative data is hindered by a lack of sensitivity, standardization to properly classify severity, and limited clinical phenotyping. These limitations combined with reduced awareness of AKI and the subjective nature of reporting limit understanding of disease burden across settings and time periods. As administrative data become more sophisticated and complex, important opportunities to employ more objective criteria to diagnose and stage AKI as well as improve contextual phenotyping exist that can help address knowledge gaps and improve care.

Defense Logistics Agency Disposition Services Afghanistan Disposal Process Needed Improvement

DTIC Science & Technology

2013-11-08

audit, and management was proactive in correcting the deficiencies we identified. DLA DS eliminated backlogs, identified and corrected system ...problems, provided additional system training, corrected coding errors, added personnel to key positions, addressed scale issues, submitted debit...Service Automated Information System to the Reutilization Business Integration2 (RBI) solution. The implementation of RBI in Afghanistan occurred in

Evaluation of Diagnostic Codes in Morbidity and Mortality Data Sources for Heat-Related Illness Surveillance

PubMed Central

Watkins, Sharon

2017-01-01

Objectives: The primary objective of this study was to identify patients with heat-related illness (HRI) using codes for heat-related injury diagnosis and external cause of injury in 3 administrative data sets: emergency department (ED) visit records, hospital discharge records, and death certificates. Methods: We obtained data on ED visits, hospitalizations, and deaths for Florida residents for May 1 through October 31, 2005-2012. To identify patients with HRI, we used codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to search data on ED visits and hospitalizations and codes from the International Classification of Diseases, Tenth Revision (ICD-10) to search data on deaths. We stratified the results by data source and whether the HRI was work related. Results: We identified 23 981 ED visits, 4816 hospitalizations, and 140 deaths in patients with non–work-related HRI and 2979 ED visits, 415 hospitalizations, and 23 deaths in patients with work-related HRI. The most common diagnosis codes among patients were for severe HRI (heat exhaustion or heatstroke). The proportion of patients with a severe HRI diagnosis increased with data source severity. If ICD-9-CM code E900.1 and ICD-10 code W92 (excessive heat of man-made origin) were used as exclusion criteria for HRI, 5.0% of patients with non–work-related deaths, 3.0% of patients with work-related ED visits, and 1.7% of patients with work-related hospitalizations would have been removed. Conclusions: Using multiple data sources and all diagnosis fields may improve the sensitivity of HRI surveillance. Future studies should evaluate the impact of converting ICD-9-CM to ICD-10-CM codes on HRI surveillance of ED visits and hospitalizations. PMID:28379784

Indianapolis emergency medical service and the Indiana Network for Patient Care: evaluating the patient match algorithm.

PubMed

Park, Seong C; Finnell, John T

2012-01-01

In 2009, Indianapolis launched an electronic medical record system within their ambulances1 and started to exchange patient data with the Indiana Network for Patient Care (INPC) This unique system allows EMS personnel to get important information prior to the patient's arrival to the hospital. In this descriptive study, we found EMS personnel requested patient data on 14% of all transports, with a "success" match rate of 46%, and a match "failure" rate of 17%. The three major factors for causing match "failure" were ZIP code 55%, Patient Name 22%, and Birth date 12%. We conclude that the ZIP code matching process needs to be improved by applying a limitation of 5 digits in ZIP code instead of using ZIP+4 code. Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient's record.

Scanning for safety: an integrated approach to improved bar-code medication administration.

PubMed

Early, Cynde; Riha, Chris; Martin, Jennifer; Lowdon, Karen W; Harvey, Ellen M

2011-03-01

This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.

Supplementing Public Health Inspection via Social Media

PubMed Central

Schomberg, John P.; Haimson, Oliver L.; Hayes, Gillian R.; Anton-Culver, Hoda

2016-01-01

Foodborne illness is prevented by inspection and surveillance conducted by health departments across America. Appropriate restaurant behavior is enforced and monitored via public health inspections. However, surveillance coverage provided by state and local health departments is insufficient in preventing the rising number of foodborne illness outbreaks. To address this need for improved surveillance coverage we conducted a supplementary form of public health surveillance using social media data: Yelp.com restaurant reviews in the city of San Francisco. Yelp is a social media site where users post reviews and rate restaurants they have personally visited. Presence of keywords related to health code regulations and foodborne illness symptoms, number of restaurant reviews, number of Yelp stars, and restaurant price range were included in a model predicting a restaurant’s likelihood of health code violation measured by the assigned San Francisco public health code rating. For a list of major health code violations see (S1 Table). We built the predictive model using 71,360 Yelp reviews of restaurants in the San Francisco Bay Area. The predictive model was able to predict health code violations in 78% of the restaurants receiving serious citations in our pilot study of 440 restaurants. Training and validation data sets each pulled data from 220 restaurants in San Francisco. Keyword analysis of free text within Yelp not only improved detection of high-risk restaurants, but it also served to identify specific risk factors related to health code violation. To further validate our model we applied the model generated in our pilot study to Yelp data from 1,542 restaurants in San Francisco. The model achieved 91% sensitivity 74% specificity, area under the receiver operator curve of 98%, and positive predictive value of 29% (given a substandard health code rating prevalence of 10%). When our model was applied to restaurant reviews in New York City we achieved 74% sensitivity, 54% specificity, area under the receiver operator curve of 77%, and positive predictive value of 25% (given a prevalence of 12%). Model accuracy improved when reviews ranked highest by Yelp were utilized. Our results indicate that public health surveillance can be improved by using social media data to identify restaurants at high risk for health code violation. Additionally, using highly ranked Yelp reviews improves predictive power and limits the number of reviews needed to generate prediction. Use of this approach as an adjunct to current risk ranking of restaurants prior to inspection may enhance detection of those restaurants participating in high risk practices that may have gone previously undetected. This model represents a step forward in the integration of social media into meaningful public health interventions. PMID:27023681

Supplementing Public Health Inspection via Social Media.

PubMed

Schomberg, John P; Haimson, Oliver L; Hayes, Gillian R; Anton-Culver, Hoda

2016-01-01

Foodborne illness is prevented by inspection and surveillance conducted by health departments across America. Appropriate restaurant behavior is enforced and monitored via public health inspections. However, surveillance coverage provided by state and local health departments is insufficient in preventing the rising number of foodborne illness outbreaks. To address this need for improved surveillance coverage we conducted a supplementary form of public health surveillance using social media data: Yelp.com restaurant reviews in the city of San Francisco. Yelp is a social media site where users post reviews and rate restaurants they have personally visited. Presence of keywords related to health code regulations and foodborne illness symptoms, number of restaurant reviews, number of Yelp stars, and restaurant price range were included in a model predicting a restaurant's likelihood of health code violation measured by the assigned San Francisco public health code rating. For a list of major health code violations see (S1 Table). We built the predictive model using 71,360 Yelp reviews of restaurants in the San Francisco Bay Area. The predictive model was able to predict health code violations in 78% of the restaurants receiving serious citations in our pilot study of 440 restaurants. Training and validation data sets each pulled data from 220 restaurants in San Francisco. Keyword analysis of free text within Yelp not only improved detection of high-risk restaurants, but it also served to identify specific risk factors related to health code violation. To further validate our model we applied the model generated in our pilot study to Yelp data from 1,542 restaurants in San Francisco. The model achieved 91% sensitivity 74% specificity, area under the receiver operator curve of 98%, and positive predictive value of 29% (given a substandard health code rating prevalence of 10%). When our model was applied to restaurant reviews in New York City we achieved 74% sensitivity, 54% specificity, area under the receiver operator curve of 77%, and positive predictive value of 25% (given a prevalence of 12%). Model accuracy improved when reviews ranked highest by Yelp were utilized. Our results indicate that public health surveillance can be improved by using social media data to identify restaurants at high risk for health code violation. Additionally, using highly ranked Yelp reviews improves predictive power and limits the number of reviews needed to generate prediction. Use of this approach as an adjunct to current risk ranking of restaurants prior to inspection may enhance detection of those restaurants participating in high risk practices that may have gone previously undetected. This model represents a step forward in the integration of social media into meaningful public health interventions.

Refactoring and Its Benefits

NASA Astrophysics Data System (ADS)

Veerraju, R. P. S. P.; Rao, A. Srinivasa; Murali, G.

2010-10-01

Refactoring is a disciplined technique for restructuring an existing body of code, altering its internal structure without changing its external behavior. It improves internal code structure without altering its external functionality by transforming functions and rethinking algorithms. It is an iterative process. Refactoring include reducing scope, replacing complex instructions with simpler or built-in instructions, and combining multiple statements into one statement. By transforming the code with refactoring techniques it will be faster to change, execute, and download. It is an excellent best practice to adopt for programmers wanting to improve their productivity. Refactoring is similar to things like performance optimizations, which are also behavior- preserving transformations. It also helps us find bugs when we are trying to fix a bug in difficult-to-understand code. By cleaning things up, we make it easier to expose the bug. Refactoring improves the quality of application design and implementation. In general, three cases concerning refactoring. Iterative refactoring, Refactoring when is necessary, Not refactor. Mr. Martin Fowler identifies four key reasons to refractor. Refactoring improves the design of software, makes software easier to understand, helps us find bugs and also helps in executing the program faster. There is an additional benefit of refactoring. It changes the way a developer thinks about the implementation when not refactoring. There are the three types of refactorings. 1) Code refactoring: It often referred to simply as refactoring. This is the refactoring of programming source code. 2) Database refactoring: It is a simple change to a database schema that improves its design while retaining both its behavioral and informational semantics. 3) User interface (UI) refactoring: It is a simple change to the UI which retains its semantics. Finally, we conclude the benefits of Refactoring are: Improves the design of software, Makes software easier to understand, Software gets cleaned up and Helps us to find bugs and Helps us to program faster.

Refactoring and Its Benefits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Veerraju, R. P. S. P.; Rao, A. Srinivasa; Murali, G.

2010-10-26

Refactoring is a disciplined technique for restructuring an existing body of code, altering its internal structure without changing its external behavior. It improves internal code structure without altering its external functionality by transforming functions and rethinking algorithms. It is an iterative process. Refactoring include reducing scope, replacing complex instructions with simpler or built-in instructions, and combining multiple statements into one statement. By transforming the code with refactoring techniques it will be faster to change, execute, and download. It is an excellent best practice to adopt for programmers wanting to improve their productivity. Refactoring is similar to things like performance optimizations,more » which are also behavior- preserving transformations. It also helps us find bugs when we are trying to fix a bug in difficult-to-understand code. By cleaning things up, we make it easier to expose the bug. Refactoring improves the quality of application design and implementation. In general, three cases concerning refactoring. Iterative refactoring, Refactoring when is necessary, Not refactor.Mr. Martin Fowler identifies four key reasons to refractor. Refactoring improves the design of software, makes software easier to understand, helps us find bugs and also helps in executing the program faster. There is an additional benefit of refactoring. It changes the way a developer thinks about the implementation when not refactoring. There are the three types of refactorings. 1) Code refactoring: It often referred to simply as refactoring. This is the refactoring of programming source code. 2) Database refactoring: It is a simple change to a database schema that improves its design while retaining both its behavioral and informational semantics. 3) User interface (UI) refactoring: It is a simple change to the UI which retains its semantics. Finally, we conclude the benefits of Refactoring are: Improves the design of software, Makes software easier to understand, Software gets cleaned up and Helps us to find bugs and Helps us to program faster.« less

Transcription Factor Binding Profiles Reveal Cyclic Expression of Human Protein-coding Genes and Non-coding RNAs

PubMed Central

Cheng, Chao; Ung, Matthew; Grant, Gavin D.; Whitfield, Michael L.

2013-01-01

Cell cycle is a complex and highly supervised process that must proceed with regulatory precision to achieve successful cellular division. Despite the wide application, microarray time course experiments have several limitations in identifying cell cycle genes. We thus propose a computational model to predict human cell cycle genes based on transcription factor (TF) binding and regulatory motif information in their promoters. We utilize ENCODE ChIP-seq data and motif information as predictors to discriminate cell cycle against non-cell cycle genes. Our results show that both the trans- TF features and the cis- motif features are predictive of cell cycle genes, and a combination of the two types of features can further improve prediction accuracy. We apply our model to a complete list of GENCODE promoters to predict novel cell cycle driving promoters for both protein-coding genes and non-coding RNAs such as lincRNAs. We find that a similar percentage of lincRNAs are cell cycle regulated as protein-coding genes, suggesting the importance of non-coding RNAs in cell cycle division. The model we propose here provides not only a practical tool for identifying novel cell cycle genes with high accuracy, but also new insights on cell cycle regulation by TFs and cis-regulatory elements. PMID:23874175

Detecting and Characterizing Semantic Inconsistencies in Ported Code

NASA Technical Reports Server (NTRS)

Ray, Baishakhi; Kim, Miryung; Person, Suzette J.; Rungta, Neha

2013-01-01

Adding similar features and bug fixes often requires porting program patches from reference implementations and adapting them to target implementations. Porting errors may result from faulty adaptations or inconsistent updates. This paper investigates (I) the types of porting errors found in practice, and (2) how to detect and characterize potential porting errors. Analyzing version histories, we define five categories of porting errors, including incorrect control- and data-flow, code redundancy, inconsistent identifier renamings, etc. Leveraging this categorization, we design a static control- and data-dependence analysis technique, SPA, to detect and characterize porting inconsistencies. Our evaluation on code from four open-source projects shows thai SPA can dell-oct porting inconsistencies with 65% to 73% precision and 90% recall, and identify inconsistency types with 58% to 63% precision and 92% to 100% recall. In a comparison with two existing error detection tools, SPA improves precision by 14 to 17 percentage points

Detecting and Characterizing Semantic Inconsistencies in Ported Code

NASA Technical Reports Server (NTRS)

Ray, Baishakhi; Kim, Miryung; Person,Suzette; Rungta, Neha

2013-01-01

Adding similar features and bug fixes often requires porting program patches from reference implementations and adapting them to target implementations. Porting errors may result from faulty adaptations or inconsistent updates. This paper investigates (1) the types of porting errors found in practice, and (2) how to detect and characterize potential porting errors. Analyzing version histories, we define five categories of porting errors, including incorrect control- and data-flow, code redundancy, inconsistent identifier renamings, etc. Leveraging this categorization, we design a static control- and data-dependence analysis technique, SPA, to detect and characterize porting inconsistencies. Our evaluation on code from four open-source projects shows that SPA can detect porting inconsistencies with 65% to 73% precision and 90% recall, and identify inconsistency types with 58% to 63% precision and 92% to 100% recall. In a comparison with two existing error detection tools, SPA improves precision by 14 to 17 percentage points.

Methodology for fast detection of false sharing in threaded scientific codes

DOEpatents

Chung, I-Hsin; Cong, Guojing; Murata, Hiroki; Negishi, Yasushi; Wen, Hui-Fang

2014-11-25

A profiling tool identifies a code region with a false sharing potential. A static analysis tool classifies variables and arrays in the identified code region. A mapping detection library correlates memory access instructions in the identified code region with variables and arrays in the identified code region while a processor is running the identified code region. The mapping detection library identifies one or more instructions at risk, in the identified code region, which are subject to an analysis by a false sharing detection library. A false sharing detection library performs a run-time analysis of the one or more instructions at risk while the processor is re-running the identified code region. The false sharing detection library determines, based on the performed run-time analysis, whether two different portions of the cache memory line are accessed by the generated binary code.

ICD-10 procedure codes produce transition challenges

PubMed Central

Boyd, Andrew D.; Li, Jianrong ‘John’; Kenost, Colleen; Zaim, Samir Rachid; Krive, Jacob; Mittal, Manish; Satava, Richard A.; Burton, Michael; Smith, Jacob; Lussier, Yves A.

2018-01-01

The transition of procedure coding from ICD-9-CM-Vol-3 to ICD-10-PCS has generated problems for the medical community at large resulting from the lack of clarity required to integrate two non-congruent coding systems. We hypothesized that quantifying these issues with network topology analyses offers a better understanding of the issues, and therefore we developed solutions (online tools) to empower hospital administrators and researchers to address these challenges. Five topologies were identified: “identity”(I), “class-to-subclass”(C2S), “subclass-toclass”(S2C), “convoluted(C)”, and “no mapping”(NM). The procedure codes in the 2010 Illinois Medicaid dataset (3,290 patients, 116 institutions) were categorized as C=55%, C2S=40%, I=3%, NM=2%, and S2C=1%. Majority of the problematic and ambiguous mappings (convoluted) pertained to operations in ophthalmology cardiology, urology, gyneco-obstetrics, and dermatology. Finally, the algorithms were expanded into a user-friendly tool to identify problematic topologies and specify lists of procedural codes utilized by medical professionals and researchers for mitigating error-prone translations, simplifying research, and improving quality.http://www.lussiergroup.org/transition-to-ICD10PCS PMID:29888037

Metal Matrix Laminate Tailoring (MMLT) code: User's manual

NASA Technical Reports Server (NTRS)

Murthy, P. L. N.; Morel, M. R.; Saravanos, D. A.

1993-01-01

The User's Manual for the Metal Matrix Laminate Tailoring (MMLT) program is presented. The code is capable of tailoring the fabrication process, constituent characteristics, and laminate parameters (individually or concurrently) for a wide variety of metal matrix composite (MMC) materials, to improve the performance and identify trends or behavior of MMC's under different thermo-mechanical loading conditions. This document is meant to serve as a guide in the use of the MMLT code. Detailed explanations of the composite mechanics and tailoring analysis are beyond the scope of this document, and may be found in the references. MMLT was developed by the Structural Mechanics Branch at NASA Lewis Research Center (LeRC).

RNA-Seq Based Transcriptional Map of Bovine Respiratory Disease Pathogen “Histophilus somni 2336”

PubMed Central

Kumar, Ranjit; Lawrence, Mark L.; Watt, James; Cooksey, Amanda M.; Burgess, Shane C.; Nanduri, Bindu

2012-01-01

Genome structural annotation, i.e., identification and demarcation of the boundaries for all the functional elements in a genome (e.g., genes, non-coding RNAs, proteins and regulatory elements), is a prerequisite for systems level analysis. Current genome annotation programs do not identify all of the functional elements of the genome, especially small non-coding RNAs (sRNAs). Whole genome transcriptome analysis is a complementary method to identify “novel” genes, small RNAs, regulatory regions, and operon structures, thus improving the structural annotation in bacteria. In particular, the identification of non-coding RNAs has revealed their widespread occurrence and functional importance in gene regulation, stress and virulence. However, very little is known about non-coding transcripts in Histophilus somni, one of the causative agents of Bovine Respiratory Disease (BRD) as well as bovine infertility, abortion, septicemia, arthritis, myocarditis, and thrombotic meningoencephalitis. In this study, we report a single nucleotide resolution transcriptome map of H. somni strain 2336 using RNA-Seq method. The RNA-Seq based transcriptome map identified 94 sRNAs in the H. somni genome of which 82 sRNAs were never predicted or reported in earlier studies. We also identified 38 novel potential protein coding open reading frames that were absent in the current genome annotation. The transcriptome map allowed the identification of 278 operon (total 730 genes) structures in the genome. When compared with the genome sequence of a non-virulent strain 129Pt, a disproportionate number of sRNAs (∼30%) were located in genomic region unique to strain 2336 (∼18% of the total genome). This observation suggests that a number of the newly identified sRNAs in strain 2336 may be involved in strain-specific adaptations. PMID:22276113

RNA-seq based transcriptional map of bovine respiratory disease pathogen "Histophilus somni 2336".

PubMed

Kumar, Ranjit; Lawrence, Mark L; Watt, James; Cooksey, Amanda M; Burgess, Shane C; Nanduri, Bindu

2012-01-01

Genome structural annotation, i.e., identification and demarcation of the boundaries for all the functional elements in a genome (e.g., genes, non-coding RNAs, proteins and regulatory elements), is a prerequisite for systems level analysis. Current genome annotation programs do not identify all of the functional elements of the genome, especially small non-coding RNAs (sRNAs). Whole genome transcriptome analysis is a complementary method to identify "novel" genes, small RNAs, regulatory regions, and operon structures, thus improving the structural annotation in bacteria. In particular, the identification of non-coding RNAs has revealed their widespread occurrence and functional importance in gene regulation, stress and virulence. However, very little is known about non-coding transcripts in Histophilus somni, one of the causative agents of Bovine Respiratory Disease (BRD) as well as bovine infertility, abortion, septicemia, arthritis, myocarditis, and thrombotic meningoencephalitis. In this study, we report a single nucleotide resolution transcriptome map of H. somni strain 2336 using RNA-Seq method.The RNA-Seq based transcriptome map identified 94 sRNAs in the H. somni genome of which 82 sRNAs were never predicted or reported in earlier studies. We also identified 38 novel potential protein coding open reading frames that were absent in the current genome annotation. The transcriptome map allowed the identification of 278 operon (total 730 genes) structures in the genome. When compared with the genome sequence of a non-virulent strain 129Pt, a disproportionate number of sRNAs (∼30%) were located in genomic region unique to strain 2336 (∼18% of the total genome). This observation suggests that a number of the newly identified sRNAs in strain 2336 may be involved in strain-specific adaptations.

Surviving "Payment by Results": a simple method of improving clinical coding in burn specialised services in the United Kingdom.

PubMed

Wallis, Katy L; Malic, Claudia C; Littlewood, Sonia L; Judkins, Keith; Phipps, Alan R

2009-03-01

Coding inpatient episodes plays an important role in determining the financial remuneration of a clinical service. Insufficient or incomplete data may have very significant consequences on its viability. We created a document that improves the coding process in our Burns Centre. At Yorkshire Regional Burns Centre an inpatient summary sheet was designed to prospectively record and present essential information on a daily basis, for use in the coding process. The level of care was also recorded. A 3-month audit was conducted to assess the efficacy of the new forms. Forty-nine patients were admitted to the Burns Centre with a mean age of 27.6 years and TBSA ranging from 0.5% to 65%. The total stay in the Burns Centre was 758 days, of which 22% were at level B3-B5 and 39% at level B2. The use of the new discharge document identified potential income of about 500,000 GB pound sterling at our local daily tariffs for high dependency and intensive care. The new form is able to ensure a high quality of coding with a possible direct impact on the financial resources accrued for burn care.

Simulation of in-hospital pediatric medical emergencies and cardiopulmonary arrests: highlighting the importance of the first 5 minutes.

PubMed

Hunt, Elizabeth A; Walker, Allen R; Shaffner, Donald H; Miller, Marlene R; Pronovost, Peter J

2008-01-01

Outcomes of in-hospital pediatric cardiopulmonary arrest are dismal. Recent data suggest that the quality of basic and advanced life support delivered to adults is low and contributes to poor outcomes, but few data regarding pediatric events have been reported. The objectives of this study were to (1) measure the median elapsed time to initiate important resuscitation maneuvers in simulated pediatric medical emergencies (ie, "mock codes") and (2) identify the types and frequency of errors committed during pediatric mock codes. A prospective, observational study was conducted of 34 consecutive hospital-based mock codes. A mannequin or computerized simulator was used to enact unannounced, simulated crisis situations involving children with respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest. Assessment included time elapsed to initiation of specific resuscitation maneuvers and deviation from American Heart Association guidelines. Among the 34 mock codes, the median time to assessment of airway and breathing was 1.3 minutes, to administration of oxygen was 2.0 minutes, to assessment of circulation was 4.0 minutes, to arrival of any physician was 3.0 minutes, and to arrival of first member of code team was 6.0 minutes. Among cardiopulmonary arrest scenarios, elapsed time to initiation of compressions was 1.5 minutes and to request for defibrillator was 4.3 minutes. In 75% of mock codes, the team deviated from American Heart Association pediatric basic life support protocols, and in 100% of mock codes there was a communication error. Alarming delays and deviations occur in the major components of pediatric resuscitation. Future educational and organizational interventions should focus on improving the quality of care delivered during the first 5 minutes of resuscitation. Simulation of pediatric crises can identify targets for educational intervention to improve pediatric cardiopulmonary resuscitation and, ideally, outcomes.

Assessment of the National Combustion Code

NASA Technical Reports Server (NTRS)

Liu, nan-Suey; Iannetti, Anthony; Shih, Tsan-Hsing

2007-01-01

The advancements made during the last decade in the areas of combustion modeling, numerical simulation, and computing platform have greatly facilitated the use of CFD based tools in the development of combustion technology. Further development of verification, validation and uncertainty quantification will have profound impact on the reliability and utility of these CFD based tools. The objectives of the present effort are to establish baseline for the National Combustion Code (NCC) and experimental data, as well as to document current capabilities and identify gaps for further improvements.

Improving Care for Veterans with PTSD: Comparing Risks and Benefits of Antipsychotics Versus Other Medications to Augment First-Line Pharmacologic Therapy

DTIC Science & Technology

2017-10-01

for all project Aims. Timeline- months 3-6. Status: completed. Task 6: Complete primary analyses and hypothesis testing for Aim 2, including...glucose. For each of these lab tests , each VA site can name them something different and can change names over times. Labs should be linked to Logical...Observation Identifiers Names (LOINC) codes, an international standard system that assigns a numeric code to specific lab tests . However, VA data

Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.

PubMed

Kelly, Kandace; Harrington, Linda; Matos, Pat; Turner, Barbara; Johnson, Constance

2016-01-01

Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.

Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study.

PubMed

Ock, Minsu; Kim, Hwa Jung; Jeon, Bomin; Kim, Ye-Jee; Ryu, Hyun Mi; Lee, Moo-Song

2018-01-01

The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.

Brief surgical procedure code lists for outcomes measurement and quality improvement in resource-limited settings.

PubMed

Liu, Charles; Kayima, Peter; Riesel, Johanna; Situma, Martin; Chang, David; Firth, Paul

2017-11-01

The lack of a classification system for surgical procedures in resource-limited settings hinders outcomes measurement and reporting. Existing procedure coding systems are prohibitively large and expensive to implement. We describe the creation and prospective validation of 3 brief procedure code lists applicable in low-resource settings, based on analysis of surgical procedures performed at Mbarara Regional Referral Hospital, Uganda's second largest public hospital. We reviewed operating room logbooks to identify all surgical operations performed at Mbarara Regional Referral Hospital during 2014. Based on the documented indication for surgery and procedure(s) performed, we assigned each operation up to 4 procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification. Coding of procedures was performed by 2 investigators, and a random 20% of procedures were coded by both investigators. These codes were aggregated to generate procedure code lists. During 2014, 6,464 surgical procedures were performed at Mbarara Regional Referral Hospital, to which we assigned 435 unique procedure codes. Substantial inter-rater reliability was achieved (κ = 0.7037). The 111 most common procedure codes accounted for 90% of all codes assigned, 180 accounted for 95%, and 278 accounted for 98%. We considered these sets of codes as 3 procedure code lists. In a prospective validation, we found that these lists described 83.2%, 89.2%, and 92.6% of surgical procedures performed at Mbarara Regional Referral Hospital during August to September of 2015, respectively. Empirically generated brief procedure code lists based on International Classification of Diseases, 9th Revision, Clinical Modification can be used to classify almost all surgical procedures performed at a Ugandan referral hospital. Such a standardized procedure coding system may enable better surgical data collection for administration, research, and quality improvement in resource-limited settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimal sensor placement for spatial lattice structure based on genetic algorithms

NASA Astrophysics Data System (ADS)

Liu, Wei; Gao, Wei-cheng; Sun, Yi; Xu, Min-jian

2008-10-01

Optimal sensor placement technique plays a key role in structural health monitoring of spatial lattice structures. This paper considers the problem of locating sensors on a spatial lattice structure with the aim of maximizing the data information so that structural dynamic behavior can be fully characterized. Based on the criterion of optimal sensor placement for modal test, an improved genetic algorithm is introduced to find the optimal placement of sensors. The modal strain energy (MSE) and the modal assurance criterion (MAC) have been taken as the fitness function, respectively, so that three placement designs were produced. The decimal two-dimension array coding method instead of binary coding method is proposed to code the solution. Forced mutation operator is introduced when the identical genes appear via the crossover procedure. A computational simulation of a 12-bay plain truss model has been implemented to demonstrate the feasibility of the three optimal algorithms above. The obtained optimal sensor placements using the improved genetic algorithm are compared with those gained by exiting genetic algorithm using the binary coding method. Further the comparison criterion based on the mean square error between the finite element method (FEM) mode shapes and the Guyan expansion mode shapes identified by data-driven stochastic subspace identification (SSI-DATA) method are employed to demonstrate the advantage of the different fitness function. The results showed that some innovations in genetic algorithm proposed in this paper can enlarge the genes storage and improve the convergence of the algorithm. More importantly, the three optimal sensor placement methods can all provide the reliable results and identify the vibration characteristics of the 12-bay plain truss model accurately.

Reusability of coded data in the primary care electronic medical record: A dynamic cohort study concerning cancer diagnoses.

PubMed

Sollie, Annet; Sijmons, Rolf H; Helsper, Charles; Numans, Mattijs E

2017-03-01

To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs) from 52 general practices was performed. Coded data from 2000 to 2011 for the three most common cancer types (breast, colon and prostate cancer) was compared to the Netherlands Cancer Registry. Data quality is expressed in Standard Incidence Ratios (SIRs): the ratio between the number of coded cases observed in the primary care network database and the expected number of cases based on the Netherlands Cancer Registry. Ratios were multiplied by 100% for readability. The overall SIR was 91.5% (95%CI 88.5-94.5) and showed improvement over the years. SIRs differ between cancer types: from 71.5% for colon cancer in males to 103.9% for breast cancer. There are differences in data quality (SIRs 76.2% - 99.7%) depending on the EMR system used, with SIRs up to 232.9% for breast cancer. Frequently observed errors in routine healthcare data can be classified as: lack of integrity checks, inaccurate use and/or lack of codes, and lack of EMR system functionality. Re-users of coded routine primary care Electronic Medical Record data should be aware that 30% of cancer cases can be missed. Up to 130% of cancer cases found in the EMR data can be false-positive. The type of EMR system and the type of cancer influence the quality of coded diagnosis registry. While data quality can be improved (e.g. through improving system design and by training EMR system users), re-use should only be taken care of by appropriately trained experts. Copyright © 2016. Published by Elsevier B.V.

Report of experiments and evidence for ASC L2 milestone 4467 : demonstration of a legacy application's path to exascale.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Curry, Matthew L.; Ferreira, Kurt Brian; Pedretti, Kevin Thomas Tauke

2012-03-01

This report documents thirteen of Sandia's contributions to the Computational Systems and Software Environment (CSSE) within the Advanced Simulation and Computing (ASC) program between fiscal years 2009 and 2012. It describes their impact on ASC applications. Most contributions are implemented in lower software levels allowing for application improvement without source code changes. Improvements are identified in such areas as reduced run time, characterizing power usage, and Input/Output (I/O). Other experiments are more forward looking, demonstrating potential bottlenecks using mini-application versions of the legacy codes and simulating their network activity on Exascale-class hardware. The purpose of this report is to provemore » that the team has completed milestone 4467-Demonstration of a Legacy Application's Path to Exascale. Cielo is expected to be the last capability system on which existing ASC codes can run without significant modifications. This assertion will be tested to determine where the breaking point is for an existing highly scalable application. The goal is to stretch the performance boundaries of the application by applying recent CSSE RD in areas such as resilience, power, I/O, visualization services, SMARTMAP, lightweight LWKs, virtualization, simulation, and feedback loops. Dedicated system time reservations and/or CCC allocations will be used to quantify the impact of system-level changes to extend the life and performance of the ASC code base. Finally, a simulation of anticipated exascale-class hardware will be performed using SST to supplement the calculations. Determine where the breaking point is for an existing highly scalable application: Chapter 15 presented the CSSE work that sought to identify the breaking point in two ASC legacy applications-Charon and CTH. Their mini-app versions were also employed to complete the task. There is no single breaking point as more than one issue was found with the two codes. The results were that applications can expect to encounter performance issues related to the computing environment, system software, and algorithms. Careful profiling of runtime performance will be needed to identify the source of an issue, in strong combination with knowledge of system software and application source code.« less

An international survey of building energy codes and their implementation

DOE PAGES

Evans, Meredydd; Roshchanka, Volha; Graham, Peter

2017-08-01

Buildings are key to low-carbon development everywhere, and many countries have introduced building energy codes to improve energy efficiency in buildings. Yet, building energy codes can only deliver results when the codes are implemented. For this reason, studies of building energy codes need to consider implementation of building energy codes in a consistent and comprehensive way. This research identifies elements and practices in implementing building energy codes, covering codes in 22 countries that account for 70% of global energy use in buildings. These elements and practices include: comprehensive coverage of buildings by type, age, size, and geographic location; an implementationmore » framework that involves a certified agency to inspect construction at critical stages; and building materials that are independently tested, rated, and labeled. Training and supporting tools are another element of successful code implementation. Some countries have also introduced compliance evaluation studies, which suggested that tightening energy requirements would only be meaningful when also addressing gaps in implementation (Pitt&Sherry, 2014; U.S. DOE, 2016b). Here, this article provides examples of practices that countries have adopted to assist with implementation of building energy codes.« less

An international survey of building energy codes and their implementation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Evans, Meredydd; Roshchanka, Volha; Graham, Peter

Buildings are key to low-carbon development everywhere, and many countries have introduced building energy codes to improve energy efficiency in buildings. Yet, building energy codes can only deliver results when the codes are implemented. For this reason, studies of building energy codes need to consider implementation of building energy codes in a consistent and comprehensive way. This research identifies elements and practices in implementing building energy codes, covering codes in 22 countries that account for 70% of global energy use in buildings. These elements and practices include: comprehensive coverage of buildings by type, age, size, and geographic location; an implementationmore » framework that involves a certified agency to inspect construction at critical stages; and building materials that are independently tested, rated, and labeled. Training and supporting tools are another element of successful code implementation. Some countries have also introduced compliance evaluation studies, which suggested that tightening energy requirements would only be meaningful when also addressing gaps in implementation (Pitt&Sherry, 2014; U.S. DOE, 2016b). Here, this article provides examples of practices that countries have adopted to assist with implementation of building energy codes.« less

De Novo Origin of Human Protein-Coding Genes

PubMed Central

Wu, Dong-Dong; Irwin, David M.; Zhang, Ya-Ping

2011-01-01

The de novo origin of a new protein-coding gene from non-coding DNA is considered to be a very rare occurrence in genomes. Here we identify 60 new protein-coding genes that originated de novo on the human lineage since divergence from the chimpanzee. The functionality of these genes is supported by both transcriptional and proteomic evidence. RNA–seq data indicate that these genes have their highest expression levels in the cerebral cortex and testes, which might suggest that these genes contribute to phenotypic traits that are unique to humans, such as improved cognitive ability. Our results are inconsistent with the traditional view that the de novo origin of new genes is very rare, thus there should be greater appreciation of the importance of the de novo origination of genes. PMID:22102831

First benchmark of the Unstructured Grid Adaptation Working Group

NASA Technical Reports Server (NTRS)

Ibanez, Daniel; Barral, Nicolas; Krakos, Joshua; Loseille, Adrien; Michal, Todd; Park, Mike

2017-01-01

Unstructured grid adaptation is a technology that holds the potential to improve the automation and accuracy of computational fluid dynamics and other computational disciplines. Difficulty producing the highly anisotropic elements necessary for simulation on complex curved geometries that satisfies a resolution request has limited this technology's widespread adoption. The Unstructured Grid Adaptation Working Group is an open gathering of researchers working on adapting simplicial meshes to conform to a metric field. Current members span a wide range of institutions including academia, industry, and national laboratories. The purpose of this group is to create a common basis for understanding and improving mesh adaptation. We present our first major contribution: a common set of benchmark cases, including input meshes and analytic metric specifications, that are publicly available to be used for evaluating any mesh adaptation code. We also present the results of several existing codes on these benchmark cases, to illustrate their utility in identifying key challenges common to all codes and important differences between available codes. Future directions are defined to expand this benchmark to mature the technology necessary to impact practical simulation workflows.

Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups.

PubMed

Yap, Tracey L; Kennerly, Susan; Corazzini, Kirsten; Porter, Kristie; Toles, Mark; Anderson, Ruth A

2014-07-25

The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention's characteristics, outcomes, and sustainability. This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled "brainstormed ideas", focusing on strategies for improving the innovation. Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

CACTI: free, open-source software for the sequential coding of behavioral interactions.

PubMed

Glynn, Lisa H; Hallgren, Kevin A; Houck, Jon M; Moyers, Theresa B

2012-01-01

The sequential analysis of client and clinician speech in psychotherapy sessions can help to identify and characterize potential mechanisms of treatment and behavior change. Previous studies required coding systems that were time-consuming, expensive, and error-prone. Existing software can be expensive and inflexible, and furthermore, no single package allows for pre-parsing, sequential coding, and assignment of global ratings. We developed a free, open-source, and adaptable program to meet these needs: The CASAA Application for Coding Treatment Interactions (CACTI). Without transcripts, CACTI facilitates the real-time sequential coding of behavioral interactions using WAV-format audio files. Most elements of the interface are user-modifiable through a simple XML file, and can be further adapted using Java through the terms of the GNU Public License. Coding with this software yields interrater reliabilities comparable to previous methods, but at greatly reduced time and expense. CACTI is a flexible research tool that can simplify psychotherapy process research, and has the potential to contribute to the improvement of treatment content and delivery.

Energy information data base: report number codes

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

1979-09-01

Each report processed by the US DOE Technical Information Center is identified by a unique report number consisting of a code plus a sequential number. In most cases, the code identifies the originating installation. In some cases, it identifies a specific program or a type of publication. Listed in this publication are all codes that have been used by DOE in cataloging reports. This compilation consists of two parts. Part I is an alphabetical listing of report codes identified with the issuing installations that have used the codes. Part II is an alphabetical listing of installations identified with codes eachmore » has used. (RWR)« less

Efficient Prediction Structures for H.264 Multi View Coding Using Temporal Scalability

NASA Astrophysics Data System (ADS)

Guruvareddiar, Palanivel; Joseph, Biju K.

2014-03-01

Prediction structures with "disposable view components based" hierarchical coding have been proven to be efficient for H.264 multi view coding. Though these prediction structures along with the QP cascading schemes provide superior compression efficiency when compared to the traditional IBBP coding scheme, the temporal scalability requirements of the bit stream could not be met to the fullest. On the other hand, a fully scalable bit stream, obtained by "temporal identifier based" hierarchical coding, provides a number of advantages including bit rate adaptations and improved error resilience, but lacks in compression efficiency when compared to the former scheme. In this paper it is proposed to combine the two approaches such that a fully scalable bit stream could be realized with minimal reduction in compression efficiency when compared to state-of-the-art "disposable view components based" hierarchical coding. Simulation results shows that the proposed method enables full temporal scalability with maximum BDPSNR reduction of only 0.34 dB. A novel method also has been proposed for the identification of temporal identifier for the legacy H.264/AVC base layer packets. Simulation results also show that this enables the scenario where the enhancement views could be extracted at a lower frame rate (1/2nd or 1/4th of base view) with average extraction time for a view component of only 0.38 ms.

Accuracy of administrative data for identification of patients with infective endocarditis.

PubMed

Tan, Charlie; Hansen, Mark; Cohen, Gideon; Boyle, Karl; Daneman, Nick; Adhikari, Neill K J

2016-12-01

Infective endocarditis is associated with high morbidity and mortality rates that have plateaued over recent decades. Research to improve outcomes for these patients is limited by the rarity of this condition. Therefore, we sought to validate administrative database codes for the diagnosis of infective endocarditis. We conducted a retrospective validation study of International Classification of Diseases (ICD-10-CM) codes for infective endocarditis against clinical Duke criteria (definite and probable) at a large acute care hospital between October 1, 2013 and June 30, 2015. To identify potential cases missed by ICD-10-CM codes, we also screened the hospital's valvular heart surgery database and the microbiology laboratory database (the latter for patients with bacteremia due to organisms commonly causing endocarditis). Using definite Duke criteria or probable criteria with clinical suspicion as the reference standard, the ICD-10-CM codes had a sensitivity (SN) of 0.90 (95% confidence interval (CI), 0.81-0.95), specificity (SP) of 1 (95% CI, 1-1), positive predictive value (PPV) of 0.78 (95% CI, 0.68-0.85) and negative predictive value (NPV) of 1 (95% CI, 1-1). Restricting the case definition to definite Duke criteria resulted in an increase in SN to 0.95 (95% CI, 0.86-0.99) and a decrease in PPV to 0.6 (95% CI, 0.49-0.69), with no change in specificity. ICD-10-CM codes can accurately identify patients with infective endocarditis, and so administrative databases offer a potential means to study this infection over large jurisdictions, and thereby improve the prediction, diagnosis, treatment and prevention of this rare but serious infection. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Color-coded fluid-attenuated inversion recovery images improve inter-rater reliability of fluid-attenuated inversion recovery signal changes within acute diffusion-weighted image lesions.

PubMed

Kim, Bum Joon; Kim, Yong-Hwan; Kim, Yeon-Jung; Ahn, Sung Ho; Lee, Deok Hee; Kwon, Sun U; Kim, Sang Joon; Kim, Jong S; Kang, Dong-Wha

2014-09-01

Diffusion-weighted image fluid-attenuated inversion recovery (FLAIR) mismatch has been considered to represent ischemic lesion age. However, the inter-rater agreement of diffusion-weighted image FLAIR mismatch is low. We hypothesized that color-coded images would increase its inter-rater agreement. Patients with ischemic stroke <24 hours of a clear onset were retrospectively studied. FLAIR signal change was rated as negative, subtle, or obvious on conventional and color-coded FLAIR images based on visual inspection. Inter-rater agreement was evaluated using κ and percent agreement. The predictive value of diffusion-weighted image FLAIR mismatch for identification of patients <4.5 hours of symptom onset was evaluated. One hundred and thirteen patients were enrolled. The inter-rater agreement of FLAIR signal change improved from 69.9% (k=0.538) with conventional images to 85.8% (k=0.754) with color-coded images (P=0.004). Discrepantly rated patients on conventional, but not on color-coded images, had a higher prevalence of cardioembolic stroke (P=0.02) and cortical infarction (P=0.04). The positive predictive value for patients <4.5 hours of onset was 85.3% and 71.9% with conventional and 95.7% and 82.1% with color-coded images, by each rater. Color-coded FLAIR images increased the inter-rater agreement of diffusion-weighted image FLAIR recovery mismatch and may ultimately help identify unknown-onset stroke patients appropriate for thrombolysis. © 2014 American Heart Association, Inc.

Use of the International Classification of Diseases, 9th revision, coding in identifying chronic hepatitis B virus infection in health system data: implications for national surveillance.

PubMed

Mahajan, Reena; Moorman, Anne C; Liu, Stephen J; Rupp, Loralee; Klevens, R Monina

2013-05-01

With increasing use electronic health records (EHR) in the USA, we looked at the predictive values of the International Classification of Diseases, 9th revision (ICD-9) coding system for surveillance of chronic hepatitis B virus (HBV) infection. The chronic HBV cohort from the Chronic Hepatitis Cohort Study was created based on electronic health records (EHR) of adult patients who accessed services from 2006 to 2008 from four healthcare systems in the USA. Using the gold standard of abstractor review to confirm HBV cases, we calculated the sensitivity, specificity, positive and negative predictive values using one qualifying ICD-9 code versus using two qualifying ICD-9 codes separated by 6 months or greater. Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive predictive value of 61.0%, and specificity and negative predictive values greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a sensitivity of 58.4% and a positive predictive value of 89.9%. Use of one or two hepatitis B ICD-9 codes can identify cases with chronic HBV infection with varying sensitivity and positive predictive values. As the USA increases the use of EHR, surveillance using ICD-9 codes may be reliable to determine the burden of chronic HBV infection and would be useful to improve reporting by state and local health departments.

Optimizing ATLAS code with different profilers

NASA Astrophysics Data System (ADS)

Kama, S.; Seuster, R.; Stewart, G. A.; Vitillo, R. A.

2014-06-01

After the current maintenance period, the LHC will provide higher energy collisions with increased luminosity. In order to keep up with these higher rates, ATLAS software needs to speed up substantially. However, ATLAS code is composed of approximately 6M lines, written by many different programmers with different backgrounds, which makes code optimisation a challenge. To help with this effort different profiling tools and techniques are being used. These include well known tools, such as the Valgrind suite and Intel Amplifier; less common tools like Pin, PAPI, and GOoDA; as well as techniques such as library interposing. In this paper we will mainly focus on Pin tools and GOoDA. Pin is a dynamic binary instrumentation tool which can obtain statistics such as call counts, instruction counts and interrogate functions' arguments. It has been used to obtain CLHEP Matrix profiles, operations and vector sizes for linear algebra calculations which has provided the insight necessary to achieve significant performance improvements. Complimenting this, GOoDA, an in-house performance tool built in collaboration with Google, which is based on hardware performance monitoring unit events, is used to identify hot-spots in the code for different types of hardware limitations, such as CPU resources, caches, or memory bandwidth. GOoDA has been used in improvement of the performance of new magnetic field code and identification of potential vectorization targets in several places, such as Runge-Kutta propagation code.

Identification of Long Bone Fractures in Radiology Reports Using Natural Language Processing to support Healthcare Quality Improvement.

PubMed

Grundmeier, Robert W; Masino, Aaron J; Casper, T Charles; Dean, Jonathan M; Bell, Jamie; Enriquez, Rene; Deakyne, Sara; Chamberlain, James M; Alpern, Elizabeth R

2016-11-09

Important information to support healthcare quality improvement is often recorded in free text documents such as radiology reports. Natural language processing (NLP) methods may help extract this information, but these methods have rarely been applied outside the research laboratories where they were developed. To implement and validate NLP tools to identify long bone fractures for pediatric emergency medicine quality improvement. Using freely available statistical software packages, we implemented NLP methods to identify long bone fractures from radiology reports. A sample of 1,000 radiology reports was used to construct three candidate classification models. A test set of 500 reports was used to validate the model performance. Blinded manual review of radiology reports by two independent physicians provided the reference standard. Each radiology report was segmented and word stem and bigram features were constructed. Common English "stop words" and rare features were excluded. We used 10-fold cross-validation to select optimal configuration parameters for each model. Accuracy, recall, precision and the F1 score were calculated. The final model was compared to the use of diagnosis codes for the identification of patients with long bone fractures. There were 329 unique word stems and 344 bigrams in the training documents. A support vector machine classifier with Gaussian kernel performed best on the test set with accuracy=0.958, recall=0.969, precision=0.940, and F1 score=0.954. Optimal parameters for this model were cost=4 and gamma=0.005. The three classification models that we tested all performed better than diagnosis codes in terms of accuracy, precision, and F1 score (diagnosis code accuracy=0.932, recall=0.960, precision=0.896, and F1 score=0.927). NLP methods using a corpus of 1,000 training documents accurately identified acute long bone fractures from radiology reports. Strategic use of straightforward NLP methods, implemented with freely available software, offers quality improvement teams new opportunities to extract information from narrative documents.

Discovery of rare protein-coding genes in model methylotroph Methylobacterium extorquens AM1.

PubMed

Kumar, Dhirendra; Mondal, Anupam Kumar; Yadav, Amit Kumar; Dash, Debasis

2014-12-01

Proteogenomics involves the use of MS to refine annotation of protein-coding genes and discover genes in a genome. We carried out comprehensive proteogenomic analysis of Methylobacterium extorquens AM1 (ME-AM1) from publicly available proteomics data with a motive to improve annotation for methylotrophs; organisms capable of surviving in reduced carbon compounds such as methanol. Besides identifying 2482(50%) proteins, 29 new genes were discovered and 66 annotated gene models were revised in ME-AM1 genome. One such novel gene is identified with 75 peptides, lacks homolog in other methylobacteria but has glycosyl transferase and lipopolysaccharide biosynthesis protein domains, indicating its potential role in outer membrane synthesis. Many novel genes are present only in ME-AM1 among methylobacteria. Distant homologs of these genes in unrelated taxonomic classes and low GC-content of few genes suggest lateral gene transfer as a potential mode of their origin. Annotations of methylotrophy related genes were also improved by the discovery of a short gene in methylotrophy gene island and redefining a gene important for pyrroquinoline quinone synthesis, essential for methylotrophy. The combined use of proteogenomics and rigorous bioinformatics analysis greatly enhanced the annotation of protein-coding genes in model methylotroph ME-AM1 genome. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding: Can Lessons Be Learned?

PubMed

Barennes, Hubert; Slesak, Guenther; Goyet, Sophie; Aaron, Percy; Srour, Leila M

2016-02-01

Exclusive breastfeeding, one of the best natural resources, needs protection and promotion. The International Code of Marketing of Breast-milk Substitutes (the Code), which aims to prevent the undermining of breastfeeding by formula advertising, faces implementation challenges. We reviewed frequently overlooked challenges and obstacles that the Code is facing worldwide, but particularly in Southeast Asia. Drawing lessons from various countries where we work, and following the example of successful public health interventions, we discussed legislation, enforcement, and experiences that are needed to successfully implement the Code. Successful holistic approaches that have strengthened the Code need to be scaled up. Community-based actions and peer-to-peer promotions have proved successful. Legislation without stringent enforcement and sufficient penalties is ineffective. The public needs education about the benefits and ways and means to support breastfeeding. It is crucial to combine strong political commitment and leadership with strict national regulations, definitions, and enforcement. National breastfeeding committees, with the authority to improve regulations, investigate violations, and enforce the laws, must be established. Systematic monitoring and reporting are needed to identify companies, individuals, intermediaries, and practices that infringe on the Code. Penalizing violators is crucial. Managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established. Further measures should include improved regulations to protect the breastfeeding mother: large-scale education campaigns; strong penalties for Code violators; exclusion of the formula industry from nutrition, education, and policy roles; supportive legal networks; and independent research of interventions supporting breastfeeding. © The Author(s) 2015.

Validation of coding algorithms for the identification of patients hospitalized for alcoholic hepatitis using administrative data.

PubMed

Pang, Jack X Q; Ross, Erin; Borman, Meredith A; Zimmer, Scott; Kaplan, Gilaad G; Heitman, Steven J; Swain, Mark G; Burak, Kelly W; Quan, Hude; Myers, Robert P

2015-09-11

Epidemiologic studies of alcoholic hepatitis (AH) have been hindered by the lack of a validated International Classification of Disease (ICD) coding algorithm for use with administrative data. Our objective was to validate coding algorithms for AH using a hospitalization database. The Hospital Discharge Abstract Database (DAD) was used to identify consecutive adults (≥18 years) hospitalized in the Calgary region with a diagnosis code for AH (ICD-10, K70.1) between 01/2008 and 08/2012. Medical records were reviewed to confirm the diagnosis of AH, defined as a history of heavy alcohol consumption, elevated AST and/or ALT (<300 U/L), serum bilirubin >34 μmol/L, and elevated INR. Subgroup analyses were performed according to the diagnosis field in which the code was recorded (primary vs. secondary) and AH severity. Algorithms that incorporated ICD-10 codes for cirrhosis and its complications were also examined. Of 228 potential AH cases, 122 patients had confirmed AH, corresponding to a positive predictive value (PPV) of 54% (95% CI 47-60%). PPV improved when AH was the primary versus a secondary diagnosis (67% vs. 21%; P < 0.001). Algorithms that included diagnosis codes for ascites (PPV 75%; 95% CI 63-86%), cirrhosis (PPV 60%; 47-73%), and gastrointestinal hemorrhage (PPV 62%; 51-73%) had improved performance, however, the prevalence of these diagnoses in confirmed AH cases was low (29-39%). In conclusion the low PPV of the diagnosis code for AH suggests that caution is necessary if this hospitalization database is used in large-scale epidemiologic studies of this condition.

Adapting the coping in deliberation (CODE) framework: a multi-method approach in the context of familial ovarian cancer risk management.

PubMed

Witt, Jana; Elwyn, Glyn; Wood, Fiona; Rogers, Mark T; Menon, Usha; Brain, Kate

2014-11-01

To test whether the coping in deliberation (CODE) framework can be adapted to a specific preference-sensitive medical decision: risk-reducing bilateral salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer. We performed a systematic literature search to identify issues important to women during deliberations about RRSO. Three focus groups with patients (most were pre-menopausal and untested for genetic mutations) and 11 interviews with health professionals were conducted to determine which issues mattered in the UK context. Data were used to adapt the generic CODE framework. The literature search yielded 49 relevant studies, which highlighted various issues and coping options important during deliberations, including mutation status, risks of surgery, family obligations, physician recommendation, peer support and reliable information sources. Consultations with UK stakeholders confirmed most of these factors as pertinent influences on deliberations. Questions in the generic framework were adapted to reflect the issues and coping options identified. The generic CODE framework was readily adapted to a specific preference-sensitive medical decision, showing that deliberations and coping are linked during deliberations about RRSO. Adapted versions of the CODE framework may be used to develop tailored decision support methods and materials in order to improve patient-centred care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The reliability of diagnostic coding and laboratory data to identify tuberculosis and nontuberculous mycobacterial disease among rheumatoid arthritis patients using anti-tumor necrosis factor therapy.

PubMed

Winthrop, Kevin L; Baxter, Roger; Liu, Liyan; McFarland, Bentson; Austin, Donald; Varley, Cara; Radcliffe, LeAnn; Suhler, Eric; Choi, Dongsoek; Herrinton, Lisa J

2011-03-01

Anti-tumor necrosis factor-alpha (anti-TNF) therapies are associated with severe mycobacterial infections in rheumatoid arthritis patients. We developed and validated electronic record search algorithms for these serious infections. The study used electronic clinical, microbiologic, and pharmacy records from Kaiser Permanente Northern California (KPNC) and the Portland Veterans Affairs Medical Center (PVAMC). We identified suspect tuberculosis and nontuberculous mycobacteria (NTM) cases using inpatient and outpatient diagnostic codes, culture results, and anti-tuberculous medication dispensing. We manually reviewed records to validate our case-finding algorithms. We identified 64 tuberculosis and 367 NTM potential cases, respectively. For tuberculosis, diagnostic code positive predictive value (PPV) was 54% at KPNC and 9% at PVAMC. Adding medication dispensings improved these to 87% and 46%, respectively. Positive tuberculosis cultures had a PPV of 100% with sensitivities of 79% (KPNC) and 55% (PVAMC). For NTM, the PPV of diagnostic codes was 91% (KPNC) and 76% (PVAMC). At KPNC, ≥ 1 positive NTM culture was sensitive (100%) and specific (PPV, 74%) if non-pathogenic species were excluded; at PVAMC, ≥1 positive NTM culture identified 76% of cases with PPV of 41%. Application of the American Thoracic Society NTM microbiology criteria yielded the highest PPV (100% KPNC, 78% PVAMC). The sensitivity and predictive value of electronic microbiologic data for tuberculosis and NTM infections is generally high, but varies with different facilities or models of care. Unlike NTM, tuberculosis diagnostic codes have poor PPV, and in the absence of laboratory data, should be combined with anti-tuberculous therapy dispensings for pharmacoepidemiologic research. Copyright © 2010 John Wiley & Sons, Ltd.

The validity of using ICD-9 codes and pharmacy records to identify patients with chronic obstructive pulmonary disease

PubMed Central

2011-01-01

Background Administrative data is often used to identify patients with chronic obstructive pulmonary disease (COPD), yet the validity of this approach is unclear. We sought to develop a predictive model utilizing administrative data to accurately identify patients with COPD. Methods Sequential logistic regression models were constructed using 9573 patients with postbronchodilator spirometry at two Veterans Affairs medical centers (2003-2007). COPD was defined as: 1) FEV1/FVC <0.70, and 2) FEV1/FVC < lower limits of normal. Model inputs included age, outpatient or inpatient COPD-related ICD-9 codes, and the number of metered does inhalers (MDI) prescribed over the one year prior to and one year post spirometry. Model performance was assessed using standard criteria. Results 4564 of 9573 patients (47.7%) had an FEV1/FVC < 0.70. The presence of ≥1 outpatient COPD visit had a sensitivity of 76% and specificity of 67%; the AUC was 0.75 (95% CI 0.74-0.76). Adding the use of albuterol MDI increased the AUC of this model to 0.76 (95% CI 0.75-0.77) while the addition of ipratropium bromide MDI increased the AUC to 0.77 (95% CI 0.76-0.78). The best performing model included: ≥6 albuterol MDI, ≥3 ipratropium MDI, ≥1 outpatient ICD-9 code, ≥1 inpatient ICD-9 code, and age, achieving an AUC of 0.79 (95% CI 0.78-0.80). Conclusion Commonly used definitions of COPD in observational studies misclassify the majority of patients as having COPD. Using multiple diagnostic codes in combination with pharmacy data improves the ability to accurately identify patients with COPD. PMID:21324188

Women deans' perceptions of the gender gap in American medical deanships.

PubMed

Humberstone, Elizabeth

2017-01-01

: Women account for 16% of deans of American medical schools. To investigate this gender gap, female deans were interviewed about the barriers facing women advancing toward deanships. The author conducted semi-structured interviews with eight women deans. Interviews were analyzed using provisional coding and sub coding techniques. Four main themes emerged during the interviews: (1) the role of relationships in personal and career development, (2) leadership challenges, (3) barriers between women and leadership advancement, and (4) recommendations for improvement. Recommendations included allocating resources, mentorship, career flexibility, faculty development, updating the criteria for deanships, and restructuring search committees. The barriers identified by the deans are similar to those found in previous studies on female faculty and department chairs, suggesting limited improvement in gender equity progress.

Elementary Teachers' Perceptions of Teaching Science to Improve Student Content Knowledge

NASA Astrophysics Data System (ADS)

Stephenson, Robert L.

The majority of Grade 5 students demonstrate limited science knowledge on state assessments. This trend has been documented since 2010 with no evidence of improvement. Because state accountability formulas include proficiency scores and carry sanctions against districts that fail to meet proficiency thresholds, improved student performance in science is an important issue to school districts. The purpose of this study was to explore elementary teachers' perceptions about their students' science knowledge, the strategies used to teach science, the barriers affecting science teaching, and the self-efficacy beliefs teachers maintain for teaching science. This study, guided by Vygotsky's social constructivist theory and Bandura's concept of self-efficacy, was a bounded instrumental case study in which 15 participants, required to be teaching K-5 elementary science in the county, were interviewed. An analytic technique was used to review the qualitative interview data through open coding, clustering, and analytical coding resulting in identified categorical themes that addressed the research questions. Key findings reflect students' limited content knowledge in earth and physical science. Teachers identified barriers including limited science instructional time, poor curricular resources, few professional learning opportunities, concern about new state standards, and a lack of teaching confidence. To improve student content knowledge, teachers identified the need for professional development. The project is a professional development series provided by a regional education service agency for K-5 teachers to experience science and engineering 3-dimensional learning. Area students will demonstrate deeper science content knowledge and benefit from improved science instructional practice and learning opportunities to become science problem solvers and innovative contributors to society.

Patient complaints in healthcare systems: a systematic review and coding taxonomy

PubMed Central

Reader, Tom W; Gillespie, Alex; Roberts, Jane

2014-01-01

Background Patient complaints have been identified as a valuable resource for monitoring and improving patient safety. This article critically reviews the literature on patient complaints, and synthesises the research findings to develop a coding taxonomy for analysing patient complaints. Methods The PubMed, Science Direct and Medline databases were systematically investigated to identify patient complaint research studies. Publications were included if they reported primary quantitative data on the content of patient-initiated complaints. Data were extracted and synthesised on (1) basic study characteristics; (2) methodological details; and (3) the issues patients complained about. Results 59 studies, reporting 88 069 patient complaints, were included. Patient complaint coding methodologies varied considerably (eg, in attributing single or multiple causes to complaints). In total, 113 551 issues were found to underlie the patient complaints. These were analysed using 205 different analytical codes which when combined represented 29 subcategories of complaint issue. The most common issues complained about were ‘treatment’ (15.6%) and ‘communication’ (13.7%). To develop a patient complaint coding taxonomy, the subcategories were thematically grouped into seven categories, and then three conceptually distinct domains. The first domain related to complaints on the safety and quality of clinical care (representing 33.7% of complaint issues), the second to the management of healthcare organisations (35.1%) and the third to problems in healthcare staff–patient relationships (29.1%). Conclusions Rigorous analyses of patient complaints will help to identify problems in patient safety. To achieve this, it is necessary to standardise how patient complaints are analysed and interpreted. Through synthesising data from 59 patient complaint studies, we propose a coding taxonomy for supporting future research and practice in the analysis of patient complaint data. PMID:24876289

Prototype Mixed Finite Element Hydrodynamics Capability in ARES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rieben, R N

This document describes work on a prototype Mixed Finite Element Method (MFEM) hydrodynamics algorithm in the ARES code, and its application to a set of standard test problems. This work is motivated by the need for improvements to the algorithms used in the Lagrange hydrodynamics step to make them more robust. We begin by identifying the outstanding issues with traditional numerical hydrodynamics algorithms followed by a description of the proposed method and how it may address several of these longstanding issues. We give a theoretical overview of the proposed MFEM algorithm as well as a summary of the coding additionsmore » and modifications that were made to add this capability to the ARES code. We present results obtained with the new method on a set of canonical hydrodynamics test problems and demonstrate significant improvement in comparison to results obtained with traditional methods. We conclude with a summary of the issues still at hand and motivate the need for continued research to develop the proposed method into maturity.« less

Development Of A Parallel Performance Model For The THOR Neutral Particle Transport Code

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yessayan, Raffi; Azmy, Yousry; Schunert, Sebastian

The THOR neutral particle transport code enables simulation of complex geometries for various problems from reactor simulations to nuclear non-proliferation. It is undergoing a thorough V&V requiring computational efficiency. This has motivated various improvements including angular parallelization, outer iteration acceleration, and development of peripheral tools. For guiding future improvements to the code’s efficiency, better characterization of its parallel performance is useful. A parallel performance model (PPM) can be used to evaluate the benefits of modifications and to identify performance bottlenecks. Using INL’s Falcon HPC, the PPM development incorporates an evaluation of network communication behavior over heterogeneous links and a functionalmore » characterization of the per-cell/angle/group runtime of each major code component. After evaluating several possible sources of variability, this resulted in a communication model and a parallel portion model. The former’s accuracy is bounded by the variability of communication on Falcon while the latter has an error on the order of 1%.« less

Overcoming Codes and Standards Barriers to Innovations in Building Energy Efficiency

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cole, Pamala C.; Gilbride, Theresa L.

2015-02-15

In this journal article, the authors discuss approaches to overcoming building code barriers to energy-efficiency innovations in home construction. Building codes have been a highly motivational force for increasing the energy efficiency of new homes in the United States in recent years. But as quickly as the codes seem to be changing, new products are coming to the market at an even more rapid pace, sometimes offering approaches and construction techniques unthought of when the current code was first proposed, which might have been several years before its adoption by various jurisdictions. Due to this delay, the codes themselves canmore » become barriers to innovations that might otherwise be helping to further increase the efficiency, comfort, health or durability of new homes. . The U.S. Department of Energy’s Building America, a program dedicated to improving the energy efficiency of America’s housing stock through research and education, is working with the U.S. housing industry through its research teams to help builders identify and remove code barriers to innovation in the home construction industry. The article addresses several approaches that builders use to achieve approval for innovative building techniques when code barriers appear to exist.« less

GenomeVista

DOE Office of Scientific and Technical Information (OSTI.GOV)

Poliakov, Alexander; Couronne, Olivier

2002-11-04

Aligning large vertebrate genomes that are structurally complex poses a variety of problems not encountered on smaller scales. Such genomes are rich in repetitive elements and contain multiple segmental duplications, which increases the difficulty of identifying true orthologous SNA segments in alignments. The sizes of the sequences make many alignment algorithms designed for comparing single proteins extremely inefficient when processing large genomic intervals. We integrated both local and global alignment tools and developed a suite of programs for automatically aligning large vertebrate genomes and identifying conserved non-coding regions in the alignments. Our method uses the BLAT local alignment program tomore » find anchors on the base genome to identify regions of possible homology for a query sequence. These regions are postprocessed to find the best candidates which are then globally aligned using the AVID global alignment program. In the last step conserved non-coding segments are identified using VISTA. Our methods are fast and the resulting alignments exhibit a high degree of sensitivity, covering more than 90% of known coding exons in the human genome. The GenomeVISTA software is a suite of Perl programs that is built on a MySQL database platform. The scheduler gets control data from the database, builds a queve of jobs, and dispatches them to a PC cluster for execution. The main program, running on each node of the cluster, processes individual sequences. A Perl library acts as an interface between the database and the above programs. The use of a separate library allows the programs to function independently of the database schema. The library also improves on the standard Perl MySQL database interfere package by providing auto-reconnect functionality and improved error handling.« less

Preparing a collection of radiology examinations for distribution and retrieval.

PubMed

Demner-Fushman, Dina; Kohli, Marc D; Rosenman, Marc B; Shooshan, Sonya E; Rodriguez, Laritza; Antani, Sameer; Thoma, George R; McDonald, Clement J

2016-03-01

Clinical documents made available for secondary use play an increasingly important role in discovery of clinical knowledge, development of research methods, and education. An important step in facilitating secondary use of clinical document collections is easy access to descriptions and samples that represent the content of the collections. This paper presents an approach to developing a collection of radiology examinations, including both the images and radiologist narrative reports, and making them publicly available in a searchable database. The authors collected 3996 radiology reports from the Indiana Network for Patient Care and 8121 associated images from the hospitals' picture archiving systems. The images and reports were de-identified automatically and then the automatic de-identification was manually verified. The authors coded the key findings of the reports and empirically assessed the benefits of manual coding on retrieval. The automatic de-identification of the narrative was aggressive and achieved 100% precision at the cost of rendering a few findings uninterpretable. Automatic de-identification of images was not quite as perfect. Images for two of 3996 patients (0.05%) showed protected health information. Manual encoding of findings improved retrieval precision. Stringent de-identification methods can remove all identifiers from text radiology reports. DICOM de-identification of images does not remove all identifying information and needs special attention to images scanned from film. Adding manual coding to the radiologist narrative reports significantly improved relevancy of the retrieved clinical documents. The de-identified Indiana chest X-ray collection is available for searching and downloading from the National Library of Medicine (http://openi.nlm.nih.gov/). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.

Empirically evaluating the WHO global code of practice on the international recruitment of health personnel's impact on four high-income countries four years after adoption.

PubMed

Tam, Vivian; Edge, Jennifer S; Hoffman, Steven J

2016-10-12

Shortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers' right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term. Forty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis. The main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code's non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact. The Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code's purpose to emphasize health system sustainability, are proposed to improve the Code's uptake and impact.

Testing Scientific Software: A Systematic Literature Review.

PubMed

Kanewala, Upulee; Bieman, James M

2014-10-01

Scientific software plays an important role in critical decision making, for example making weather predictions based on climate models, and computation of evidence for research publications. Recently, scientists have had to retract publications due to errors caused by software faults. Systematic testing can identify such faults in code. This study aims to identify specific challenges, proposed solutions, and unsolved problems faced when testing scientific software. We conducted a systematic literature survey to identify and analyze relevant literature. We identified 62 studies that provided relevant information about testing scientific software. We found that challenges faced when testing scientific software fall into two main categories: (1) testing challenges that occur due to characteristics of scientific software such as oracle problems and (2) testing challenges that occur due to cultural differences between scientists and the software engineering community such as viewing the code and the model that it implements as inseparable entities. In addition, we identified methods to potentially overcome these challenges and their limitations. Finally we describe unsolved challenges and how software engineering researchers and practitioners can help to overcome them. Scientific software presents special challenges for testing. Specifically, cultural differences between scientist developers and software engineers, along with the characteristics of the scientific software make testing more difficult. Existing techniques such as code clone detection can help to improve the testing process. Software engineers should consider special challenges posed by scientific software such as oracle problems when developing testing techniques.

Features of Coping with Disease in Iranian Multiple Sclerosis Patients: a Qualitative Study.

PubMed

Dehghani, Ali; Dehghan Nayeri, Nahid; Ebadi, Abbas

2018-03-01

Introduction: Coping with disease is of the main components improving the quality of life in multiple sclerosis patients. Identifying the characteristics of this concept is based on the experiences of patients. Using qualitative research is essential to improve the quality of life. This study was conducted to explore the features of coping with the disease in patients with multiple sclerosis. Method: In this conventional content analysis study, eleven multiple sclerosis patients from Iran MS Society in Tehran (Iran) participated. Purposive sampling was used to select participants. Data were gathered using semi structured interviews. To analyze data, a conventional content analysis approach was used to identify meaning units and to make codes and categories. Results: Results showed that features of coping with disease in multiple sclerosis patients consists of (a) accepting the current situation, (b) maintenance and development of human interactions, (c) self-regulation and (d) self-efficacy. Each of these categories is composed of sub-categories and codes that showed the perception and experience of patients about the coping with disease. Conclusion: Accordingly, a unique set of features regarding features of coping with the disease were identified among the patients with multiple sclerosis. Therefore, working to ensure the emergence of, and subsequent reinforcement of these features in MS patients can be an important step in improving the adjustment and quality of their lives.

Quality Indicators for California Community College Job Placement Programs.

ERIC Educational Resources Information Center

Mount San Antonio Community Coll. District, Walnut, CA.

Designed to help California community colleges in assessing their job placement services, identifying strengths and needs for improvement, and establishing priorities for the future, this color-coded guide lists specific tasks and responsibilities within the four essential functional areas of job placement programs and includes quality indicators…

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data].

PubMed

Jakob, J; Marenda, D; Sold, M; Schlüter, M; Post, S; Kienle, P

2014-08-01

Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument. Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications. The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

Evaluating Coding Accuracy in General Surgery Residents' Accreditation Council for Graduate Medical Education Procedural Case Logs.

PubMed

Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason

The Accreditation Council for Graduate Medical Education (ACGME) case log captures resident operative experience based on Current Procedural Terminology (CPT) codes and is used to track operative experience during residency. With increasing emphasis on resident operative experiences, coding is more important than ever. It has been shown in other surgical specialties at similar institutions that the residents' ACGME case log may not accurately reflect their operative experience. What barriers may influence this remains unclear. As the only objective measure of resident operative experience, an accurate case log is paramount in representing one's operative experience. This study aims to determine the accuracy of procedural coding by general surgical residents at a single institution. Data were collected from 2 consecutive graduating classes of surgical residents' ACGME case logs from 2008 to 2014. A total of 5799 entries from 7 residents were collected. The CPT codes entered by residents were compared to departmental billing records submitted by the attending surgeon for each procedure. Assigned CPT codes by institutional American Academy of Professional Coders certified abstract coders were considered the "gold standard." A total of 4356 (75.12%) of 5799 entries were identified in billing records. Excel 2010 and SAS 9.3 were used for analysis. In the event of multiple codes for the same patient, any match between resident codes and billing record codes was considered a "correct" entry. A 4-question survey was distributed to all current general surgical residents at our institution for feedback on coding habits, limitations to accurate coding, and opinions on ACGME case log representation of their operative experience. All 7 residents had a low percentage of correctly entered CPT codes. The overall accuracy proportion for all residents was 52.82% (range: 43.32%-60.07%). Only 1 resident showed significant improvement in accuracy during his/her training (p = 0.0043). The survey response rate was 100%. Survey results indicated that inability to find the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy. Survey results also indicated that most residents (74%) believe that they code accurately most of the time and agree that their case log would accurately represent their operative experience (66.6%). This is the first study to evaluate correctness of residents' ACGME case logs in general surgery. The degree of inaccuracy found here necessitates further investigation into the etiology of these discrepancies. Instruction on coding practices should also benefit the residents after graduation. Optimizing communication among attendings and residents, improving ACGME coding search interface, and implementing consistent coding practices could improve accuracy giving a more realistic view of residents' operative experience. Published by Elsevier Inc.

Parametric study of potential early commercial power plants Task 3-A MHD cost analysis

NASA Technical Reports Server (NTRS)

1983-01-01

The development of costs for an MHD Power Plant and the comparison of these costs to a conventional coal fired power plant are reported. The program is divided into three activities: (1) code of accounts review; (2) MHD pulverized coal power plant cost comparison; (3) operating and maintenance cost estimates. The scope of each NASA code of account item was defined to assure that the recently completed Task 3 capital cost estimates are consistent with the code of account scope. Improvement confidence in MHD plant capital cost estimates by identifying comparability with conventional pulverized coal fired (PCF) power plant systems is undertaken. The basis for estimating the MHD plant operating and maintenance costs of electricity is verified.

A Multi-Scale, Multi-Physics Optimization Framework for Additively Manufactured Structural Components

NASA Astrophysics Data System (ADS)

El-Wardany, Tahany; Lynch, Mathew; Gu, Wenjiong; Hsu, Arthur; Klecka, Michael; Nardi, Aaron; Viens, Daniel

This paper proposes an optimization framework enabling the integration of multi-scale / multi-physics simulation codes to perform structural optimization design for additively manufactured components. Cold spray was selected as the additive manufacturing (AM) process and its constraints were identified and included in the optimization scheme. The developed framework first utilizes topology optimization to maximize stiffness for conceptual design. The subsequent step applies shape optimization to refine the design for stress-life fatigue. The component weight was reduced by 20% while stresses were reduced by 75% and the rigidity was improved by 37%. The framework and analysis codes were implemented using Altair software as well as an in-house loading code. The optimized design was subsequently produced by the cold spray process.

Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture

PubMed Central

Zheng, Hou-Feng; Forgetta, Vincenzo; Hsu, Yi-Hsiang; Estrada, Karol; Rosello-Diez, Alberto; Leo, Paul J; Dahia, Chitra L; Park-Min, Kyung Hyun; Tobias, Jonathan H; Kooperberg, Charles; Kleinman, Aaron; Styrkarsdottir, Unnur; Liu, Ching-Ti; Uggla, Charlotta; Evans, Daniel S; Nielson, Carrie M; Walter, Klaudia; Pettersson-Kymmer, Ulrika; McCarthy, Shane; Eriksson, Joel; Kwan, Tony; Jhamai, Mila; Trajanoska, Katerina; Memari, Yasin; Min, Josine; Huang, Jie; Danecek, Petr; Wilmot, Beth; Li, Rui; Chou, Wen-Chi; Mokry, Lauren E; Moayyeri, Alireza; Claussnitzer, Melina; Cheng, Chia-Ho; Cheung, Warren; Medina-Gómez, Carolina; Ge, Bing; Chen, Shu-Huang; Choi, Kwangbom; Oei, Ling; Fraser, James; Kraaij, Robert; Hibbs, Matthew A; Gregson, Celia L; Paquette, Denis; Hofman, Albert; Wibom, Carl; Tranah, Gregory J; Marshall, Mhairi; Gardiner, Brooke B; Cremin, Katie; Auer, Paul; Hsu, Li; Ring, Sue; Tung, Joyce Y; Thorleifsson, Gudmar; Enneman, Anke W; van Schoor, Natasja M; de Groot, Lisette C.P.G.M.; van der Velde, Nathalie; Melin, Beatrice; Kemp, John P; Christiansen, Claus; Sayers, Adrian; Zhou, Yanhua; Calderari, Sophie; van Rooij, Jeroen; Carlson, Chris; Peters, Ulrike; Berlivet, Soizik; Dostie, Josée; Uitterlinden, Andre G; Williams, Stephen R.; Farber, Charles; Grinberg, Daniel; LaCroix, Andrea Z; Haessler, Jeff; Chasman, Daniel I; Giulianini, Franco; Rose, Lynda M; Ridker, Paul M; Eisman, John A; Nguyen, Tuan V; Center, Jacqueline R; Nogues, Xavier; Garcia-Giralt, Natalia; Launer, Lenore L; Gudnason, Vilmunder; Mellström, Dan; Vandenput, Liesbeth; Karlsson, Magnus K; Ljunggren, Östen; Svensson, Olle; Hallmans, Göran; Rousseau, François; Giroux, Sylvie; Bussière, Johanne; Arp, Pascal P; Koromani, Fjorda; Prince, Richard L; Lewis, Joshua R; Langdahl, Bente L; Hermann, A Pernille; Jensen, Jens-Erik B; Kaptoge, Stephen; Khaw, Kay-Tee; Reeve, Jonathan; Formosa, Melissa M; Xuereb-Anastasi, Angela; Åkesson, Kristina; McGuigan, Fiona E; Garg, Gaurav; Olmos, Jose M; Zarrabeitia, Maria T; Riancho, Jose A; Ralston, Stuart H; Alonso, Nerea; Jiang, Xi; Goltzman, David; Pastinen, Tomi; Grundberg, Elin; Gauguier, Dominique; Orwoll, Eric S; Karasik, David; Davey-Smith, George; Smith, Albert V; Siggeirsdottir, Kristin; Harris, Tamara B; Zillikens, M Carola; van Meurs, Joyce BJ; Thorsteinsdottir, Unnur; Maurano, Matthew T; Timpson, Nicholas J; Soranzo, Nicole; Durbin, Richard; Wilson, Scott G; Ntzani, Evangelia E; Brown, Matthew A; Stefansson, Kari; Hinds, David A; Spector, Tim; Cupples, L Adrienne; Ohlsson, Claes; Greenwood, Celia MT; Jackson, Rebecca D; Rowe, David W; Loomis, Cynthia A; Evans, David M; Ackert-Bicknell, Cheryl L; Joyner, Alexandra L; Duncan, Emma L; Kiel, Douglas P; Rivadeneira, Fernando; Richards, J Brent

2016-01-01

SUMMARY The extent to which low-frequency (minor allele frequency [MAF] between 1–5%) and rare (MAF ≤ 1%) variants contribute to complex traits and disease in the general population is largely unknown. Bone mineral density (BMD) is highly heritable, is a major predictor of osteoporotic fractures and has been previously associated with common genetic variants1–8, and rare, population-specific, coding variants9. Here we identify novel non-coding genetic variants with large effects on BMD (ntotal = 53,236) and fracture (ntotal = 508,253) in individuals of European ancestry from the general population. Associations for BMD were derived from whole-genome sequencing (n=2,882 from UK10K), whole-exome sequencing (n= 3,549), deep imputation of genotyped samples using a combined UK10K/1000Genomes reference panel (n=26,534), and de-novo replication genotyping (n= 20,271). We identified a low-frequency non-coding variant near a novel locus, EN1, with an effect size 4-fold larger than the mean of previously reported common variants for lumbar spine BMD8 (rs11692564[T], MAF = 1.7%, replication effect size = +0.20 standard deviations [SD], Pmeta = 2×10−14), which was also associated with a decreased risk of fracture (OR = 0.85; P = 2×10−11; ncases = 98,742 and ncontrols = 409,511). Using an En1Cre/flox mouse model, we observed that conditional loss of En1 results in low bone mass, likely as a consequence of high bone turn-over. We also identified a novel low-frequency non-coding variant with large effects on BMD near WNT16 (rs148771817[T], MAF = 1.1%, replication effect size = +0.39 SD, Pmeta = 1×10−11). In general, there was an excess of association signals arising from deleterious coding and conserved non-coding variants. These findings provide evidence that low-frequency non-coding variants have large effects on BMD and fracture, thereby providing rationale for whole-genome sequencing and improved imputation reference panels to study the genetic architecture of complex traits and disease in the general population. PMID:26367794

Improved Membership Probability for Moving Groups: Bayesian and Machine Learning Approaches

NASA Astrophysics Data System (ADS)

Lee, Jinhee; Song, Inseok

2018-01-01

Gravitationally unbound loose stellar associations (i.e., young nearby moving groups: moving groups hereafter) have been intensively explored because they are important in planet and disk formation studies, exoplanet imaging, and age calibration. Among the many efforts devoted to the search for moving group members, a Bayesian approach (e.g.,using the code BANYAN) has become popular recently because of the many advantages it offers. However, the resultant membership probability needs to be carefully adopted because of its sensitive dependence on input models. In this study, we have developed an improved membership calculation tool focusing on the beta-Pic moving group. We made three improvements for building models used in BANYAN II: (1) updating a list of accepted members by re-assessing memberships in terms of position, motion, and age, (2) investigating member distribution functions in XYZ, and (3) exploring field star distribution functions in XYZUVW. Our improved tool can change membership probability up to 70%. Membership probability is critical and must be better defined. For example, our code identifies only one third of the candidate members in SIMBAD that are believed to be kinematically associated with beta-Pic moving group.Additionally, we performed cluster analysis of young nearby stars using an unsupervised machine learning approach. As more moving groups and their members are identified, the complexity and ambiguity in moving group configuration has been increased. To clarify this issue, we analyzed ~4,000 X-ray bright young stellar candidates. Here, we present the preliminary results. By re-identifying moving groups with the least human intervention, we expect to understand the composition of the solar neighborhood. Moreover better defined moving group membership will help us understand star formation and evolution in relatively low density environments; especially for the low-mass stars which will be identified in the coming Gaia release.

Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo.

PubMed Central

Bradshaw, Debbie; Groenewald, Pamela; Bourne, David E.; Mahomed, Hassan; Nojilana, Beatrice; Daniels, Johan; Nixon, Jo

2006-01-01

OBJECTIVE: To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town. METHODS: Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored. FINDINGS: Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. CONCLUSION: Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers. PMID:16583080

Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo.

PubMed

Bradshaw, Debbie; Groenewald, Pamela; Bourne, David E; Mahomed, Hassan; Nojilana, Beatrice; Daniels, Johan; Nixon, Jo

2006-03-01

To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town. Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored. Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts. Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers.

Radioactive waste isolation in salt: special advisory report on the status of the Office of Nuclear Waste Isolation's plans for repository performance assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ditmars, J.D.; Walbridge, E.W.; Rote, D.M.

1983-10-01

Repository performance assessment is analysis that identifies events and processes that might affect a repository system for isolation of radioactive waste, examines their effects on barriers to waste migration, and estimates the probabilities of their occurrence and their consequences. In 1983 Battelle Memorial Institute's Office of Nuclear Waste Isolation (ONWI) prepared two plans - one for performance assessment for a waste repository in salt and one for verification and validation of performance assessment technology. At the request of the US Department of Energy's Salt Repository Project Office (SRPO), Argonne National Laboratory reviewed those plans and prepared this report to advisemore » SRPO of specific areas where ONWI's plans for performance assessment might be improved. This report presents a framework for repository performance assessment that clearly identifies the relationships among the disposal problems, the processes underlying the problems, the tools for assessment (computer codes), and the data. In particular, the relationships among important processes and 26 model codes available to ONWI are indicated. A common suggestion for computer code verification and validation is the need for specific and unambiguous documentation of the results of performance assessment activities. A major portion of this report consists of status summaries of 27 model codes indicated as potentially useful by ONWI. The code summaries focus on three main areas: (1) the code's purpose, capabilities, and limitations; (2) status of the elements of documentation and review essential for code verification and validation; and (3) proposed application of the code for performance assessment of salt repository systems. 15 references, 6 figures, 4 tables.« less

Major influence of interobserver reliability on polytrauma identification with the Injury Severity Score (ISS): Time for a centralised coding in trauma registries?

PubMed

Maduz, Roman; Kugelmeier, Patrick; Meili, Severin; Döring, Robert; Meier, Christoph; Wahl, Peter

2017-04-01

The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) find increasingly widespread use to assess trauma burden and to perform interhospital benchmarking through trauma registries. Since 2015, public resource allocation in Switzerland shall even be derived from such data. As every trauma centre is responsible for its own coding and data input, this study aims at evaluating interobserver reliability of AIS and ISS coding. Interobserver reliability of the AIS and ISS is analysed from a cohort of 50 consecutive severely injured patients treated in 2012 at our institution, coded retrospectively by 3 independent and specifically trained observers. Considering a cutoff ISS≥16, only 38/50 patients (76%) were uniformly identified as polytraumatised or not. Increasing the cut off to ≥20, this increased to 41/50 patients (82%). A difference in the AIS of ≥ 1 was present in 261 (16%) of possible codes. Excluding the vast majority of uninjured body regions, uniformly identical AIS severity values were attributed in 67/193 (35%) body regions, or 318/579 (55%) possible observer pairings. Injury severity all too often is neither identified correctly nor consistently when using the AIS. This leads to wrong identification of severely injured patients using the ISS. Improving consistency of coding through centralisation is recommended before scores based on the AIS are to be used for interhospital benchmarking and resource allocation in the treatment of severely injured patients. Copyright © 2017. Published by Elsevier Ltd.

Epidemiology of angina pectoris: role of natural language processing of the medical record

PubMed Central

Pakhomov, Serguei; Hemingway, Harry; Weston, Susan A.; Jacobsen, Steven J.; Rodeheffer, Richard; Roger, Véronique L.

2007-01-01

Background The diagnosis of angina is challenging as it relies on symptom descriptions. Natural language processing (NLP) of the electronic medical record (EMR) can provide access to such information contained in free text that may not be fully captured by conventional diagnostic coding. Objective To test the hypothesis that NLP of the EMR improves angina pectoris (AP) ascertainment over diagnostic codes. Methods Billing records of in- and out-patients were searched for ICD-9 codes for AP, chronic ischemic heart disease and chest pain. EMR clinical reports were searched electronically for 50 specific non-negated natural language synonyms to these ICD-9 codes. The two methods were compared to a standardized assessment of angina by Rose questionnaire for three diagnostic levels: unspecified chest pain, exertional chest pain, and Rose angina. Results Compared to the Rose questionnaire, the true positive rate of EMR-NLP for unspecified chest pain was 62% (95%CI:55–67) vs. 51% (95%CI:44–58) for diagnostic codes (p<0.001). For exertional chest pain, the EMR-NLP true positive rate was 71% (95%CI:61–80) vs. 62% (95%CI:52–73) for diagnostic codes (p=0.10). Both approaches had 88% (95%CI:65–100) true positive rate for Rose angina. The EMR-NLP method consistently identified more patients with exertional chest pain over 28-month follow-up. Conclusion EMR-NLP method improves the detection of unspecified and exertional chest pain cases compared to diagnostic codes. These findings have implications for epidemiological and clinical studies of angina pectoris. PMID:17383310

Alternative Formats to Achieve More Efficient Energy Codes for Commercial Buildings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conover, David R.; Rosenberg, Michael I.; Halverson, Mark A.

2013-01-26

This paper identifies and examines several formats or structures that could be used to create the next generation of more efficient energy codes and standards for commercial buildings. Pacific Northwest National Laboratory (PNNL) is funded by the U.S. Department of Energy’s Building Energy Codes Program (BECP) to provide technical support to the development of ANSI/ASHRAE/IES Standard 90.1. While the majority of PNNL’s ASHRAE Standard 90.1 support focuses on developing and evaluating new requirements, a portion of its work involves consideration of the format of energy standards. In its current working plan, the ASHRAE 90.1 committee has approved an energy goalmore » of 50% improvement in Standard 90.1-2013 relative to Standard 90.1-2004, and will likely be considering higher improvement targets for future versions of the standard. To cost-effectively achieve the 50% goal in manner that can gain stakeholder consensus, formats other than prescriptive must be considered. Alternative formats that include reducing the reliance on prescriptive requirements may make it easier to achieve these aggressive efficiency levels in new codes and standards. The focus on energy code and standard formats is meant to explore approaches to presenting the criteria that will foster compliance, enhance verification, and stimulate innovation while saving energy in buildings. New formats may also make it easier for building designers and owners to design and build the levels of efficiency called for in the new codes and standards. This paper examines a number of potential formats and structures, including prescriptive, performance-based (with sub-formats of performance equivalency and performance targets), capacity constraint-based, and outcome-based. The paper also discusses the pros and cons of each format from the viewpoint of code users and of code enforcers.« less

A Measurement and Simulation Based Methodology for Cache Performance Modeling and Tuning

NASA Technical Reports Server (NTRS)

Waheed, Abdul; Yan, Jerry; Saini, Subhash (Technical Monitor)

1998-01-01

We present a cache performance modeling methodology that facilitates the tuning of uniprocessor cache performance for applications executing on shared memory multiprocessors by accurately predicting the effects of source code level modifications. Measurements on a single processor are initially used for identifying parts of code where cache utilization improvements may significantly impact the overall performance. Cache simulation based on trace-driven techniques can be carried out without gathering detailed address traces. Minimal runtime information for modeling cache performance of a selected code block includes: base virtual addresses of arrays, virtual addresses of variables, and loop bounds for that code block. Rest of the information is obtained from the source code. We show that the cache performance predictions are as reliable as those obtained through trace-driven simulations. This technique is particularly helpful to the exploration of various "what-if' scenarios regarding the cache performance impact for alternative code structures. We explain and validate this methodology using a simple matrix-matrix multiplication program. We then apply this methodology to predict and tune the cache performance of two realistic scientific applications taken from the Computational Fluid Dynamics (CFD) domain.

CACTI: Free, Open-Source Software for the Sequential Coding of Behavioral Interactions

PubMed Central

Glynn, Lisa H.; Hallgren, Kevin A.; Houck, Jon M.; Moyers, Theresa B.

2012-01-01

The sequential analysis of client and clinician speech in psychotherapy sessions can help to identify and characterize potential mechanisms of treatment and behavior change. Previous studies required coding systems that were time-consuming, expensive, and error-prone. Existing software can be expensive and inflexible, and furthermore, no single package allows for pre-parsing, sequential coding, and assignment of global ratings. We developed a free, open-source, and adaptable program to meet these needs: The CASAA Application for Coding Treatment Interactions (CACTI). Without transcripts, CACTI facilitates the real-time sequential coding of behavioral interactions using WAV-format audio files. Most elements of the interface are user-modifiable through a simple XML file, and can be further adapted using Java through the terms of the GNU Public License. Coding with this software yields interrater reliabilities comparable to previous methods, but at greatly reduced time and expense. CACTI is a flexible research tool that can simplify psychotherapy process research, and has the potential to contribute to the improvement of treatment content and delivery. PMID:22815713

Exploration of ICD-9-CM Coding of Chronic Disease within the Elixhauser Comorbidity Measure in Patients with Chronic Heart Failure

PubMed Central

Garvin, Jennifer Hornung; Redd, Andrew; Bolton, Dan; Graham, Pauline; Roche, Dominic; Groeneveld, Peter; Leecaster, Molly; Shen, Shuying; Weiner, Mark G.

2013-01-01

Introduction International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes capture comorbidities that can be used to risk adjust nonrandom patient groups. We explored the accuracy of capturing comorbidities associated with one risk adjustment method, the Elixhauser Comorbidity Measure (ECM), in patients with chronic heart failure (CHF) at one Veterans Affairs (VA) medical center. We explored potential reasons for the differences found between the original codes assigned and conditions found through retrospective review. Methods This descriptive, retrospective study used a cohort of patients discharged with a principal diagnosis coded as CHF from one VA medical center in 2003. One admission per patient was used in the study; with multiple admissions, only the first admission was analyzed. We compared the assignment of original codes assigned to conditions found in a retrospective, manual review of the medical record conducted by an investigator with coding expertise as well as by physicians. Members of the team experienced with assigning ICD-9-CM codes and VA coding processes developed themes related to systemic reasons why chronic conditions were not coded in VA records using applied thematic techniques. Results In the 181-patient cohort, 388 comorbid conditions were identified; 305 of these were chronic conditions, originally coded at the time of discharge with an average of 1.7 comorbidities related to the ECM per patient. The review by an investigator with coding expertise revealed a total of 937 comorbidities resulting in 618 chronic comorbid conditions with an average of 3.4 per patient; physician review found 872 total comorbidities with 562 chronic conditions (average 3.1 per patient). The agreement between the original and the retrospective coding review was 88 percent. The kappa statistic for the original and the retrospective coding review was 0.375 with a 95 percent confidence interval (CI) of 0.352 to 0.398. The kappa statistic for the retrospective coding review and physician review was 0.849 (CI, 0.823–0.875). The kappa statistic for the original coding and the physician review was 0.340 (CI, 0.316–0.364). Several systemic factors were identified, including familiarity with inpatient VA and non-VA guidelines, the quality of documentation, and operational requirements to complete the coding process within short time frames and to identify the reasons for movement within a given facility. Conclusion Comorbidities within the ECM representing chronic conditions were significantly underrepresented in the original code assignment. Contributing factors potentially include prioritization of codes related to acute conditions over chronic conditions; coders’ professional training, educational level, and experience; and the limited number of codes allowed in initial coding software. This study highlights the need to evaluate systemic causes of underrepresentation of chronic conditions to improve the accuracy of risk adjustment used for health services research, resource allocation, and performance measurement. PMID:24159270

Narrative-compression coding for a channel with errors. Professional paper for period ending June 1987

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bond, J.W.

1988-01-01

Data-compression codes offer the possibility of improving the thruput of existing communication systems in the near term. This study was undertaken to determine if data-compression codes could be utilized to provide message compression in a channel with up to a 0.10-bit error rate. The data-compression capabilities of codes were investigated by estimating the average number of bits-per-character required to transmit narrative files. The performance of the codes in a channel with errors (a noisy channel) was investigated in terms of the average numbers of characters-decoded-in-error and of characters-printed-in-error-per-bit-error. Results were obtained by encoding four narrative files, which were resident onmore » an IBM-PC and use a 58-character set. The study focused on Huffman codes and suffix/prefix comma-free codes. Other data-compression codes, in particular, block codes and some simple variants of block codes, are briefly discussed to place the study results in context. Comma-free codes were found to have the most-promising data compression because error propagation due to bit errors are limited to a few characters for these codes. A technique was found to identify a suffix/prefix comma-free code giving nearly the same data compressions as a Huffman code with much less error propagation than the Huffman codes. Greater data compression can be achieved through the use of this comma-free code word assignments based on conditioned probabilities of character occurrence.« less

Validation of ICD-9 Codes for Stable Miscarriage in the Emergency Department.

PubMed

Quinley, Kelly E; Falck, Ailsa; Kallan, Michael J; Datner, Elizabeth M; Carr, Brendan G; Schreiber, Courtney A

2015-07-01

International Classification of Disease, Ninth Revision (ICD-9) diagnosis codes have not been validated for identifying cases of missed abortion where a pregnancy is no longer viable but the cervical os remains closed. Our goal was to assess whether ICD-9 code "632" for missed abortion has high sensitivity and positive predictive value (PPV) in identifying patients in the emergency department (ED) with cases of stable early pregnancy failure (EPF). We studied females ages 13-50 years presenting to the ED of an urban academic medical center. We approached our analysis from two perspectives, evaluating both the sensitivity and PPV of ICD-9 code "632" in identifying patients with stable EPF. All patients with chief complaints "pregnant and bleeding" or "pregnant and cramping" over a 12-month period were identified. We randomly reviewed two months of patient visits and calculated the sensitivity of ICD-9 code "632" for true cases of stable miscarriage. To establish the PPV of ICD-9 code "632" for capturing missed abortions, we identified patients whose visits from the same time period were assigned ICD-9 code "632," and identified those with actual cases of stable EPF. We reviewed 310 patient records (17.6% of 1,762 sampled). Thirteen of 31 patient records assigned ICD-9 code for missed abortion correctly identified cases of stable EPF (sensitivity=41.9%), and 140 of the 142 patients without EPF were not assigned the ICD-9 code "632"(specificity=98.6%). Of the 52 eligible patients identified by ICD-9 code "632," 39 cases met the criteria for stable EPF (PPV=75.0%). ICD-9 code "632" has low sensitivity for identifying stable EPF, but its high specificity and moderately high PPV are valuable for studying cases of stable EPF in epidemiologic studies using administrative data.

Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan Conflicts: review of case reports from a National Veterans Affairs Database.

PubMed

Mills, Peter D; Huber, Samuel J; Vince Watts, Bradley; Bagian, James P

2011-02-01

While suicide among recently returned veterans is of great concern, it is a relatively rare occurrence within individual hospitals and clinics. Root cause analysis (RCA) generates a detailed case report that can be used to identify system-based vulnerabilities following an adverse event. Review of a national database of RCA reports may identify common vulnerabilities and assist in the development of more robust prevention strategies. Our objective was to identify and compare common themes among reports of suicide among veterans of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) in the Veterans Affairs system. Common themes among root causes of suicide as identified in RCA reports were collected and compared as the primary outcome--systematic vulnerabilities. Actions recommended within the reports were coded as the secondary outcome--prevention strategies. Fifty-one RCA reports of OIF/OEF suicides were identified by our search. Coding generated 16 common categories among 132 root causes, and 13 categories among 108 recommended actions. Assessment of suicidal risk, coordination of care, timely access to care, and communication among providers were the most common root causes. Actions identified by RCA teams to reduce suicide included improving referral processes, staff education in suicide assessment, and follow-up with suicidal veterans. Review of multiple RCA reports can identify organizational vulnerabilities detected at the local level that may be applicable system wide. Attention to improving suicide assessment, coordination of care, and timely access may have the largest impact on reducing suicide among OIF/OEF veterans. © 2011 The American Association of Suicidology.

RELAP-7 Code Assessment Plan and Requirement Traceability Matrix

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoo, Junsoo; Choi, Yong-joon; Smith, Curtis L.

2016-10-01

The RELAP-7, a safety analysis code for nuclear reactor system, is under development at Idaho National Laboratory (INL). Overall, the code development is directed towards leveraging the advancements in computer science technology, numerical solution methods and physical models over the last decades. Recently, INL has also been putting an effort to establish the code assessment plan, which aims to ensure an improved final product quality through the RELAP-7 development process. The ultimate goal of this plan is to propose a suitable way to systematically assess the wide range of software requirements for RELAP-7, including the software design, user interface, andmore » technical requirements, etc. To this end, we first survey the literature (i.e., international/domestic reports, research articles) addressing the desirable features generally required for advanced nuclear system safety analysis codes. In addition, the V&V (verification and validation) efforts as well as the legacy issues of several recently-developed codes (e.g., RELAP5-3D, TRACE V5.0) are investigated. Lastly, this paper outlines the Requirement Traceability Matrix (RTM) for RELAP-7 which can be used to systematically evaluate and identify the code development process and its present capability.« less

Modelling Conditions and Health Care Processes in Electronic Health Records: An Application to Severe Mental Illness with the Clinical Practice Research Datalink.

PubMed

Olier, Ivan; Springate, David A; Ashcroft, Darren M; Doran, Tim; Reeves, David; Planner, Claire; Reilly, Siobhan; Kontopantelis, Evangelos

2016-01-01

The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rpcdsearch) to help researchers in this task. We present severe mental illness as an example. We used the Clinical Practice Research Datalink, a UK Primary Care Database in which clinical information is largely organised using Read codes, a hierarchical clinical coding system. Pcdsearch is used to identify potentially relevant clinical codes and/or product codes from word-stubs and code-stubs suggested by clinicians. The returned code-lists are reviewed and codes relevant to the condition of interest are selected. The final code-list is then used to identify patients. We identified 270 Read codes linked to SMI and used them to identify cases in the database. We observed that our approach identified cases that would have been missed with a simpler approach using SMI registers defined within the UK Quality and Outcomes Framework. We described a framework for researchers of Electronic Health Records databases, for identifying patients with a particular condition or matching certain clinical criteria. The method is invariant to coding system or database and can be used with SNOMED CT, ICD or other medical classification code-lists.

Discectomy-related information on the internet: does the quality follow the surge?

PubMed

Elhassan, Yahya; Sheridan, Gerard; Nassiri, Mujtaba; Osman, Mugtaba; Kiely, Pat; Noel, Jacques

2015-01-15

A quality-control Internet-based study using recognized quality-scoring systems. To evaluate the quality of information available on the Internet. Quality of health information on the Internet is of much concern and the emphasis for appraisal of Internet Web sites is needed. This study is to determine if it has improved with the surge in Internet usage. The 3 most commonly used search engines were identified and a search for "Discectomy" was performed on each. Two reviewers categorized the Web sites according to their types and the quality of each was assessed using recognized scoring systems including the Journal of the American Medical Association (JAMA) benchmark, DISCERN score, and discectomy-specific content score. The quality of the information was also assessed according to the presence and absence of the Health on the Net code. Fifty-three Web sites were identified, and analyzed. Commercial Web sites were predominant, 24 of them were identified, 7 were governmental, 6 were produced by physicians, none were produced by allied health professionals, 3 were academic, 4 were public health information Web sites, 4 were attached to social media and discussion groups, 3 were related to media, and 2 were unspecified. Internet sites with a Health on the Net code demonstrated significantly higher quality than those without the code (P < 0.0001). Public health information Web sites attained the highest overall DISCERN and discectomy-specific scores followed by Web sites of the government and nonprofit organizations. The overall quality of information regarding discectomy remains poor and variable despite an exponential increase in the number of users and Web sites, with a slight trend toward improvement, only 20% to 30% are of good quality, compared with that 10 years ago (<10%). Presence of Health on the Net code is a very reliable marker for health information quality.

Validation of two case definitions to identify pressure ulcers using hospital administrative data

PubMed Central

Ho, Chester; Jiang, Jason; Eastwood, Cathy A; Wong, Holly; Weaver, Brittany; Quan, Hude

2017-01-01

Objective Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. Setting A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. Participants There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. Results Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. Conclusion DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies. PMID:28851785

Improvement of Modeling HTGR Neutron Physics by Uncertainty Analysis with the Use of Cross-Section Covariance Information

NASA Astrophysics Data System (ADS)

Boyarinov, V. F.; Grol, A. V.; Fomichenko, P. A.; Ternovykh, M. Yu

2017-01-01

This work is aimed at improvement of HTGR neutron physics design calculations by application of uncertainty analysis with the use of cross-section covariance information. Methodology and codes for preparation of multigroup libraries of covariance information for individual isotopes from the basic 44-group library of SCALE-6 code system were developed. A 69-group library of covariance information in a special format for main isotopes and elements typical for high temperature gas cooled reactors (HTGR) was generated. This library can be used for estimation of uncertainties, associated with nuclear data, in analysis of HTGR neutron physics with design codes. As an example, calculations of one-group cross-section uncertainties for fission and capture reactions for main isotopes of the MHTGR-350 benchmark, as well as uncertainties of the multiplication factor (k∞) for the MHTGR-350 fuel compact cell model and fuel block model were performed. These uncertainties were estimated by the developed technology with the use of WIMS-D code and modules of SCALE-6 code system, namely, by TSUNAMI, KENO-VI and SAMS. Eight most important reactions on isotopes for MHTGR-350 benchmark were identified, namely: 10B(capt), 238U(n,γ), ν5, 235U(n,γ), 238U(el), natC(el), 235U(fiss)-235U(n,γ), 235U(fiss).

Postoperative complications following colectomy for ulcerative colitis: A validation study

PubMed Central

2012-01-01

Background Ulcerative colitis (UC) patients failing medical management require colectomy. This study compares risk estimates for predictors of postoperative complication derived from administrative data against that of chart review and evaluates the accuracy of administrative coding for this population. Methods Hospital administrative databases were used to identify adults with UC undergoing colectomy from 1996–2007. Medical charts were reviewed and regression analyses comparing chart versus administrative data were performed to assess the effect of age, emergent operation, and Charlson comorbidities on the occurrence of postoperative complications. Sensitivity, specificity, and positive/negative predictive values of administrative coding for identifying the study population, Charlson comorbidities, and postoperative complications were assessed. Results Compared to chart review, administrative data estimated a higher magnitude of effect for emergent admission (OR 2.52 [95% CI: 1.80–3.52] versus 1.49 [1.06–2.09]) and Charlson comorbidities (OR 2.91 [1.86–4.56] versus 1.50 [1.05–2.15]) as predictors of postoperative complications. Administrative data correctly identified UC and colectomy in 85.9% of cases. The administrative database was 37% sensitive in identifying patients with ≥ 1Charlson comorbidity. Restricting analysis to active comorbidities increased the sensitivity to 63%. The sensitivity of identifying patients with at least one postoperative complication was 68%; restricting analysis to more severe complications improved the sensitivity to 84%. Conclusions Administrative data identified the same risk factors for postoperative complications as chart review, but overestimated the magnitude of risk. This discrepancy may be explained by coding inaccuracies that selectively identifying the most serious complications and comorbidities. PMID:22943760

Development and preliminary evaluation of a practice-based learning and improvement tool for assessing resident competence and guiding curriculum development.

PubMed

Lawrence, Renée H; Tomolo, Anne M

2011-03-01

Although practice-based learning and improvement (PBLI) is now recognized as a fundamental and necessary skill set, we are still in need of tools that yield specific information about gaps in knowledge and application to help nurture the development of quality improvement (QI) skills in physicians in a proficient and proactive manner. We developed a questionnaire and coding system as an assessment tool to evaluate and provide feedback regarding PBLI self-efficacy, knowledge, and application skills for residency programs and related professional requirements. Five nationally recognized QI experts/leaders reviewed and completed our questionnaire. Through an iterative process, a coding system based on identifying key variables needed for ideal responses was developed to score project proposals. The coding system comprised 14 variables related to the QI projects, and an additional 30 variables related to the core knowledge concepts related to PBLI. A total of 86 residents completed the questionnaire, and 2 raters coded their open-ended responses. Interrater reliability was assessed by percentage agreement and Cohen κ for individual variables and Lin concordance correlation for total scores for knowledge and application. Discriminative validity (t test to compare known groups) and coefficient of reproducibility as an indicator of construct validity (item difficulty hierarchy) were also assessed. Interrater reliability estimates were good (percentage of agreements, above 90%; κ, above 0.4 for most variables; concordances for total scores were R  =  .88 for knowledge and R  =  .98 for application). Despite the residents' limited range of experiences in the group with prior PBLI exposure, our tool met our goal of differentiating between the 2 groups in our preliminary analyses. Correcting for chance agreement identified some variables that are potentially problematic. Although additional evaluation is needed, our tool may prove helpful and provide detailed information about trainees' progress and the curriculum.

Development and Preliminary Evaluation of a Practice-Based Learning and Improvement Tool for Assessing Resident Competence and Guiding Curriculum Development

PubMed Central

Lawrence, Renée H; Tomolo, Anne M

2011-01-01

Background Although practice-based learning and improvement (PBLI) is now recognized as a fundamental and necessary skill set, we are still in need of tools that yield specific information about gaps in knowledge and application to help nurture the development of quality improvement (QI) skills in physicians in a proficient and proactive manner. We developed a questionnaire and coding system as an assessment tool to evaluate and provide feedback regarding PBLI self-efficacy, knowledge, and application skills for residency programs and related professional requirements. Methods Five nationally recognized QI experts/leaders reviewed and completed our questionnaire. Through an iterative process, a coding system based on identifying key variables needed for ideal responses was developed to score project proposals. The coding system comprised 14 variables related to the QI projects, and an additional 30 variables related to the core knowledge concepts related to PBLI. A total of 86 residents completed the questionnaire, and 2 raters coded their open-ended responses. Interrater reliability was assessed by percentage agreement and Cohen κ for individual variables and Lin concordance correlation for total scores for knowledge and application. Discriminative validity (t test to compare known groups) and coefficient of reproducibility as an indicator of construct validity (item difficulty hierarchy) were also assessed. Results Interrater reliability estimates were good (percentage of agreements, above 90%; κ, above 0.4 for most variables; concordances for total scores were R  =  .88 for knowledge and R  =  .98 for application). Conclusion Despite the residents' limited range of experiences in the group with prior PBLI exposure, our tool met our goal of differentiating between the 2 groups in our preliminary analyses. Correcting for chance agreement identified some variables that are potentially problematic. Although additional evaluation is needed, our tool may prove helpful and provide detailed information about trainees' progress and the curriculum. PMID:22379522

Pseudo-color coding method for high-dynamic single-polarization SAR images

NASA Astrophysics Data System (ADS)

Feng, Zicheng; Liu, Xiaolin; Pei, Bingzhi

2018-04-01

A raw synthetic aperture radar (SAR) image usually has a 16-bit or higher bit depth, which cannot be directly visualized on 8-bit displays. In this study, we propose a pseudo-color coding method for high-dynamic singlepolarization SAR images. The method considers the characteristics of both SAR images and human perception. In HSI (hue, saturation and intensity) color space, the method carries out high-dynamic range tone mapping and pseudo-color processing simultaneously in order to avoid loss of details and to improve object identifiability. It is a highly efficient global algorithm.

Towards acute pediatric status epilepticus intervention teams: Do we need "Seizure Codes"?

PubMed

Stredny, Coral M; Abend, Nicholas S; Loddenkemper, Tobias

2018-05-01

To identify areas of treatment delay and barriers to care in pediatric status epilepticus, review ongoing quality improvement initiatives, and provide suggestions for further innovations to improve and standardize these patient care processes. Narrative review of current status epilepticus management algorithms, anti-seizure medication administration and outcomes associated with delays, and initiatives to improve time to treatment. Articles reviewing or reporting quality improvement initiatives were identified through a PubMed search with keywords "status epilepticus," "quality improvement," "guideline adherence," and/or "protocol;" references of included articles were also reviewed. Rapid initiation and escalation of status epilepticus treatment has been associated with shortened seizure duration and more favorable outcomes. Current evidence-based guidelines for management of status epilepticus propose medication algorithms with suggested times for each management step. However, time to antiseizure medication administration for pediatric status epilepticus remains delayed in both the pre- and in-hospital settings. Barriers to timely treatment include suboptimal preventive care, inaccurate seizure detection, infrequent or restricted use of home rescue medications by caregivers and pre-hospital emergency personnel, delayed summoning and arrival of emergency personnel, and use of inappropriately dosed medications. Ongoing quality improvement initiatives in the pre- and in-hospital settings targeting these barriers are reviewed. Improved preventive care, seizure detection, and rescue medication education may advance pre-hospital management, and we propose the use of acute status epilepticus intervention teams to initiate and incorporate in-hospital interventions as time-sensitive "Seizure Code" emergencies. Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Do Special Education Interventions Improve Learning of Secondary Content? A Meta-Analysis

ERIC Educational Resources Information Center

Scruggs, Thomas E.; Mastropieri, Margo A.; Berkeley, Sheri; Graetz, Janet E.

2010-01-01

The authors describe findings from a research synthesis on content area instruction for students with disabilities. Seventy studies were identified from a comprehensive literature search, examined, and coded for a number of variables, including weighted standardized mean-difference effect sizes. More than 2,400 students were participants in these…

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

Nonassertive Mothers, Aggressive Teens: Toughlove as a Community Intervention.

ERIC Educational Resources Information Center

Klug, Wayne

A process study was conducted in two phases to measure the effects of whether a mother's participation in a Toughlove program improved her child's behavior. During phase 1, small-group Toughlove meetings were used for observation and then were tape-recorded and transcribed. Transcriptions were coded to identify instances of social support;…

Potential application of item-response theory to interpretation of medical codes in electronic patient records

PubMed Central

2011-01-01

Background Electronic patient records are generally coded using extensive sets of codes but the significance of the utilisation of individual codes may be unclear. Item response theory (IRT) models are used to characterise the psychometric properties of items included in tests and questionnaires. This study asked whether the properties of medical codes in electronic patient records may be characterised through the application of item response theory models. Methods Data were provided by a cohort of 47,845 participants from 414 family practices in the UK General Practice Research Database (GPRD) with a first stroke between 1997 and 2006. Each eligible stroke code, out of a set of 202 OXMIS and Read codes, was coded as either recorded or not recorded for each participant. A two parameter IRT model was fitted using marginal maximum likelihood estimation. Estimated parameters from the model were considered to characterise each code with respect to the latent trait of stroke diagnosis. The location parameter is referred to as a calibration parameter, while the slope parameter is referred to as a discrimination parameter. Results There were 79,874 stroke code occurrences available for analysis. Utilisation of codes varied between family practices with intraclass correlation coefficients of up to 0.25 for the most frequently used codes. IRT analyses were restricted to 110 Read codes. Calibration and discrimination parameters were estimated for 77 (70%) codes that were endorsed for 1,942 stroke patients. Parameters were not estimated for the remaining more frequently used codes. Discrimination parameter values ranged from 0.67 to 2.78, while calibration parameters values ranged from 4.47 to 11.58. The two parameter model gave a better fit to the data than either the one- or three-parameter models. However, high chi-square values for about a fifth of the stroke codes were suggestive of poor item fit. Conclusion The application of item response theory models to coded electronic patient records might potentially contribute to identifying medical codes that offer poor discrimination or low calibration. This might indicate the need for improved coding sets or a requirement for improved clinical coding practice. However, in this study estimates were only obtained for a small proportion of participants and there was some evidence of poor model fit. There was also evidence of variation in the utilisation of codes between family practices raising the possibility that, in practice, properties of codes may vary for different coders. PMID:22176509

An Atlas of Soybean Small RNAs Identifies Phased siRNAs from Hundreds of Coding Genes[W

PubMed Central

Kakrana, Atul; Huang, Kun; Zhai, Jixian; Yan, Zhe; Valdés-López, Oswaldo; Prince, Silvas; Musket, Theresa A.; Stacey, Gary

2014-01-01

Small RNAs are ubiquitous, versatile repressors and include (1) microRNAs (miRNAs), processed from mRNA forming stem-loops; and (2) small interfering RNAs (siRNAs), the latter derived in plants by a process typically requiring an RNA-dependent RNA polymerase. We constructed and analyzed an expression atlas of soybean (Glycine max) small RNAs, identifying over 500 loci generating 21-nucleotide phased siRNAs (phasiRNAs; from PHAS loci), of which 483 overlapped annotated protein-coding genes. Via the integration of miRNAs with parallel analysis of RNA end (PARE) data, 20 miRNA triggers of 127 PHAS loci were detected. The primary class of PHAS loci (208 or 41% of the total) corresponded to NB-LRR genes; some of these small RNAs preferentially accumulate in nodules. Among the PHAS loci, novel representatives of TAS3 and noncanonical phasing patterns were also observed. A noncoding PHAS locus, triggered by miR4392, accumulated preferentially in anthers; the phasiRNAs are predicted to target transposable elements, with their peak abundance during soybean reproductive development. Thus, phasiRNAs show tremendous diversity in dicots. We identified novel miRNAs and assessed the veracity of soybean miRNAs registered in miRBase, substantially improving the soybean miRNA annotation, facilitating an improvement of miRBase annotations and identifying at high stringency novel miRNAs and their targets. PMID:25465409

Identifying clinical features in primary care electronic health record studies: methods for codelist development.

PubMed

Watson, Jessica; Nicholson, Brian D; Hamilton, Willie; Price, Sarah

2017-11-22

Analysis of routinely collected electronic health record (EHR) data from primary care is reliant on the creation of codelists to define clinical features of interest. To improve scientific rigour, transparency and replicability, we describe and demonstrate a standardised reproducible methodology for clinical codelist development. We describe a three-stage process for developing clinical codelists. First, the clear definition a priori of the clinical feature of interest using reliable clinical resources. Second, development of a list of potential codes using statistical software to comprehensively search all available codes. Third, a modified Delphi process to reach consensus between primary care practitioners on the most relevant codes, including the generation of an 'uncertainty' variable to allow sensitivity analysis. These methods are illustrated by developing a codelist for shortness of breath in a primary care EHR sample, including modifiable syntax for commonly used statistical software. The codelist was used to estimate the frequency of shortness of breath in a cohort of 28 216 patients aged over 18 years who received an incident diagnosis of lung cancer between 1 January 2000 and 30 November 2016 in the Clinical Practice Research Datalink (CPRD). Of 78 candidate codes, 29 were excluded as inappropriate. Complete agreement was reached for 44 (90%) of the remaining codes, with partial disagreement over 5 (10%). 13 091 episodes of shortness of breath were identified in the cohort of 28 216 patients. Sensitivity analysis demonstrates that codes with the greatest uncertainty tend to be rarely used in clinical practice. Although initially time consuming, using a rigorous and reproducible method for codelist generation 'future-proofs' findings and an auditable, modifiable syntax for codelist generation enables sharing and replication of EHR studies. Published codelists should be badged by quality and report the methods of codelist generation including: definitions and justifications associated with each codelist; the syntax or search method; the number of candidate codes identified; and the categorisation of codes after Delphi review. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

HSR combustion analytical research

NASA Technical Reports Server (NTRS)

Nguyen, H. Lee

1992-01-01

Increasing the pressure and temperature of the engines of a new generation of supersonic airliners increases the emissions of nitrogen oxides (NO(x)) to a level that would have an adverse impact on the Earth's protective ozone layer. In the process of evolving and implementing low emissions combustor technologies, NASA LeRC has pursued a combustion analysis code program to guide combustor design processes, to identify potential concepts of the greatest promise, and to optimize them at low cost, with short turnaround time. The computational analyses are evaluated at actual engine operating conditions. The approach is to upgrade and apply advanced computer programs for gas turbine applications. Efforts were made in further improving the code capabilities for modeling the physics and the numerical methods of solution. Then test cases and measurements from experiments are used for code validation.

Reliability of routinely collected hospital data for child maltreatment surveillance.

PubMed

McKenzie, Kirsten; Scott, Debbie A; Waller, Garry S; Campbell, Margaret

2011-01-05

Internationally, research on child maltreatment-related injuries has been hampered by a lack of available routinely collected health data to identify cases, examine causes, identify risk factors and explore health outcomes. Routinely collected hospital separation data coded using the International Classification of Diseases and Related Health Problems (ICD) system provide an internationally standardised data source for classifying and aggregating diseases, injuries, causes of injuries and related health conditions for statistical purposes. However, there has been limited research to examine the reliability of these data for child maltreatment surveillance purposes. This study examined the reliability of coding of child maltreatment in Queensland, Australia. A retrospective medical record review and recoding methodology was used to assess the reliability of coding of child maltreatment. A stratified sample of hospitals across Queensland was selected for this study, and a stratified random sample of cases was selected from within those hospitals. In 3.6% of cases the coders disagreed on whether any maltreatment code could be assigned (definite or possible) versus no maltreatment being assigned (unintentional injury), giving a sensitivity of 0.982 and specificity of 0.948. The review of these cases where discrepancies existed revealed that all cases had some indications of risk documented in the records. 15.5% of cases originally assigned a definite or possible maltreatment code, were recoded to a more or less definite strata. In terms of the number and type of maltreatment codes assigned, the auditor assigned a greater number of maltreatment types based on the medical documentation than the original coder assigned (22% of the auditor coded cases had more than one maltreatment type assigned compared to only 6% of the original coded data). The maltreatment types which were the most 'under-coded' by the original coder were psychological abuse and neglect. Cases coded with a sexual abuse code showed the highest level of reliability. Given the increasing international attention being given to improving the uniformity of reporting of child-maltreatment related injuries and the emphasis on the better utilisation of routinely collected health data, this study provides an estimate of the reliability of maltreatment-specific ICD-10-AM codes assigned in an inpatient setting.

Reliability of Routinely Collected Hospital Data for Child Maltreatment Surveillance

PubMed Central

2011-01-01

Background Internationally, research on child maltreatment-related injuries has been hampered by a lack of available routinely collected health data to identify cases, examine causes, identify risk factors and explore health outcomes. Routinely collected hospital separation data coded using the International Classification of Diseases and Related Health Problems (ICD) system provide an internationally standardised data source for classifying and aggregating diseases, injuries, causes of injuries and related health conditions for statistical purposes. However, there has been limited research to examine the reliability of these data for child maltreatment surveillance purposes. This study examined the reliability of coding of child maltreatment in Queensland, Australia. Methods A retrospective medical record review and recoding methodology was used to assess the reliability of coding of child maltreatment. A stratified sample of hospitals across Queensland was selected for this study, and a stratified random sample of cases was selected from within those hospitals. Results In 3.6% of cases the coders disagreed on whether any maltreatment code could be assigned (definite or possible) versus no maltreatment being assigned (unintentional injury), giving a sensitivity of 0.982 and specificity of 0.948. The review of these cases where discrepancies existed revealed that all cases had some indications of risk documented in the records. 15.5% of cases originally assigned a definite or possible maltreatment code, were recoded to a more or less definite strata. In terms of the number and type of maltreatment codes assigned, the auditor assigned a greater number of maltreatment types based on the medical documentation than the original coder assigned (22% of the auditor coded cases had more than one maltreatment type assigned compared to only 6% of the original coded data). The maltreatment types which were the most 'under-coded' by the original coder were psychological abuse and neglect. Cases coded with a sexual abuse code showed the highest level of reliability. Conclusion Given the increasing international attention being given to improving the uniformity of reporting of child-maltreatment related injuries and the emphasis on the better utilisation of routinely collected health data, this study provides an estimate of the reliability of maltreatment-specific ICD-10-AM codes assigned in an inpatient setting. PMID:21208411

Impacts of casinos on key pathways to health: qualitative findings from American Indian gaming communities in California.

PubMed

Kodish, Stephen R; Gittelsohn, Joel; Oddo, Vanessa M; Jones-Smith, Jessica C

2016-07-22

Three decades ago, casino gaming on sovereign American Indian lands was legalized with differential economic and social implications. While casinos have improved the incomes of tribal communities, there have been both positive and negative findings in relation to health impacts. We sought to understand the perceived pathways by which casinos impact individual and community health through voices of the community. We conducted semi-structured, interviews with tribal leaders (n =12) and tribal members (n =24) from tribal communities (n = 23) representing different regions of California. We inductively analyzed textual data drawing from Grounded Theory, first using line-by-line coding to identify analytic categories from emergent themes in consideration of the study objective. Then, focused codes were applied to identify salient themes, which we represented through exemplar quotes and an overall conceptual framework. Data were managed and coded using Dedoose software. American Indian-owned casinos are perceived to influence the health of tribal communities through three pathways: 1) improving the tribal economy 2) altering the built environment, and 3) disrupting the the social landscape. Forming these pathways are a series of interrelated health determinants. Improvement of the tribal economy, through both job creation for tribal members and improved tribal cash flow, was perceived by participants to both influence health. Specifically, improved cash flow has resulted in new wellness programs, community centers, places for recreation, and improved social services. Higher disposable incomes have led to better financial stability, increased access to healthy food, and more opportunities for physical activity. Yet, higher disposable incomes were perceived to also contribute to negative health behaviors, most notably increased drug and alcohol abuse. Casinos were also perceived to alter built environments, resulting in increased availability and access to unhealthy food. And to a lesser extent, they were perceived to disrupt the social landscape of communities with impacts on tribal community value systems. Casino environments improve economic conditions of tribal communities, but present important social and public health challenges. Policy makers at federal, state, and tribal levels should consider the perceptions of tribal members and leaders when determining policies in light of casino development.

Modelling Conditions and Health Care Processes in Electronic Health Records: An Application to Severe Mental Illness with the Clinical Practice Research Datalink

PubMed Central

Olier, Ivan; Springate, David A.; Ashcroft, Darren M.; Doran, Tim; Reeves, David; Planner, Claire; Reilly, Siobhan; Kontopantelis, Evangelos

2016-01-01

Background The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rpcdsearch) to help researchers in this task. We present severe mental illness as an example. Methods We used the Clinical Practice Research Datalink, a UK Primary Care Database in which clinical information is largely organised using Read codes, a hierarchical clinical coding system. Pcdsearch is used to identify potentially relevant clinical codes and/or product codes from word-stubs and code-stubs suggested by clinicians. The returned code-lists are reviewed and codes relevant to the condition of interest are selected. The final code-list is then used to identify patients. Results We identified 270 Read codes linked to SMI and used them to identify cases in the database. We observed that our approach identified cases that would have been missed with a simpler approach using SMI registers defined within the UK Quality and Outcomes Framework. Conclusion We described a framework for researchers of Electronic Health Records databases, for identifying patients with a particular condition or matching certain clinical criteria. The method is invariant to coding system or database and can be used with SNOMED CT, ICD or other medical classification code-lists. PMID:26918439

A fast algorithm for identifying friends-of-friends halos

NASA Astrophysics Data System (ADS)

Feng, Y.; Modi, C.

2017-07-01

We describe a simple and fast algorithm for identifying friends-of-friends features and prove its correctness. The algorithm avoids unnecessary expensive neighbor queries, uses minimal memory overhead, and rejects slowdown in high over-density regions. We define our algorithm formally based on pair enumeration, a problem that has been heavily studied in fast 2-point correlation codes and our reference implementation employs a dual KD-tree correlation function code. We construct features in a hierarchical tree structure, and use a splay operation to reduce the average cost of identifying the root of a feature from O [ log L ] to O [ 1 ] (L is the size of a feature) without additional memory costs. This reduces the overall time complexity of merging trees from O [ L log L ] to O [ L ] , reducing the number of operations per splay by orders of magnitude. We next introduce a pruning operation that skips merge operations between two fully self-connected KD-tree nodes. This improves the robustness of the algorithm, reducing the number of merge operations in high density peaks from O [δ2 ] to O [ δ ] . We show that for cosmological data set the algorithm eliminates more than half of merge operations for typically used linking lengths b ∼ 0 . 2 (relative to mean separation). Furthermore, our algorithm is extremely simple and easy to implement on top of an existing pair enumeration code, reusing the optimization effort that has been invested in fast correlation function codes.

Patient complaints as a means to improve quality of hospital care. Results of a qualitative content analysis

PubMed

Hoffmann, Susanne; Dreher-Hummel, Thomas; Dollinger, Claudia; Frei, Irena Anna

2018-04-01

Background: Many hospitals have defined procedures for a complaint management. A systematic analysis of patient complaints helps to identify similar complaints and patterns so that targeted improvement measures can be derived (Gallagher & Mazor, 2015). Aim: Our three-month, nurse-led practice development project aimed 1) to identify complaints regarding communication issues, 2) to systemise and prioritise complaints regarding communication issues, and 3) to derive clinic-specific recommendations for improvement. Method: We analysed 273 complaints of patients documented by the quality management (secondary data analysis). Using content analysis and applying the coding taxonomy for inpatient complaints by Reader, Gillespie and Roberts (2014), we distinguished communication-related complaints. By further inductive differentiation of these complaints, we identified patterns and prioritised fields of action. Results: We identified 186 communication-related complaints divided into 16 subcategories. For each subcategory, improvement interventions were derived, discussed and prioritised. Conclusions: Thus, patient complaints provided an excellent opportunity for reflection and workplace learning for nurses. The analysis gave impulse to exemplify the subject “person-centered care” for nurses.

Directed educational training improves coding and billing skills for residents.

PubMed

Benke, James R; Lin, Sandra Y; Ishman, Stacey L

2013-03-01

To determine if coding and billing acumen improves after a single directed educational training session. Case-control series. Fourteen otolaryngology practitioners including trainees each completed two clinical scenarios before and after a directed educational session covering basic skills and common mistakes in otolaryngology billing and coding. Ten practitioners had never coded before; while, four regularly billed and coded in a clinical setting. Individuals with no previous billing experience had a mean score of 54% (median 55%) before the educational session which was significantly lower than that of the experienced billers who averaged 82% (median 83%, p=0.002). After the educational billing and coding session, the inexperienced billers mean score improved to 62% (median, 67%) which was still statistically lower than that of the experienced billers who averaged 76% (median 75%, p=0.039). The inexperienced billers demonstrated a significant improvement in their total score after the intervention (P=0.019); however, the change observed in experienced billers before and after the educational intervention was not significant (P=0.469). Billing and coding skill was improved after a single directed education session. Residents, who are not responsible for regular billing and coding, were found to have the greatest improvement in skill. However, providers who regularly bill and code had no significant improvement after this session. These data suggest that a single 90min billing and coding education session is effective in preparing those with limited experience to competently bill and code. Copyright © 2012. Published by Elsevier Ireland Ltd.

Testing Scientific Software: A Systematic Literature Review

PubMed Central

Kanewala, Upulee; Bieman, James M.

2014-01-01

Context Scientific software plays an important role in critical decision making, for example making weather predictions based on climate models, and computation of evidence for research publications. Recently, scientists have had to retract publications due to errors caused by software faults. Systematic testing can identify such faults in code. Objective This study aims to identify specific challenges, proposed solutions, and unsolved problems faced when testing scientific software. Method We conducted a systematic literature survey to identify and analyze relevant literature. We identified 62 studies that provided relevant information about testing scientific software. Results We found that challenges faced when testing scientific software fall into two main categories: (1) testing challenges that occur due to characteristics of scientific software such as oracle problems and (2) testing challenges that occur due to cultural differences between scientists and the software engineering community such as viewing the code and the model that it implements as inseparable entities. In addition, we identified methods to potentially overcome these challenges and their limitations. Finally we describe unsolved challenges and how software engineering researchers and practitioners can help to overcome them. Conclusions Scientific software presents special challenges for testing. Specifically, cultural differences between scientist developers and software engineers, along with the characteristics of the scientific software make testing more difficult. Existing techniques such as code clone detection can help to improve the testing process. Software engineers should consider special challenges posed by scientific software such as oracle problems when developing testing techniques. PMID:25125798

Validation of a coding algorithm for intra-abdominal surgeries and adhesion-related complications in an electronic medical records database

PubMed Central

Scott, Frank I; Mamtani, Ronac; Haynes, Kevin; Goldberg, David S; Mahmoud, Najjia N.; Lewis, James D

2016-01-01

PURPOSE Epidemiological data on adhesion-related complications following intra-abdominal surgery are limited. We tested the accuracy of recording of these surgeries and complications within The Health Improvement Network (THIN), a primary care database within the United Kingdom. METHODS Individuals within THIN from 1995–2011 with an incident intra-abdominal surgery and subsequent bowel obstruction (SBO) or adhesiolysis were identified using diagnostic codes. To compute positive predictive values (PPVs), requests were sent to treating physicians of patients with these diagnostic codes to confirm the surgery, SBO, or adhesiolysis code. Completeness of recording was estimated by comparing observed surgical rates within THIN to expected rates derived from the Hospital Episode Statistics (HES) dataset within England. Cumulative incidence rates of adhesion-related complications at 5 years were compared to a previously published cohort within Scotland. RESULTS 217 of 245 (89%) questionnaires were returned (180 SBO and 37 adhesiolysis). The PPV of codes for surgery was 94.5% (95%CI: 91–97%). 88.8% of procedure types were correctly coded. The PPV for SBO and adhesiolysis was 86.1% (95% CI: 80–91%) and 89.2% (95% CI: 75–97%), respectively. Colectomy, appendectomy, and cholecystectomy rates within THIN were 99%, 95%, and 84% of rates observed in national HES data, respectively. Cumulative incidence rates of adhesion related complications following colectomy, appendectomy, and small bowel surgery were similar to those published previously. CONCLUSIONS Surgical procedures, SBO, and adhesiolysis can be accurately identified within THIN using diagnostic codes. THIN represents a new tool for assessing patient-specific risk factors for adhesion-related complications and long term outcomes. PMID:26860870

Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010-2015.

PubMed

Wiltz, Jennifer L; Blanck, Heidi M; Lee, Brian; Kocot, S Lawrence; Seeff, Laura; McGuire, Lisa C; Collins, Janet

2017-10-26

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the "ABCDs" of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public-private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems.

Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010–2015

PubMed Central

Blanck, Heidi M.; Lee, Brian; Kocot, S. Lawrence; Seeff, Laura; McGuire, Lisa C.; Collins, Janet

2017-01-01

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the “ABCDs” of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public–private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems. PMID:29072985

DD3MAT - a code for yield criteria anisotropy parameters identification.

NASA Astrophysics Data System (ADS)

Barros, P. D.; Carvalho, P. D.; Alves, J. L.; Oliveira, M. C.; Menezes, L. F.

2016-08-01

This work presents the main strategies and algorithms adopted in the DD3MAT inhouse code, specifically developed for identifying the anisotropy parameters. The algorithm adopted is based on the minimization of an error function, using a downhill simplex method. The set of experimental values can consider yield stresses and r -values obtained from in-plane tension, for different angles with the rolling direction (RD), yield stress and r -value obtained for biaxial stress state, and yield stresses from shear tests performed also for different angles to RD. All these values can be defined for a specific value of plastic work. Moreover, it can also include the yield stresses obtained from in-plane compression tests. The anisotropy parameters are identified for an AA2090-T3 aluminium alloy, highlighting the importance of the user intervention to improve the numerical fit.

[The ENCODE project and functional genomics studies].

PubMed

Ding, Nan; Qu, Hongzhu; Fang, Xiangdong

2014-03-01

Upon the completion of the Human Genome Project, scientists have been trying to interpret the underlying genomic code for human biology. Since 2003, National Human Genome Research Institute (NHGRI) has invested nearly $0.3 billion and gathered over 440 scientists from more than 32 institutions in the United States, China, United Kingdom, Japan, Spain and Singapore to initiate the Encyclopedia of DNA Elements (ENCODE) project, aiming to identify and analyze all regulatory elements in the human genome. Taking advantage of the development of next-generation sequencing technologies and continuous improvement of experimental methods, ENCODE had made remarkable achievements: identified methylation and histone modification of DNA sequences and their regulatory effects on gene expression through altering chromatin structures, categorized binding sites of various transcription factors and constructed their regulatory networks, further revised and updated database for pseudogenes and non-coding RNA, and identified SNPs in regulatory sequences associated with diseases. These findings help to comprehensively understand information embedded in gene and genome sequences, the function of regulatory elements as well as the molecular mechanism underlying the transcriptional regulation by noncoding regions, and provide extensive data resource for life sciences, particularly for translational medicine. We re-viewed the contributions of high-throughput sequencing platform development and bioinformatical technology improve-ment to the ENCODE project, the association between epigenetics studies and the ENCODE project, and the major achievement of the ENCODE project. We also provided our prospective on the role of the ENCODE project in promoting the development of basic and clinical medicine.

Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.

PubMed

Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W

2012-11-19

There are no empirically-grounded criteria or tools to define or benchmark the quality of outpatient clinical documentation. Outpatient clinical notes document care, communicate treatment plans and support patient safety, medical education, medico-legal investigations and reimbursement. Accurately describing and assessing quality of clinical documentation is a necessary improvement in an increasingly team-based healthcare delivery system. In this paper we describe the quality of outpatient clinical notes from the perspective of multiple stakeholders. Using purposeful sampling for maximum diversity, we conducted focus groups and individual interviews with clinicians, nursing and ancillary staff, patients, and healthcare administrators at six federal health care facilities between 2009 and 2011. All sessions were audio-recorded, transcribed and qualitatively analyzed using open, axial and selective coding. The 163 participants included 61 clinicians, 52 nurse/ancillary staff, 31 patients and 19 administrative staff. Three organizing themes emerged: 1) characteristics of quality in clinical notes, 2) desired elements within the clinical notes and 3) system supports to improve the quality of clinical notes. We identified 11 codes to describe characteristics of clinical notes, 20 codes to describe desired elements in quality clinical notes and 11 codes to describe clinical system elements that support quality when writing clinical notes. While there was substantial overlap between the aspects of quality described by the four stakeholder groups, only clinicians and administrators identified ease of translation into billing codes as an important characteristic of a quality note. Only patients rated prioritization of their medical problems as an aspect of quality. Nurses included care and education delivered to the patient, information added by the patient, interdisciplinary information, and infection alerts as important content. Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

Identification of Long Bone Fractures in Radiology Reports Using Natural Language Processing to Support Healthcare Quality Improvement

PubMed Central

Masino, Aaron J.; Casper, T. Charles; Dean, Jonathan M.; Bell, Jamie; Enriquez, Rene; Deakyne, Sara; Chamberlain, James M.; Alpern, Elizabeth R.

2016-01-01

Summary Background Important information to support healthcare quality improvement is often recorded in free text documents such as radiology reports. Natural language processing (NLP) methods may help extract this information, but these methods have rarely been applied outside the research laboratories where they were developed. Objective To implement and validate NLP tools to identify long bone fractures for pediatric emergency medicine quality improvement. Methods Using freely available statistical software packages, we implemented NLP methods to identify long bone fractures from radiology reports. A sample of 1,000 radiology reports was used to construct three candidate classification models. A test set of 500 reports was used to validate the model performance. Blinded manual review of radiology reports by two independent physicians provided the reference standard. Each radiology report was segmented and word stem and bigram features were constructed. Common English “stop words” and rare features were excluded. We used 10-fold cross-validation to select optimal configuration parameters for each model. Accuracy, recall, precision and the F1 score were calculated. The final model was compared to the use of diagnosis codes for the identification of patients with long bone fractures. Results There were 329 unique word stems and 344 bigrams in the training documents. A support vector machine classifier with Gaussian kernel performed best on the test set with accuracy=0.958, recall=0.969, precision=0.940, and F1 score=0.954. Optimal parameters for this model were cost=4 and gamma=0.005. The three classification models that we tested all performed better than diagnosis codes in terms of accuracy, precision, and F1 score (diagnosis code accuracy=0.932, recall=0.960, precision=0.896, and F1 score=0.927). Conclusions NLP methods using a corpus of 1,000 training documents accurately identified acute long bone fractures from radiology reports. Strategic use of straightforward NLP methods, implemented with freely available software, offers quality improvement teams new opportunities to extract information from narrative documents. PMID:27826610

Code-based Diagnostic Algorithms for Idiopathic Pulmonary Fibrosis. Case Validation and Improvement.

PubMed

Ley, Brett; Urbania, Thomas; Husson, Gail; Vittinghoff, Eric; Brush, David R; Eisner, Mark D; Iribarren, Carlos; Collard, Harold R

2017-06-01

Population-based studies of idiopathic pulmonary fibrosis (IPF) in the United States have been limited by reliance on diagnostic code-based algorithms that lack clinical validation. To validate a well-accepted International Classification of Diseases, Ninth Revision, code-based algorithm for IPF using patient-level information and to develop a modified algorithm for IPF with enhanced predictive value. The traditional IPF algorithm was used to identify potential cases of IPF in the Kaiser Permanente Northern California adult population from 2000 to 2014. Incidence and prevalence were determined overall and by age, sex, and race/ethnicity. A validation subset of cases (n = 150) underwent expert medical record and chest computed tomography review. A modified IPF algorithm was then derived and validated to optimize positive predictive value. From 2000 to 2014, the traditional IPF algorithm identified 2,608 cases among 5,389,627 at-risk adults in the Kaiser Permanente Northern California population. Annual incidence was 6.8/100,000 person-years (95% confidence interval [CI], 6.1-7.7) and was higher in patients with older age, male sex, and white race. The positive predictive value of the IPF algorithm was only 42.2% (95% CI, 30.6 to 54.6%); sensitivity was 55.6% (95% CI, 21.2 to 86.3%). The corrected incidence was estimated at 5.6/100,000 person-years (95% CI, 2.6-10.3). A modified IPF algorithm had improved positive predictive value but reduced sensitivity compared with the traditional algorithm. A well-accepted International Classification of Diseases, Ninth Revision, code-based IPF algorithm performs poorly, falsely classifying many non-IPF cases as IPF and missing a substantial proportion of IPF cases. A modification of the IPF algorithm may be useful for future population-based studies of IPF.

Hardware-efficient bosonic quantum error-correcting codes based on symmetry operators

NASA Astrophysics Data System (ADS)

Niu, Murphy Yuezhen; Chuang, Isaac L.; Shapiro, Jeffrey H.

2018-03-01

We establish a symmetry-operator framework for designing quantum error-correcting (QEC) codes based on fundamental properties of the underlying system dynamics. Based on this framework, we propose three hardware-efficient bosonic QEC codes that are suitable for χ(2 )-interaction based quantum computation in multimode Fock bases: the χ(2 ) parity-check code, the χ(2 ) embedded error-correcting code, and the χ(2 ) binomial code. All of these QEC codes detect photon-loss or photon-gain errors by means of photon-number parity measurements, and then correct them via χ(2 ) Hamiltonian evolutions and linear-optics transformations. Our symmetry-operator framework provides a systematic procedure for finding QEC codes that are not stabilizer codes, and it enables convenient extension of a given encoding to higher-dimensional qudit bases. The χ(2 ) binomial code is of special interest because, with m ≤N identified from channel monitoring, it can correct m -photon-loss errors, or m -photon-gain errors, or (m -1 )th -order dephasing errors using logical qudits that are encoded in O (N ) photons. In comparison, other bosonic QEC codes require O (N2) photons to correct the same degree of bosonic errors. Such improved photon efficiency underscores the additional error-correction power that can be provided by channel monitoring. We develop quantum Hamming bounds for photon-loss errors in the code subspaces associated with the χ(2 ) parity-check code and the χ(2 ) embedded error-correcting code, and we prove that these codes saturate their respective bounds. Our χ(2 ) QEC codes exhibit hardware efficiency in that they address the principal error mechanisms and exploit the available physical interactions of the underlying hardware, thus reducing the physical resources required for implementing their encoding, decoding, and error-correction operations, and their universal encoded-basis gate sets.

Introduction to the internal fluid mechanics research session

NASA Technical Reports Server (NTRS)

Miller, Brent A.; Povinelli, Louis A.

1990-01-01

Internal fluid mechanics research at LeRC is directed toward an improved understanding of the important flow physics affecting aerospace propulsion systems, and applying this improved understanding to formulate accurate predictive codes. To this end, research is conducted involving detailed experimentation and analysis. The following three papers summarize ongoing work and indicate future emphasis in three major research thrusts: inlets, ducts, and nozzles; turbomachinery; and chemical reacting flows. The underlying goal of the research in each of these areas is to bring internal computational fluid mechanic to a state of practical application for aerospace propulsion systems. Achievement of this goal requires that carefully planned and executed experiments be conducted in order to develop and validate useful codes. It is critical that numerical code development work and experimental work be closely coupled. The insights gained are represented by mathematical models that form the basis for code development. The resultant codes are then tested by comparing them with appropriate experiments in order to ensure their validity and determine their applicable range. The ultimate user community must be a part of this process to assure relevancy of the work and to hasten its practical application. Propulsion systems are characterized by highly complex and dynamic internal flows. Many complex, 3-D flow phenomena may be present, including unsteadiness, shocks, and chemical reactions. By focusing on specific portions of a propulsion system, it is often possible to identify the dominant phenomena that must be understood and modeled for obtaining accurate predictive capability. The three major research thrusts serve as a focus leading to greater understanding of the relevant physics and to an improvement in analytic tools. This in turn will hasten continued advancements in propulsion system performance and capability.

Neutron Capture Gamma-Ray Libraries for Nuclear Applications

NASA Astrophysics Data System (ADS)

Sleaford, B. W.; Firestone, R. B.; Summers, N.; Escher, J.; Hurst, A.; Krticka, M.; Basunia, S.; Molnar, G.; Belgya, T.; Revay, Z.; Choi, H. D.

2011-06-01

The neutron capture reaction is useful in identifying and analyzing the gamma-ray spectrum from an unknown assembly as it gives unambiguous information on its composition. This can be done passively or actively where an external neutron source is used to probe an unknown assembly. There are known capture gamma-ray data gaps in the ENDF libraries used by transport codes for various nuclear applications. The Evaluated Gamma-ray Activation file (EGAF) is a new thermal neutron capture database of discrete line spectra and cross sections for over 260 isotopes that was developed as part of an IAEA Coordinated Research Project. EGAF is being used to improve the capture gamma production in ENDF libraries. For medium to heavy nuclei the quasi continuum contribution to the gamma cascades is not experimentally resolved. The continuum contains up to 90% of all the decay energy and is modeled here with the statistical nuclear structure code DICEBOX. This code also provides a consistency check of the level scheme nuclear structure evaluation. The calculated continuum is of sufficient accuracy to include in the ENDF libraries. This analysis also determines new total thermal capture cross sections and provides an improved RIPL database. For higher energy neutron capture there is less experimental data available making benchmarking of the modeling codes more difficult. We are investigating the capture spectra from higher energy neutrons experimentally using surrogate reactions and modeling this with Hauser-Feshbach codes. This can then be used to benchmark CASINO, a version of DICEBOX modified for neutron capture at higher energy. This can be used to simulate spectra from neutron capture at incident neutron energies up to 20 MeV to improve the gamma-ray spectrum in neutron data libraries used for transport modeling of unknown assemblies.

Using fault tree analysis to identify causes of non-compliance: enhancing violation outcome data for the purposes of education and prevention.

PubMed

Emery, R J; Charlton, M A; Orders, A B; Hernandez, M

2001-02-01

An enhanced coding system for the characterization of notices of violation (NOV's) issued to radiation permit holders in the State of Texas was developed based on a series of fault tree analyses serving to identify a set of common causes. The coding system enhancement was retroactively applied to a representative sample (n = 185) of NOV's issued to specific licensees of radioactive materials in Texas during calendar year 1999. The results obtained were then compared to the currently available summary NOV information for the same year. In addition to identifying the most common NOV's, the enhanced coding system revealed that approximately 70% of the sampled NOV's were issued for non-compliance with a specific regulation as opposed to a permit condition. Furthermore, an underlying cause of 94% of the NOV's was the failure on the part of the licensee to execute a specific task. The findings suggest that opportunities exist to improve permit holder compliance through various means, including the creation of summaries which detail specific tasks to be completed, and revising training programs with more focus on the identification and scheduling of permit-related requirements. Broad application of these results is cautioned due to the bias associated with the restricted scope of the project.

Identifying patients with hypertension: a case for auditing electronic health record data.

PubMed

Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).

Research on pre-processing of QR Code

NASA Astrophysics Data System (ADS)

Sun, Haixing; Xia, Haojie; Dong, Ning

2013-10-01

QR code encodes many kinds of information because of its advantages: large storage capacity, high reliability, full arrange of utter-high-speed reading, small printing size and high-efficient representation of Chinese characters, etc. In order to obtain the clearer binarization image from complex background, and improve the recognition rate of QR code, this paper researches on pre-processing methods of QR code (Quick Response Code), and shows algorithms and results of image pre-processing for QR code recognition. Improve the conventional method by changing the Souvola's adaptive text recognition method. Additionally, introduce the QR code Extraction which adapts to different image size, flexible image correction approach, and improve the efficiency and accuracy of QR code image processing.

Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

PubMed Central

Quint, Jennifer K; Müllerova, Hana; DiSantostefano, Rachael L; Forbes, Harriet; Eaton, Susan; Hurst, John R; Davis, Kourtney; Smeeth, Liam

2014-01-01

Objectives The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. Setting 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. Primary outcome measure The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. Results 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5–92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7–94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2–44.4%). Conclusions Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004. PMID:25056980

National Variation in Costs and Mortality for Leukodystrophy Patients in U.S. Children’s Hospitals

PubMed Central

Brimley, Cameron J; Lopez, Jonathan; van Haren, Keith; Wilkes, Jacob; Sheng, Xiaoming; Nelson, Clint; Korgenski, E. Kent; Srivastava, Rajendu; Bonkowsky, Joshua L.

2013-01-01

Background Inherited leukodystrophies are progressive, debilitating neurological disorders with few treatment options and high mortality rates. Our objective was to determine national variation in the costs for leukodystrophy patients, and to evaluate differences in their care. Methods We developed an algorithm to identify inherited leukodystrophy patients in de-identified data sets using a recursive tree model based on ICD-9 CM diagnosis and procedure charge codes. Validation of the algorithm was performed independently at two institutions, and with data from the Pediatric Health Information System (PHIS) of 43 U.S. children’s hospitals, for a seven year time period, 2004–2010. Results A recursive algorithm was developed and validated, based on six ICD-9 codes and one procedure code, that had a sensitivity up to 90% (range 61–90%) and a specificity up to 99% (range 53–99%) for identifying inherited leukodystrophy patients. Inherited leukodystrophy patients comprise 0.4% of admissions to children’s hospitals and 0.7% of costs. Over seven years these patients required $411 million of hospital care, or $131,000/patient. Hospital costs for leukodystrophy patients varied at different institutions, ranging from 2 to 15 times more than the average pediatric patient. There was a statistically significant correlation between higher volume and increased cost efficiency. Increased mortality rates had an inverse relationship with increased patient volume that was not statistically significant. Conclusions We developed and validated a code-based algorithm for identifying leukodystrophy patients in deidentified national datasets. Leukodystrophy patients account for $59 million of costs yearly at children’s hospitals. Our data highlight potential to reduce unwarranted variability and improve patient care. PMID:23953952

Recognizing short coding sequences of prokaryotic genome using a novel iteratively adaptive sparse partial least squares algorithm

PubMed Central

2013-01-01

Background Significant efforts have been made to address the problem of identifying short genes in prokaryotic genomes. However, most known methods are not effective in detecting short genes. Because of the limited information contained in short DNA sequences, it is very difficult to accurately distinguish between protein coding and non-coding sequences in prokaryotic genomes. We have developed a new Iteratively Adaptive Sparse Partial Least Squares (IASPLS) algorithm as the classifier to improve the accuracy of the identification process. Results For testing, we chose the short coding and non-coding sequences from seven prokaryotic organisms. We used seven feature sets (including GC content, Z-curve, etc.) of short genes. In comparison with GeneMarkS, Metagene, Orphelia, and Heuristic Approachs methods, our model achieved the best prediction performance in identification of short prokaryotic genes. Even when we focused on the very short length group ([60–100 nt)), our model provided sensitivity as high as 83.44% and specificity as high as 92.8%. These values are two or three times higher than three of the other methods while Metagene fails to recognize genes in this length range. The experiments also proved that the IASPLS can improve the identification accuracy in comparison with other widely used classifiers, i.e. Logistic, Random Forest (RF) and K nearest neighbors (KNN). The accuracy in using IASPLS was improved 5.90% or more in comparison with the other methods. In addition to the improvements in accuracy, IASPLS required ten times less computer time than using KNN or RF. Conclusions It is conclusive that our method is preferable for application as an automated method of short gene classification. Its linearity and easily optimized parameters make it practicable for predicting short genes of newly-sequenced or under-studied species. Reviewers This article was reviewed by Alexey Kondrashov, Rajeev Azad (nominated by Dr J.Peter Gogarten) and Yuriy Fofanov (nominated by Dr Janet Siefert). PMID:24067167

Impact design methods for ceramic components in gas turbine engines

NASA Technical Reports Server (NTRS)

Song, J.; Cuccio, J.; Kington, H.

1991-01-01

Methods currently under development to design ceramic turbine components with improved impact resistance are presented. Two different modes of impact damage are identified and characterized, i.e., structural damage and local damage. The entire computation is incorporated into the EPIC computer code. Model capability is demonstrated by simulating instrumented plate impact and particle impact tests.

Common Characteristics of Writing Interventions for Students with Learning Disabilities: A Synthesis of the Literature

ERIC Educational Resources Information Center

Kaldenberg, Erica R.; Ganzeveld, Paula; Hosp, John L.; Rodgers, Derek B.

2016-01-01

Twenty-three single-subject studies aimed at improving the writing achievement of students identified as having a learning disability were analyzed meta-analytically. The effect size phi was used to compare the writing strategies. The dependent measures used to assess the efficacy of the interventions were also coded and reviewed. Results suggest…

Physical and numerical sources of computational inefficiency in integration of chemical kinetic rate equations: Etiology, treatment and prognosis

NASA Technical Reports Server (NTRS)

Pratt, D. T.; Radhakrishnan, K.

1986-01-01

The design of a very fast, automatic black-box code for homogeneous, gas-phase chemical kinetics problems requires an understanding of the physical and numerical sources of computational inefficiency. Some major sources reviewed in this report are stiffness of the governing ordinary differential equations (ODE's) and its detection, choice of appropriate method (i.e., integration algorithm plus step-size control strategy), nonphysical initial conditions, and too frequent evaluation of thermochemical and kinetic properties. Specific techniques are recommended (and some advised against) for improving or overcoming the identified problem areas. It is argued that, because reactive species increase exponentially with time during induction, and all species exhibit asymptotic, exponential decay with time during equilibration, exponential-fitted integration algorithms are inherently more accurate for kinetics modeling than classical, polynomial-interpolant methods for the same computational work. But current codes using the exponential-fitted method lack the sophisticated stepsize-control logic of existing black-box ODE solver codes, such as EPISODE and LSODE. The ultimate chemical kinetics code does not exist yet, but the general characteristics of such a code are becoming apparent.

Using the Astrophysics Source Code Library

NASA Astrophysics Data System (ADS)

Allen, Alice; Teuben, P. J.; Berriman, G. B.; DuPrie, K.; Hanisch, R. J.; Mink, J. D.; Nemiroff, R. J.; Shamir, L.; Wallin, J. F.

2013-01-01

The Astrophysics Source Code Library (ASCL) is a free on-line registry of source codes that are of interest to astrophysicists; with over 500 codes, it is the largest collection of scientist-written astrophysics programs in existence. All ASCL source codes have been used to generate results published in or submitted to a refereed journal and are available either via a download site or from an identified source. An advisory committee formed in 2011 provides input and guides the development and expansion of the ASCL, and since January 2012, all accepted ASCL entries are indexed by ADS. Though software is increasingly important for the advancement of science in astrophysics, these methods are still often hidden from view or difficult to find. The ASCL (ascl.net/) seeks to improve the transparency and reproducibility of research by making these vital methods discoverable, and to provide recognition and incentive to those who write and release programs useful for astrophysics research. This poster provides a description of the ASCL, an update on recent additions, and the changes in the astrophysics community we are starting to see because of the ASCL.

Logical qubit fusion

NASA Astrophysics Data System (ADS)

Moussa, Jonathan; Ryan-Anderson, Ciaran

The canonical modern plan for universal quantum computation is a Clifford+T gate set implemented in a topological error-correcting code. This plan has the basic disparity that logical Clifford gates are natural for codes in two spatial dimensions while logical T gates are natural in three. Recent progress has reduced this disparity by proposing logical T gates in two dimensions with doubled, stacked, or gauge color codes, but these proposals lack an error threshold. An alternative universal gate set is Clifford+F, where a fusion (F) gate converts two logical qubits into a logical qudit. We show that logical F gates can be constructed by identifying compatible pairs of qubit and qudit codes that stabilize the same logical subspace, much like the original Bravyi-Kitaev construction of magic state distillation. The simplest example of high-distance compatible codes results in a proposal that is very similar to the stacked color code with the key improvement of retaining an error threshold. Sandia National Labs is a multi-program laboratory managed and operated by Sandia Corp, a wholly owned subsidiary of Lockheed Martin Corp, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.

Characterization of Surface Reflectance Variation Effects on Remote Sensing

NASA Technical Reports Server (NTRS)

Pearce, W. A.

1984-01-01

The use of Monte Carlo radiative transfer codes to simulate the effects on remote sensing in visible and infrared wavelengths of variables which affect classification is examined. These variables include detector viewing angle, atmospheric aerosol size distribution, aerosol vertical and horizontal distribution (e.g., finite clouds), the form of the bidirectional ground reflectance function, and horizontal variability of reflectance type and reflectivity (albedo). These simulations are used to characterize the sensitivity of observables (intensity and polarization) to variations in the underlying physical parameters both to improve algorithms for the removal of atmospheric effects and to identify techniques which can improve classification accuracy. It was necessary to revise and validate the simulation codes (CTRANS, ARTRAN, and the Mie scattering code) to improve efficiency and accommodate a new operational environment, and to build the basic software tools for acquisition and off-line manipulation of simulation results. Initial calculations compare cases in which increasing amounts of aerosol are shifted into the stratosphere, maintaining a constant optical depth. In the case of moderate aerosol optical depth, the effect on the spread function is to scale it linearly as would be expected from a single scattering model. Varying the viewing angle appears to provide the same qualitative effect as modifying the vertical optical depth (for Lambertian ground reflectance).

Performance and Limitations of Administrative Data in the Identification of AKI

PubMed Central

Waikar, Sushrut S.; MacMahon, Blaithin; Whelton, Seamus; Ballew, Shoshana H.; Coresh, Josef

2014-01-01

Background and objectives Billing codes are frequently used to identify AKI events in epidemiologic research. The goals of this study were to validate billing code–identified AKI against the current AKI consensus definition and to ascertain whether sensitivity and specificity vary by patient characteristic or over time. Design, setting, participants, & measurements The study population included 10,056 Atherosclerosis Risk in Communities study participants hospitalized between 1996 and 2008. Billing code–identified AKI was compared with the 2012 Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria (AKIcr) and an approximation of the 2012 KDIGO creatinine- and urine output–based criteria (AKIcr_uop) in a subset with available outpatient data. Sensitivity and specificity of billing code–identified AKI were evaluated over time and according to patient age, race, sex, diabetes status, and CKD status in 546 charts selected for review, with estimates adjusted for sampling technique. Results A total of 34,179 hospitalizations were identified; 1353 had a billing code for AKI. The sensitivity of billing code–identified AKI was 17.2% (95% confidence interval [95% CI], 13.2% to 21.2%) compared with AKIcr (n=1970 hospitalizations) and 11.7% (95% CI, 8.8% to 14.5%) compared with AKIcr_uop (n=1839 hospitalizations). Specificity was >98% in both cases. Sensitivity was significantly higher in the more recent time period (2002–2008) and among participants aged 65 years and older. Billing code–identified AKI captured a more severe spectrum of disease than did AKIcr and AKIcr_uop, with a larger proportion of patients with stage 3 AKI (34.9%, 19.7%, and 11.5%, respectively) and higher in-hospital mortality (41.2%, 18.7%, and 12.8%, respectively). Conclusions The use of billing codes to identify AKI has low sensitivity compared with the current KDIGO consensus definition, especially when the urine output criterion is included, and results in the identification of a more severe phenotype. Epidemiologic studies using billing codes may benefit from a high specificity, but the variation in sensitivity may result in bias, particularly when trends over time are the outcome of interest. PMID:24458075

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives.

PubMed

Morgan, Kerri A; Engsberg, Jack R; Gray, David B

2017-01-01

The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair. Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes. The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program. Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions. Implications for Rehabilitation Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level. Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training. Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs. The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.

Validating administrative records in post-traumatic stress disorder.

PubMed

Abrams, Thad E; Vaughan-Sarrazin, Mary; Keane, Terence M; Richardson, Kelly

2016-03-01

There is insufficient data on the accuracy of administrative coding data (ACD) for post-traumatic stress disorder (PTSD). Medical records were reviewed for (1) a diagnosis of PTSD; (2) treatment for PTSD. The records were compared against the Veterans Health Administration (VHA) data in order to determine the positive predictive value (PPV) and negative predictive value (NPV) of three commonly used approaches. The PPV and NPV varied according to the ACD approach. Relative to a medical records review, the ACD approach of one or two PTSD coded outpatient encounters had a PPV of 78% and an NPV of 91%; whereas the PPV was 97% and the NPV was 98% for three or more PTSD codes. For pharmacotherapy, the ACD approach with one or two codes for PTSD had a PPV of 33% (NPV = 93%), whereas three or more PTSD coded encounters improved the PPV to 85% (NPV = 100%). When using VHA data, we recommend tailoring the identification strategy according to the research aims. An ACD approach identifying one or more PTSD outpatient encounters should be considered sufficient for a diagnosis of PTSD. Assessments for PTSD associated pharmacotherapy require using an ACD approach that identifies veterans with the presence ≥ 3 outpatient PTSD encounters. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Clinical coding of prospectively identified paediatric adverse drug reactions--a retrospective review of patient records.

PubMed

Bellis, Jennifer R; Kirkham, Jamie J; Nunn, Anthony J; Pirmohamed, Munir

2014-12-17

National Health Service (NHS) hospitals in the UK use a system of coding for patient episodes. The coding system used is the International Classification of Disease (ICD-10). There are ICD-10 codes which may be associated with adverse drug reactions (ADRs) and there is a possibility of using these codes for ADR surveillance. This study aimed to determine whether ADRs prospectively identified in children admitted to a paediatric hospital were coded appropriately using ICD-10. The electronic admission abstract for each patient with at least one ADR was reviewed. A record was made of whether the ADR(s) had been coded using ICD-10. Of 241 ADRs, 76 (31.5%) were coded using at least one ICD-10 ADR code. Of the oncology ADRs, 70/115 (61%) were coded using an ICD-10 ADR code compared with 6/126 (4.8%) non-oncology ADRs (difference in proportions 56%, 95% CI 46.2% to 65.8%; p < 0.001). The majority of ADRs detected in a prospective study at a paediatric centre would not have been identified if the study had relied on ICD-10 codes as a single means of detection. Data derived from administrative healthcare databases are not reliable for identifying ADRs by themselves, but may complement other methods of detection.

Differentiation of ileostomy from colostomy procedures: assessing the accuracy of current procedural terminology codes and the utility of natural language processing.

PubMed

Vo, Elaine; Davila, Jessica A; Hou, Jason; Hodge, Krystle; Li, Linda T; Suliburk, James W; Kao, Lillian S; Berger, David H; Liang, Mike K

2013-08-01

Large databases provide a wealth of information for researchers, but identifying patient cohorts often relies on the use of current procedural terminology (CPT) codes. In particular, studies of stoma surgery have been limited by the accuracy of CPT codes in identifying and differentiating ileostomy procedures from colostomy procedures. It is important to make this distinction because the prevalence of complications associated with stoma formation and reversal differ dramatically between types of stoma. Natural language processing (NLP) is a process that allows text-based searching. The Automated Retrieval Console is an NLP-based software that allows investigators to design and perform NLP-assisted document classification. In this study, we evaluated the role of CPT codes and NLP in differentiating ileostomy from colostomy procedures. Using CPT codes, we conducted a retrospective study that identified all patients undergoing a stoma-related procedure at a single institution between January 2005 and December 2011. All operative reports during this time were reviewed manually to abstract the following variables: formation or reversal and ileostomy or colostomy. Sensitivity and specificity for validation of the CPT codes against the mastery surgery schedule were calculated. Operative reports were evaluated by use of NLP to differentiate ileostomy- from colostomy-related procedures. Sensitivity and specificity for identifying patients with ileostomy or colostomy procedures were calculated for CPT codes and NLP for the entire cohort. CPT codes performed well in identifying stoma procedures (sensitivity 87.4%, specificity 97.5%). A total of 664 stoma procedures were identified by CPT codes between 2005 and 2011. The CPT codes were adequate in identifying stoma formation (sensitivity 97.7%, specificity 72.4%) and stoma reversal (sensitivity 74.1%, specificity 98.7%), but they were inadequate in identifying ileostomy (sensitivity 35.0%, specificity 88.1%) and colostomy (75.2% and 80.9%). NLP performed with greater sensitivity, specificity, and accuracy than CPT codes in identifying stoma procedures and stoma types. Major differences where NLP outperformed CPT included identifying ileostomy (specificity 95.8%, sensitivity 88.3%, and accuracy 91.5%) and colostomy (97.6%, 90.5%, and 92.8%, respectively). CPT codes can identify effectively patients who have had stoma procedures and are adequate in distinguishing between formation and reversal; however, CPT codes cannot differentiate ileostomy from colostomy. NLP can be used to differentiate between ileostomy- and colostomy-related procedures. The role of NLP in conjunction with electronic medical records in data retrieval warrants further investigation. Published by Mosby, Inc.

Approaches to Fungal Genome Annotation

PubMed Central

Haas, Brian J.; Zeng, Qiandong; Pearson, Matthew D.; Cuomo, Christina A.; Wortman, Jennifer R.

2011-01-01

Fungal genome annotation is the starting point for analysis of genome content. This generally involves the application of diverse methods to identify features on a genome assembly such as protein-coding and non-coding genes, repeats and transposable elements, and pseudogenes. Here we describe tools and methods leveraged for eukaryotic genome annotation with a focus on the annotation of fungal nuclear and mitochondrial genomes. We highlight the application of the latest technologies and tools to improve the quality of predicted gene sets. The Broad Institute eukaryotic genome annotation pipeline is described as one example of how such methods and tools are integrated into a sequencing center’s production genome annotation environment. PMID:22059117

What Not To Do: Anti-patterns for Developing Scientific Workflow Software Components

NASA Astrophysics Data System (ADS)

Futrelle, J.; Maffei, A. R.; Sosik, H. M.; Gallager, S. M.; York, A.

2013-12-01

Scientific workflows promise to enable efficient scaling-up of researcher code to handle large datasets and workloads, as well as documentation of scientific processing via standardized provenance records, etc. Workflow systems and related frameworks for coordinating the execution of otherwise separate components are limited, however, in their ability to overcome software engineering design problems commonly encountered in pre-existing components, such as scripts developed externally by scientists in their laboratories. In practice, this often means that components must be rewritten or replaced in a time-consuming, expensive process. In the course of an extensive workflow development project involving large-scale oceanographic image processing, we have begun to identify and codify 'anti-patterns'--problematic design characteristics of software--that make components fit poorly into complex automated workflows. We have gone on to develop and document low-effort solutions and best practices that efficiently address the anti-patterns we have identified. The issues, solutions, and best practices can be used to evaluate and improve existing code, as well as guiding the development of new components. For example, we have identified a common anti-pattern we call 'batch-itis' in which a script fails and then cannot perform more work, even if that work is not precluded by the failure. The solution we have identified--removing unnecessary looping over independent units of work--is often easier to code than the anti-pattern, as it eliminates the need for complex control flow logic in the component. Other anti-patterns we have identified are similarly easy to identify and often easy to fix. We have drawn upon experience working with three science teams at Woods Hole Oceanographic Institution, each of which has designed novel imaging instruments and associated image analysis code. By developing use cases and prototypes within these teams, we have undertaken formal evaluations of software components developed by programmers with widely varying levels of expertise, and have been able to discover and characterize a number of anti-patterns. Our evaluation methodology and testbed have also enabled us to assess the efficacy of strategies to address these anti-patterns according to scientifically relevant metrics, such as ability of algorithms to perform faster than the rate of data acquisition and the accuracy of workflow component output relative to ground truth. The set of anti-patterns and solutions we have identified augments of the body of more well-known software engineering anti-patterns by addressing additional concerns that obtain when a software component has to function as part of a workflow assembled out of independently-developed codebases. Our experience shows that identifying and resolving these anti-patterns reduces development time and improves performance without reducing component reusability.

Work-related ladder fall fractures: identification and diagnosis validation using narrative text.

PubMed

Smith, Gordon S; Timmons, Robert A; Lombardi, David A; Mamidi, Dheeresh K; Matz, Simon; Courtney, Theodore K; Perry, Melissa J

2006-09-01

To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Genome-wide identification of miRNAs and lncRNAs in Cajanus cajan.

PubMed

Nithin, Chandran; Thomas, Amal; Basak, Jolly; Bahadur, Ranjit Prasad

2017-11-15

Non-coding RNAs (ncRNAs) are important players in the post transcriptional regulation of gene expression (PTGR). On one hand, microRNAs (miRNAs) are an abundant class of small ncRNAs (~22nt long) that negatively regulate gene expression at the levels of messenger RNAs stability and translation inhibition, on the other hand, long ncRNAs (lncRNAs) are a large and diverse class of transcribed non-protein coding RNA molecules (> 200nt) that play both up-regulatory as well as down-regulatory roles at the transcriptional level. Cajanus cajan, a leguminosae pulse crop grown in tropical and subtropical areas of the world, is a source of high value protein to vegetarians or very poor populations globally. Hence, genome-wide identification of miRNAs and lncRNAs in C. cajan is extremely important to understand their role in PTGR with a possible implication to generate improve variety of crops. We have identified 616 mature miRNAs in C. cajan belonging to 118 families, of which 578 are novel and not reported in MirBase21. A total of 1373 target sequences were identified for 180 miRNAs. Of these, 298 targets were characterized at the protein level. Besides, we have also predicted 3919 lncRNAs. Additionally, we have identified 87 of the predicted lncRNAs to be targeted by 66 miRNAs. miRNA and lncRNAs in plants are known to control a variety of traits including yield, quality and stress tolerance. Owing to its agricultural importance and medicinal value, the identified miRNA, lncRNA and their targets in C. cajan may be useful for genome editing to improve better quality crop. A thorough understanding of ncRNA-based cellular regulatory networks will aid in the improvement of C. cajan agricultural traits.

Long term integrity for space station power systems

NASA Technical Reports Server (NTRS)

Leckie, F. A.; Marriott, D. L.

1991-01-01

A study was made of the High Temperature Design Codes ASME N47, British R5, and the French RCC-MR Rules. It is concluded that all these codes provide a good basis of design for space application. The new British R5 is the most complete since it deals with the problem of defects. The ASME N47 was subjected longer to practical application and scrutiny. A draft code is introduced, and a proposed draft for high temperature design in which attempts were made to identify gaps and improvements is suggested. The design is limited by creep characteristics. In these circumstances, life is strongly affected by the selected value of the factor of safety. The factor of safety of primary loads adopted in the codes is 1.5. Maybe a lower value of 1.25 is permissible for use in space. Long term creep rupture data for HAYNES 188 is deficient and it is suggested that extrapolation methods be investigated.

FUN3D and CFL3D Computations for the First High Lift Prediction Workshop

NASA Technical Reports Server (NTRS)

Park, Michael A.; Lee-Rausch, Elizabeth M.; Rumsey, Christopher L.

2011-01-01

Two Reynolds-averaged Navier-Stokes codes were used to compute flow over the NASA Trapezoidal Wing at high lift conditions for the 1st AIAA CFD High Lift Prediction Workshop, held in Chicago in June 2010. The unstructured-grid code FUN3D and the structured-grid code CFL3D were applied to several different grid systems. The effects of code, grid system, turbulence model, viscous term treatment, and brackets were studied. The SST model on this configuration predicted lower lift than the Spalart-Allmaras model at high angles of attack; the Spalart-Allmaras model agreed better with experiment. Neglecting viscous cross-derivative terms caused poorer prediction in the wing tip vortex region. Output-based grid adaptation was applied to the unstructured-grid solutions. The adapted grids better resolved wake structures and reduced flap flow separation, which was also observed in uniform grid refinement studies. Limitations of the adaptation method as well as areas for future improvement were identified.

A modified carrier-to-code leveling method for retrieving ionospheric observables and detecting short-term temporal variability of receiver differential code biases

NASA Astrophysics Data System (ADS)

Zhang, Baocheng; Teunissen, Peter J. G.; Yuan, Yunbin; Zhang, Xiao; Li, Min

2018-03-01

Sensing the ionosphere with the global positioning system involves two sequential tasks, namely the ionospheric observable retrieval and the ionospheric parameter estimation. A prominent source of error has long been identified as short-term variability in receiver differential code bias (rDCB). We modify the carrier-to-code leveling (CCL), a method commonly used to accomplish the first task, through assuming rDCB to be unlinked in time. Aside from the ionospheric observables, which are affected by, among others, the rDCB at one reference epoch, the Modified CCL (MCCL) can also provide the rDCB offsets with respect to the reference epoch as by-products. Two consequences arise. First, MCCL is capable of excluding the effects of time-varying rDCB from the ionospheric observables, which, in turn, improves the quality of ionospheric parameters of interest. Second, MCCL has significant potential as a means to detect between-epoch fluctuations experienced by rDCB of a single receiver.

Verification and Validation in a Rapid Software Development Process

NASA Technical Reports Server (NTRS)

Callahan, John R.; Easterbrook, Steve M.

1997-01-01

The high cost of software production is driving development organizations to adopt more automated design and analysis methods such as rapid prototyping, computer-aided software engineering (CASE) tools, and high-level code generators. Even developers of safety-critical software system have adopted many of these new methods while striving to achieve high levels Of quality and reliability. While these new methods may enhance productivity and quality in many cases, we examine some of the risks involved in the use of new methods in safety-critical contexts. We examine a case study involving the use of a CASE tool that automatically generates code from high-level system designs. We show that while high-level testing on the system structure is highly desirable, significant risks exist in the automatically generated code and in re-validating releases of the generated code after subsequent design changes. We identify these risks and suggest process improvements that retain the advantages of rapid, automated development methods within the quality and reliability contexts of safety-critical projects.

The location and recognition of anti-counterfeiting code image with complex background

NASA Astrophysics Data System (ADS)

Ni, Jing; Liu, Quan; Lou, Ping; Han, Ping

2017-07-01

The order of cigarette market is a key issue in the tobacco business system. The anti-counterfeiting code, as a kind of effective anti-counterfeiting technology, can identify counterfeit goods, and effectively maintain the normal order of market and consumers' rights and interests. There are complex backgrounds, light interference and other problems in the anti-counterfeiting code images obtained by the tobacco recognizer. To solve these problems, the paper proposes a locating method based on Susan operator, combined with sliding window and line scanning,. In order to reduce the interference of background and noise, we extract the red component of the image and convert the color image into gray image. For the confusing characters, recognition results correction based on the template matching method has been adopted to improve the recognition rate. In this method, the anti-counterfeiting code can be located and recognized correctly in the image with complex background. The experiment results show the effectiveness and feasibility of the approach.

Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation.

PubMed

Keith, Rosalind E; Crosson, Jesse C; O'Malley, Ann S; Cromp, DeAnn; Taylor, Erin Fries

2017-02-10

Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data. NCT02318108.

Gene and translation initiation site prediction in metagenomic sequences

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hyatt, Philip Douglas; LoCascio, Philip F; Hauser, Loren John

2012-01-01

Gene prediction in metagenomic sequences remains a difficult problem. Current sequencing technologies do not achieve sufficient coverage to assemble the individual genomes in a typical sample; consequently, sequencing runs produce a large number of short sequences whose exact origin is unknown. Since these sequences are usually smaller than the average length of a gene, algorithms must make predictions based on very little data. We present MetaProdigal, a metagenomic version of the gene prediction program Prodigal, that can identify genes in short, anonymous coding sequences with a high degree of accuracy. The novel value of the method consists of enhanced translationmore » initiation site identification, ability to identify sequences that use alternate genetic codes and confidence values for each gene call. We compare the results of MetaProdigal with other methods and conclude with a discussion of future improvements.« less

Strategies to Improve Efficiency and Specificity of Degenerate Primers in PCR.

PubMed

Campos, Maria Jorge; Quesada, Alberto

2017-01-01

PCR with degenerate primers can be used to identify the coding sequence of an unknown protein or to detect a genetic variant within a gene family. These primers, which are complex mixtures of slightly different oligonucleotide sequences, can be optimized to increase the efficiency and/or specificity of PCR in the amplification of a sequence of interest by the introduction of mismatches with the target sequence and balancing their position toward the primers 5'- or 3'-ends. In this work, we explain in detail examples of rational design of primers in two different applications, including the use of specific determinants at the 3'-end, to: (1) improve PCR efficiency with coding sequences for members of a protein family by fully degeneration at a core box of conserved genetic information, with the reduction of degeneration at the 5'-end, and (2) optimize specificity of allelic discrimination of closely related orthologous by 5'-end degenerate primers.

Automated Simplification of Full Chemical Mechanisms

NASA Technical Reports Server (NTRS)

Norris, A. T.

1997-01-01

A code has been developed to automatically simplify full chemical mechanisms. The method employed is based on the Intrinsic Low Dimensional Manifold (ILDM) method of Maas and Pope. The ILDM method is a dynamical systems approach to the simplification of large chemical kinetic mechanisms. By identifying low-dimensional attracting manifolds, the method allows complex full mechanisms to be parameterized by just a few variables; in effect, generating reduced chemical mechanisms by an automatic procedure. These resulting mechanisms however, still retain all the species used in the full mechanism. Full and skeletal mechanisms for various fuels are simplified to a two dimensional manifold, and the resulting mechanisms are found to compare well with the full mechanisms, and show significant improvement over global one step mechanisms, such as those by Westbrook and Dryer. In addition, by using an ILDM reaction mechanism in a CID code, a considerable improvement in turn-around time can be achieved.

NASA Lewis Stirling SPRE testing and analysis with reduced number of cooler tubes

NASA Technical Reports Server (NTRS)

Wong, Wayne A.; Cairelli, James E.; Swec, Diane M.; Doeberling, Thomas J.; Lakatos, Thomas F.; Madi, Frank J.

1992-01-01

Free-piston Stirling power converters are candidates for high capacity space power applications. The Space Power Research Engine (SPRE), a free-piston Stirling engine coupled with a linear alternator, is being tested at the NASA Lewis Research Center in support of the Civil Space Technology Initiative. The SPRE is used as a test bed for evaluating converter modifications which have the potential to improve the converter performance and for validating computer code predictions. Reducing the number of cooler tubes on the SPRE has been identified as a modification with the potential to significantly improve power and efficiency. Experimental tests designed to investigate the effects of reducing the number of cooler tubes on converter power, efficiency and dynamics are described. Presented are test results from the converter operating with a reduced number of cooler tubes and comparisons between this data and both baseline test data and computer code predictions.

Perspectives On Dilution Jet Mixing

NASA Technical Reports Server (NTRS)

Holdeman, J. D.; Srinivasan, R.

1990-01-01

NASA recently completed program of measurements and modeling of mixing of transverse jets with ducted crossflow, motivated by need to design or tailor temperature pattern at combustor exit in gas turbine engines. Objectives of program to identify dominant physical mechanisms governing mixing, extend empirical models to provide near-term predictive capability, and compare numerical code calculations with data to guide future analysis improvement efforts.

Coordinated crew performance in commercial aircraft operations

NASA Technical Reports Server (NTRS)

Murphy, M. R.

1977-01-01

A specific methodology is proposed for an improved system of coding and analyzing crew member interaction. The complexity and lack of precision of many crew and task variables suggest the usefulness of fuzzy linguistic techniques for modeling and computer simulation of the crew performance process. Other research methodologies and concepts that have promise for increasing the effectiveness of research on crew performance are identified.

Recommendations and Extraction of Clinical Variables of Pediatric Multiple Sclerosis Using Common Data Elements.

PubMed

Newland, Pamela; Newland, John M; Hendricks-Ferguson, Verna L; Smith, Judith M; Oliver, Brant J

2018-06-01

The purpose of this article was to demonstrate the feasibility of using common data elements (CDEs) to search for information on the pediatric patient with multiple sclerosis (MS) and provide recommendations for future quality improvement and research in the use of CDEs for pediatric MS symptom management strategies Methods: The St. Louis Children's Hospital (SLCH), Washington University (WU) pediatrics data network was evaluated for use of CDEs identified from a database to identify variables in pediatric MS, including the key clinical features from the disease course of MS. The algorithms used were based on International Classification of Diseases, Ninth/Tenth Revision, codes and text keywords to identify pediatric patients with MS from a de-identified database. Data from a coordinating center of SLCH/WU pediatrics data network, which houses inpatient and outpatient records consisting of patients (N = 498 000), were identified, and detailed information regarding the clinical course of MS were located from the text of the medical records, including medications, presence of oligoclonal bands, year of diagnosis, and diagnosis code. There were 466 pediatric patients with MS, with a few also having the comorbid diagnosis of anxiety and depression. St. Louis Children's Hospital/WU pediatrics data network is one of the largest databases in the United States of detailed data, with the ability to query and validate clinical data for research on MS. Nurses and other healthcare professionals working with pediatric MS patients will benefit from having common disease identifiers for quality improvement, research, and practice. The increased knowledge of big data from SLCH/WU pediatrics data network has the potential to provide information for intervention and decision-making that can be personalized to the pediatric MS patient.

Identifying major hemorrhage with automated data: results of the Veterans Affairs study to improve anticoagulation (VARIA).

PubMed

Jasuja, Guneet K; Reisman, Joel I; Miller, Donald R; Berlowitz, Dan R; Hylek, Elaine M; Ash, Arlene S; Ozonoff, Al; Zhao, Shibei; Rose, Adam J

2013-01-01

Identifying major bleeding is fundamental to assessing the outcomes of anticoagulation therapy. This drives the need for a credible implementation in automated data for the International Society of Thrombosis and Haemostasis (ISTH) definition of major bleeding. We studied 102,395 patients who received 158,511 person-years of warfarin treatment from the Veterans Health Administration (VA) between 10/1/06-9/30/08. We constructed a list of ICD-9-CM codes of "candidate" bleeding events. Each candidate event was identified as a major hemorrhage if it fulfilled one of four criteria: 1) associated with death within 30days; 2) bleeding in a critical anatomic site; 3) associated with a transfusion; or 4) was coded as the event that precipitated or was responsible for the majority of an inpatient hospitalization. This definition classified 11,240 (15.8%) of 71, 338 candidate events as major hemorrhage. Typically, events more likely to be severe were retained at higher rates than those less likely to be severe. For example, Diverticula of Colon with Hemorrhage (562.12) and Hematuria (599.7) were retained 46% and 4% of the time, respectively. Major, intracranial, and fatal hemorrhage were identified at rates comparable to those found in randomized clinical trials however, higher than those reported in observational studies: 4.73, 1.29, and 0.41 per 100 patient years, respectively. We describe here a workable definition for identifying major hemorrhagic events from large automated datasets. This method of identifying major bleeding may have applications for quality measurement, quality improvement, and comparative effectiveness research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Challenges in using medicaid claims to ascertain child maltreatment.

PubMed

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T; Garfield, Lauren D; Ross, Raven E; Hedeker, Donald

2015-05-01

Medicaid data contain International Classification of Diseases, Clinical Modification (ICD-9-CM) codes indicating maltreatment, yet there is a little information on how valid these codes are for the purposes of identifying maltreatment from health, as opposed to child welfare, data. This study assessed the validity of Medicaid codes in identifying maltreatment. Participants (n = 2,136) in the first National Survey of Child and Adolescent Well-Being were linked to their Medicaid claims obtained from 36 states. Caseworker determinations of maltreatment were compared with eight sets of ICD-9-CM codes. Of the 1,921 children identified by caseworkers as being maltreated, 15.2% had any relevant ICD-9-CM code in any of their Medicaid files across 4 years of observation. Maltreated boys and those of African American race had lower odds of displaying a maltreatment code. Using only Medicaid claims to identify maltreated children creates validity problems. Medicaid data linkage with other types of administrative data is required to better identify maltreated children. © The Author(s) 2014.

Incorporating the Last Four Digits of Social Security Numbers Substantially Improves Linking Patient Data from De-identified Hospital Claims Databases.

PubMed

Naessens, James M; Visscher, Sue L; Peterson, Stephanie M; Swanson, Kristi M; Johnson, Matthew G; Rahman, Parvez A; Schindler, Joe; Sonneborn, Mark; Fry, Donald E; Pine, Michael

2015-08-01

Assess algorithms for linking patients across de-identified databases without compromising confidentiality. Hospital discharges from 11 Mayo Clinic hospitals during January 2008-September 2012 (assessment and validation data). Minnesota death certificates and hospital discharges from 2009 to 2012 for entire state (application data). Cross-sectional assessment of sensitivity and positive predictive value (PPV) for four linking algorithms tested by identifying readmissions and posthospital mortality on the assessment data with application to statewide data. De-identified claims included patient gender, birthdate, and zip code. Assessment records were matched with institutional sources containing unique identifiers and the last four digits of Social Security number (SSNL4). Gender, birthdate, and five-digit zip code identified readmissions with a sensitivity of 98.0 percent and a PPV of 97.7 percent and identified postdischarge mortality with 84.4 percent sensitivity and 98.9 percent PPV. Inclusion of SSNL4 produced nearly perfect identification of readmissions and deaths. When applied statewide, regions bordering states with unavailable hospital discharge data had lower rates. Addition of SSNL4 to administrative data, accompanied by appropriate data use and data release policies, can enable trusted repositories to link data with nearly perfect accuracy without compromising patient confidentiality. States maintaining centralized de-identified databases should add SSNL4 to data specifications. © Health Research and Educational Trust.

Identifying individuals with physician-diagnosed chronic obstructive pulmonary disease in primary care electronic medical records: a retrospective chart abstraction study.

PubMed

Lee, Theresa M; Tu, Karen; Wing, Laura L; Gershon, Andrea S

2017-05-15

Little is known about using electronic medical records to identify patients with chronic obstructive pulmonary disease to improve quality of care. Our objective was to develop electronic medical record algorithms that can accurately identify patients with obstructive pulmonary disease. A retrospective chart abstraction study was conducted on data from the Electronic Medical Record Administrative data Linked Database (EMRALD ® ) housed at the Institute for Clinical Evaluative Sciences. Abstracted charts provided the reference standard based on available physician-diagnoses, chronic obstructive pulmonary disease-specific medications, smoking history and pulmonary function testing. Chronic obstructive pulmonary disease electronic medical record algorithms using combinations of terminology in the cumulative patient profile (CPP; problem list/past medical history), physician billing codes (chronic bronchitis/emphysema/other chronic obstructive pulmonary disease), and prescriptions, were tested against the reference standard. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) were calculated. There were 364 patients with chronic obstructive pulmonary disease identified in a 5889 randomly sampled cohort aged ≥ 35 years (prevalence = 6.2%). The electronic medical record algorithm consisting of ≥ 3 physician billing codes for chronic obstructive pulmonary disease per year; documentation in the CPP; tiotropium prescription; or ipratropium (or its formulations) prescription and a chronic obstructive pulmonary disease billing code had sensitivity of 76.9% (95% CI:72.2-81.2), specificity of 99.7% (99.5-99.8), PPV of 93.6% (90.3-96.1), and NPV of 98.5% (98.1-98.8). Electronic medical record algorithms can accurately identify patients with chronic obstructive pulmonary disease in primary care records. They can be used to enable further studies in practice patterns and chronic obstructive pulmonary disease management in primary care. NOVEL ALGORITHM SEARCH TECHNIQUE: Researchers develop an algorithm that can accurately search through electronic health records to find patients with chronic lung disease. Mining population-wide data for information on patients diagnosed and treated with chronic obstructive pulmonary disease (COPD) in primary care could help inform future healthcare and spending practices. Theresa Lee at the University of Toronto, Canada, and colleagues used an algorithm to search electronic medical records and identify patients with COPD from doctors' notes, prescriptions and symptom histories. They carefully adjusted the algorithm to improve sensitivity and predictive value by adding details such as specific medications, physician codes related to COPD, and different combinations of terminology in doctors' notes. The team accurately identified 364 patients with COPD in a randomly-selected cohort of 5889 people. Their results suggest opportunities for broader, informative studies of COPD in wider populations.

Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique.

PubMed

Thondoo, Meelan; Strachan, Daniel Ll; Nakirunda, Maureen; Ndima, Sozinho; Muiambo, Abel; Källander, Karin; Hill, Zelee

2015-07-23

Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation. To use formative research to explore the views of community health workers in Uganda and Mozambique on the potential role of mHealth in their work delivering integrated community case management of children. We conducted 24 in-depth interviews and 5 focus group discussions with community health workers in Uganda and Mozambique. Data were collected on: current phone use, preferred phone and charger characteristics, and perceptions of a range of potential mHealth interventions. Interviews were conducted in the local language, were audio recorded and converted into expanded notes. Interviews were coded for key thematic areas using both deductive and inductive codes. Deductive codes included mHealth's potential impact on motivation and performance. The most salient roles of mHealth in improving performance and motivation were reducing the need for travel, improving efficiency and planning, receiving feedback and information, and improving communication with supervisors and other community health workers. This was mostly through improved voice and short message service (SMS) text communication. Specific components of mHealth interventions that participants felt could improve motivation included increasing their visibility and credibility through branding of phones; providing an SMS response to data submission; and sending SMS messages about the importance of their work and achievements, rather than just reminders or technical messages. Participants identified feasibility issues related to the language of SMS messages, network coverage, and the need for a balance between phone function and battery life. Phones with a dual SIM cards would ameliorate network problems but would reduce battery life. The provision of a solar charger was viewed as beneficial. Conducting formative research with end users is likely to improve mHealth interventions by: (1) identifying interventions that are likely to have the greatest impact and be the most acceptable, (2) developing salient SMS messages, and (3) identifying feasibility issues. mHealth interventions also could have an important impact on health worker motivation, which should be considered by intervention developers and in evaluations, especially as small modifications could have a significant impact. Our study suggests that using phones to improve direct communication should be considered, even when planners aim to focus on the provision of a specific application.

Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique

PubMed Central

Thondoo, Meelan; Strachan, Daniel Ll; Nakirunda, Maureen; Ndima, Sozinho; Muiambo, Abel; Källander, Karin

2015-01-01

Background Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation. Objective To use formative research to explore the views of community health workers in Uganda and Mozambique on the potential role of mHealth in their work delivering integrated community case management of children. Methods We conducted 24 in-depth interviews and 5 focus group discussions with community health workers in Uganda and Mozambique. Data were collected on: current phone use, preferred phone and charger characteristics, and perceptions of a range of potential mHealth interventions. Interviews were conducted in the local language, were audio recorded and converted into expanded notes. Interviews were coded for key thematic areas using both deductive and inductive codes. Deductive codes included mHealth’s potential impact on motivation and performance. Results The most salient roles of mHealth in improving performance and motivation were reducing the need for travel, improving efficiency and planning, receiving feedback and information, and improving communication with supervisors and other community health workers. This was mostly through improved voice and short message service (SMS) text communication. Specific components of mHealth interventions that participants felt could improve motivation included increasing their visibility and credibility through branding of phones; providing an SMS response to data submission; and sending SMS messages about the importance of their work and achievements, rather than just reminders or technical messages. Participants identified feasibility issues related to the language of SMS messages, network coverage, and the need for a balance between phone function and battery life. Phones with a dual SIM cards would ameliorate network problems but would reduce battery life. The provision of a solar charger was viewed as beneficial. Conclusions Conducting formative research with end users is likely to improve mHealth interventions by: (1) identifying interventions that are likely to have the greatest impact and be the most acceptable, (2) developing salient SMS messages, and (3) identifying feasibility issues. mHealth interventions also could have an important impact on health worker motivation, which should be considered by intervention developers and in evaluations, especially as small modifications could have a significant impact. Our study suggests that using phones to improve direct communication should be considered, even when planners aim to focus on the provision of a specific application. PMID:26206419

Development and validation of an epidemiologic case definition of epilepsy for use with routinely collected Australian health data.

PubMed

Tan, Michael; Wilson, Ian; Braganza, Vanessa; Ignatiadis, Sophia; Boston, Ray; Sundararajan, Vijaya; Cook, Mark J; D'Souza, Wendyl J

2015-10-01

We report the diagnostic validity of a selection algorithm for identifying epilepsy cases. Retrospective validation study of International Classification of Diseases 10th Revision Australian Modification (ICD-10AM)-coded hospital records and pharmaceutical data sampled from 300 consecutive potential epilepsy-coded cases and 300 randomly chosen cases without epilepsy from 3/7/2012 to 10/7/2013. Two epilepsy specialists independently validated the diagnosis of epilepsy. A multivariable logistic regression model was fitted to identify the optimum coding algorithm for epilepsy and was internally validated. One hundred fifty-eight out of three hundred (52.6%) epilepsy-coded records and 0/300 (0%) nonepilepsy records were confirmed to have epilepsy. The kappa for interrater agreement was 0.89 (95% CI=0.81-0.97). The model utilizing epilepsy (G40), status epilepticus (G41) and ≥1 antiepileptic drug (AED) conferred the highest positive predictive value of 81.4% (95% CI=73.1-87.9) and a specificity of 99.9% (95% CI=99.9-100.0). The area under the receiver operating curve was 0.90 (95% CI=0.88-0.93). When combined with pharmaceutical data, the precision of case identification for epilepsy data linkage design was considerably improved and could provide considerable potential for efficient and reasonably accurate case ascertainment in epidemiological studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Subtypes of developmental dyslexia: testing the predictions of the dual-route and connectionist frameworks.

PubMed

Peterson, Robin L; Pennington, Bruce F; Olson, Richard K

2013-01-01

We investigated the phonological and surface subtypes of developmental dyslexia in light of competing predictions made by two computational models of single word reading, the Dual-Route Cascaded Model (DRC; Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001) and Harm and Seidenberg's connectionist model (HS model; Harm & Seidenberg, 1999). The regression-outlier procedure was applied to a large sample to identify children with disproportionately poor phonological coding skills (phonological dyslexia) or disproportionately poor orthographic coding skills (surface dyslexia). Consistent with the predictions of the HS model, children with "pure" phonological dyslexia, who did not have orthographic deficits, had milder phonological impairments than children with "relative" phonological dyslexia, who did have secondary orthographic deficits. In addition, pure cases of dyslexia were more common among older children. Consistent with the predictions of the DRC model, surface dyslexia was not well conceptualized as a reading delay; both phonological and surface dyslexia were associated with patterns of developmental deviance. In addition, some results were problematic for both models. We identified a small number of individuals with severe phonological dyslexia, relatively intact orthographic coding skills, and very poor real word reading. Further, a subset of controls could read normally despite impaired orthographic coding. The findings are discussed in terms of improvements to both models that might help better account for all cases of developmental dyslexia. Copyright © 2012 Elsevier B.V. All rights reserved.

A methodological pilot: parenting among women in substance abuse treatment.

PubMed

Lewin, Linda; Farkas, Kathleen; Niazi, Maryam

2014-01-01

Mothers who abuse substances are likely to have insecure emotional attachment with their children, placing their children at risk for social-emotional and psychiatric conditions. Sobriety does not inevitably improve parenting. We tested recruitment methods, audiovisual (AV) recording procedures, the protocol for identifying child abuse risk, the coding of mother-child interactions, and retention of the sample for repeated measures as the first phase in examining mother-child relational quality of women in substance abuse treatment. This innovative study involved AV recordings to capture the in-vivo mother-child interactional behaviors that were later coded and analyzed for mean scores on the 64-item Parent-Child Relational Quality Assessment. Repeated measurement was planned during treatment and two months after discharge from treatment. The pilot involved a small sample (n = 11) of mother-child (<6 years) dyads. Highest and lowest ratings of interaction behaviors were identified. Mothers showed less enthusiasm and creativity but matched their child's emotional state. The children showed appropriate motor skill items and attachment behaviors. The dyad coding showed less mutual enjoyment between the mother and child. Eight of the participants could not be located for the second measurement despite multiple contact methods. AV recordings capture rich, descriptive information that can be coded for interactional quality analysis. Repeated measurement with this cohort was not feasible, thus needing to assess for additional/more frequent contacts to maintain the sample.

Subtypes of developmental dyslexia: Testing the predictions of the dual-route and connectionist frameworks

PubMed Central

Peterson, Robin L.; Pennington, Bruce F.; Olson, Richard K.

2012-01-01

We investigated the phonological and surface subtypes of developmental dyslexia in light of competing predictions made by two computational models of single word reading, the dual-route cascaded model (DRC; Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001) and Harm and Seidenberg’s connectionist model (HS model; Harm & Seidenberg, 1999). The regression-outlier procedure was applied to a large sample to identify children with disproportionately poor phonological coding skills (phonological dyslexia) or disproportionately poor orthographic coding skills (surface dyslexia). Consistent with the predictions of the HS model, children with “pure” phonological dyslexia, who did not have orthographic deficits, had milder phonological impairments than children with “relative” phonological dyslexia, who did have secondary orthographic deficits. In addition, pure cases of dyslexia were more common among older children. Consistent with the predictions of the DRC model, surface dyslexia was not well conceptualized as a reading delay; both phonological and surface dyslexia were associated with patterns of developmental deviance. In addition, some results were problematic for both models. We identified a small number of individuals with severe phonological dyslexia, relatively intact orthographic coding skills, and very poor real word reading. Further, a subset of controls could read normally despite impaired orthographic coding. The findings are discussed in terms of improvements to both models that might help better account for all cases of developmental dyslexia. PMID:23010562

Defining and measuring suspicion of sepsis: an analysis of routine data.

PubMed

Inada-Kim, Matthew; Page, Bethan; Maqsood, Imran; Vincent, Charles

2017-06-09

To define the target population of patients who have suspicion of sepsis (SOS) and to provide a basis for assessing the burden of SOS, and the evaluation of sepsis guidelines and improvement programmes. Retrospective analysis of routinely collected hospital administrative data. Secondary care, eight National Health Service (NHS) Acute Trusts. Hospital Episode Statistics data for 2013-2014 was used to identify all admissions with a primary diagnosis listed in the 'suspicion of sepsis' (SOS) coding set. The SOS coding set consists of all bacterial infective diagnoses. We identified 47 475 admissions with SOS, equivalent to a rate of 17 admissions per 1000 adults in a given year. The mortality for this group was 7.2% during their acute hospital admission. Urinary tract infection was the most common diagnosis and lobar pneumonia was associated with the most deaths. A short list of 10 diagnoses can account for 85% of the deaths. Patients with SOS can be identified in routine administrative data. It is these patients who should be screened for sepsis and are the target of programmes to improve the detection and treatment of sepsis. The effectiveness of such programmes can be evaluated by examining the outcomes of patients with SOS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Leveraging the NLM map from SNOMED CT to ICD-10-CM to facilitate adoption of ICD-10-CM.

PubMed

Cartagena, F Phil; Schaeffer, Molly; Rifai, Dorothy; Doroshenko, Victoria; Goldberg, Howard S

2015-05-01

Develop and test web services to retrieve and identify the most precise ICD-10-CM code(s) for a given clinical encounter. Facilitate creation of user interfaces that 1) provide an initial shortlist of candidate codes, ideally visible on a single screen; and 2) enable code refinement. To satisfy our high-level use cases, the analysis and design process involved reviewing available maps and crosswalks, designing the rule adjudication framework, determining necessary metadata, retrieving related codes, and iteratively improving the code refinement algorithm. The Partners ICD-10-CM Search and Mapping Services (PI-10 Services) are SOAP web services written using Microsoft's.NET 4.0 Framework, Windows Communications Framework, and SQL Server 2012. The services cover 96% of the Partners problem list subset of SNOMED CT codes that map to ICD-10-CM codes and can return up to 76% of the 69,823 billable ICD-10-CM codes prior to creation of custom mapping rules. We consider ways to increase 1) the coverage ratio of the Partners problem list subset of SNOMED CT codes and 2) the upper bound of returnable ICD-10-CM codes by creating custom mapping rules. Future work will investigate the utility of the transitive closure of SNOMED CT codes and other methods to assist in custom rule creation and, ultimately, to provide more complete coverage of ICD-10-CM codes. ICD-10-CM will be easier for clinicians to manage if applications display short lists of candidate codes from which clinicians can subsequently select a code for further refinement. The PI-10 Services support ICD-10 migration by implementing this paradigm and enabling users to consistently and accurately find the best ICD-10-CM code(s) without translation from ICD-9-CM. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Laser pulse coded signal frequency measuring device based on DSP and CPLD

NASA Astrophysics Data System (ADS)

Zhang, Hai-bo; Cao, Li-hua; Geng, Ai-hui; Li, Yan; Guo, Ru-hai; Wang, Ting-feng

2011-06-01

Laser pulse code is an anti-jamming measures used in semi-active laser guided weapons. On account of the laser-guided signals adopting pulse coding mode and the weak signal processing, it need complex calculations in the frequency measurement process according to the laser pulse code signal time correlation to meet the request in optoelectronic countermeasures in semi-active laser guided weapons. To ensure accurately completing frequency measurement in a short time, it needed to carry out self-related process with the pulse arrival time series composed of pulse arrival time, calculate the signal repetition period, and then identify the letter type to achieve signal decoding from determining the time value, number and rank number in a signal cycle by Using CPLD and DSP for signal processing chip, designing a laser-guided signal frequency measurement in the pulse frequency measurement device, improving the signal processing capability through the appropriate software algorithms. In this article, we introduced the principle of frequency measurement of the device, described the hardware components of the device, the system works and software, analyzed the impact of some system factors on the accuracy of the measurement. The experimental results indicated that this system improve the accuracy of the measurement under the premise of volume, real-time, anti-interference, low power of the laser pulse frequency measuring device. The practicality of the design, reliability has been demonstrated from the experimental point of view.

Assessment of tissue allograft safety monitoring with administrative healthcare databases: a pilot project using Medicare data.

PubMed

Dhakal, Sanjaya; Burwen, Dale R; Polakowski, Laura L; Zinderman, Craig E; Wise, Robert P

2014-03-01

Assess whether Medicare data are useful for monitoring tissue allograft safety and utilization. We used health care claims (billing) data from 2007 for 35 million fee-for-service Medicare beneficiaries, a predominantly elderly population. Using search terms for transplant-related procedures, we generated lists of ICD-9-CM and CPT(®) codes and assessed the frequency of selected allograft procedures. Step 1 used inpatient data and ICD-9-CM procedure codes. Step 2 added non-institutional provider (e.g., physician) claims, outpatient institutional claims, and CPT codes. We assembled preliminary lists of diagnosis codes for infections after selected allograft procedures. Many ICD-9-CM codes were ambiguous as to whether the procedure involved an allograft. Among 1.3 million persons with a procedure ascertained using the list of ICD-9-CM codes, only 1,886 claims clearly involved an allograft. CPT codes enabled better ascertainment of some allograft procedures (over 17,000 persons had corneal transplants and over 2,700 had allograft skin transplants). For spinal fusion procedures, CPT codes improved specificity for allografts; of nearly 100,000 patients with ICD-9-CM codes for spinal fusions, more than 34,000 had CPT codes indicating allograft use. Monitoring infrequent events (infections) after infrequent exposures (tissue allografts) requires large study populations. A strength of the large Medicare databases is the substantial number of certain allograft procedures. Limitations include lack of clinical detail and donor information. Medicare data can potentially augment passive reporting systems and may be useful for monitoring tissue allograft safety and utilization where codes clearly identify allograft use and coding algorithms can effectively screen for infections.

Clinical code set engineering for reusing EHR data for research: A review.

PubMed

Williams, Richard; Kontopantelis, Evangelos; Buchan, Iain; Peek, Niels

2017-06-01

The construction of reliable, reusable clinical code sets is essential when re-using Electronic Health Record (EHR) data for research. Yet code set definitions are rarely transparent and their sharing is almost non-existent. There is a lack of methodological standards for the management (construction, sharing, revision and reuse) of clinical code sets which needs to be addressed to ensure the reliability and credibility of studies which use code sets. To review methodological literature on the management of sets of clinical codes used in research on clinical databases and to provide a list of best practice recommendations for future studies and software tools. We performed an exhaustive search for methodological papers about clinical code set engineering for re-using EHR data in research. This was supplemented with papers identified by snowball sampling. In addition, a list of e-phenotyping systems was constructed by merging references from several systematic reviews on this topic, and the processes adopted by those systems for code set management was reviewed. Thirty methodological papers were reviewed. Common approaches included: creating an initial list of synonyms for the condition of interest (n=20); making use of the hierarchical nature of coding terminologies during searching (n=23); reviewing sets with clinician input (n=20); and reusing and updating an existing code set (n=20). Several open source software tools (n=3) were discovered. There is a need for software tools that enable users to easily and quickly create, revise, extend, review and share code sets and we provide a list of recommendations for their design and implementation. Research re-using EHR data could be improved through the further development, more widespread use and routine reporting of the methods by which clinical codes were selected. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit.

PubMed

Levesque, Eric; Hoti, Emir; de La Serna, Sofia; Habouchi, Houssam; Ichai, Philippe; Saliba, Faouzi; Samuel, Didier; Azoulay, Daniel

2013-03-01

In the French healthcare system, the intensive care budget allocated is directly dependent on the activity level of the center. To evaluate this activity level, it is necessary to code the medical diagnoses and procedures performed on Intensive Care Unit (ICU) patients. The aim of this study was to evaluate the effects of using an Intensive Care Information System (ICIS) on the incidence of coding errors and its impact on the ICU budget allocated. Since 2005, the documentation on and monitoring of every patient admitted to our ICU has been carried out using an ICIS. However, the coding process was performed manually until 2008. This study focused on two periods: the period of manual coding (year 2007) and the period of computerized coding (year 2008) which covered a total of 1403 ICU patients. The time spent on the coding process, the rate of coding errors (defined as patients missed/not coded or wrongly identified as undergoing major procedure/s) and the financial impact were evaluated for these two periods. With computerized coding, the time per admission decreased significantly (from 6.8 ± 2.8 min in 2007 to 3.6 ± 1.9 min in 2008, p<0.001). Similarly, a reduction in coding errors was observed (7.9% vs. 2.2%, p<0.001). This decrease in coding errors resulted in a reduced difference between the potential and real ICU financial supplements obtained in the respective years (€194,139 loss in 2007 vs. a €1628 loss in 2008). Using specific computer programs improves the intensive process of manual coding by shortening the time required as well as reducing errors, which in turn positively impacts the ICU budget allocation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Coding tools investigation for next generation video coding based on HEVC

NASA Astrophysics Data System (ADS)

Chen, Jianle; Chen, Ying; Karczewicz, Marta; Li, Xiang; Liu, Hongbin; Zhang, Li; Zhao, Xin

2015-09-01

The new state-of-the-art video coding standard, H.265/HEVC, has been finalized in 2013 and it achieves roughly 50% bit rate saving compared to its predecessor, H.264/MPEG-4 AVC. This paper provides the evidence that there is still potential for further coding efficiency improvements. A brief overview of HEVC is firstly given in the paper. Then, our improvements on each main module of HEVC are presented. For instance, the recursive quadtree block structure is extended to support larger coding unit and transform unit. The motion information prediction scheme is improved by advanced temporal motion vector prediction, which inherits the motion information of each small block within a large block from a temporal reference picture. Cross component prediction with linear prediction model improves intra prediction and overlapped block motion compensation improves the efficiency of inter prediction. Furthermore, coding of both intra and inter prediction residual is improved by adaptive multiple transform technique. Finally, in addition to deblocking filter and SAO, adaptive loop filter is applied to further enhance the reconstructed picture quality. This paper describes above-mentioned techniques in detail and evaluates their coding performance benefits based on the common test condition during HEVC development. The simulation results show that significant performance improvement over HEVC standard can be achieved, especially for the high resolution video materials.

Privacy protection versus cluster detection in spatial epidemiology.

PubMed

Olson, Karen L; Grannis, Shaun J; Mandl, Kenneth D

2006-11-01

Patient data that includes precise locations can reveal patients' identities, whereas data aggregated into administrative regions may preserve privacy and confidentiality. We investigated the effect of varying degrees of address precision (exact latitude and longitude vs the center points of zip code or census tracts) on detection of spatial clusters of cases. We simulated disease outbreaks by adding supplementary spatially clustered emergency department visits to authentic hospital emergency department syndromic surveillance data. We identified clusters with a spatial scan statistic and evaluated detection rate and accuracy. More clusters were identified, and clusters were more accurately detected, when exact locations were used. That is, these clusters contained at least half of the simulated points and involved few additional emergency department visits. These results were especially apparent when the synthetic clustered points crossed administrative boundaries and fell into multiple zip code or census tracts. The spatial cluster detection algorithm performed better when addresses were analyzed as exact locations than when they were analyzed as center points of zip code or census tracts, particularly when the clustered points crossed administrative boundaries. Use of precise addresses offers improved performance, but this practice must be weighed against privacy concerns in the establishment of public health data exchange policies.

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

PubMed

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers: A "Positive Deviance" Approach.

PubMed

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N

2018-01-01

Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient-provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.

Applying the Verona coding definitions of emotional sequences (VR-CoDES) in the dental context involving patients with complex communication needs: An exploratory study.

PubMed

Zhou, Yuefang; Black, Rolf; Freeman, Ruth; Herron, Daniel; Humphris, Gerry; Menzies, Rachel; Quinn, Sandra; Scott, Lesley; Waller, Annalu

2014-11-01

The VR-CoDES has been previously applied in the dental context. However, we know little about how dental patients with intellectual disabilities (ID) and complex communication needs express their emotional distress during dental visits. This is the first study explored the applicability of the VR-CoDES to a dental context involving patients with ID. Fourteen dental consultations were video recorded and coded using the VR-CoDES, assisted with the additional guidelines for the VR-CoDES in a dental context. Both inter- and intra-coder reliabilities were checked on the seven consultations where cues were observed. Sixteen cues (eight non-verbal) were identified within seven of the 14 consultations. Twenty responses were observed (12 reducing space) with four multiple responses. Cohen's Kappa were 0.76 (inter-coder) and 0.88 (intra-coder). With the additional guidelines, cues and responses were reliably identified. Cue expression was exhibited by non-verbal expression of emotion with people with ID in the literature. Further guidance is needed to improve the coding accuracy on multiple providers' responses and to investigate potential impacts of conflicting responses on patients. The findings provided a useful initial step towards an ongoing exploration of how healthcare providers identify and manage emotional distress of patients with ID. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Colour coding for blood collection tube closures - a call for harmonisation.

PubMed

Simundic, Ana-Maria; Cornes, Michael P; Grankvist, Kjell; Lippi, Giuseppe; Nybo, Mads; Ceriotti, Ferruccio; Theodorsson, Elvar; Panteghini, Mauro

2015-02-01

At least one in 10 patients experience adverse events while receiving hospital care. Many of the errors are related to laboratory diagnostics. Efforts to reduce laboratory errors over recent decades have primarily focused on the measurement process while pre- and post-analytical errors including errors in sampling, reporting and decision-making have received much less attention. Proper sampling and additives to the samples are essential. Tubes and additives are identified not only in writing on the tubes but also by the colour of the tube closures. Unfortunately these colours have not been standardised, running the risk of error when tubes from one manufacturer are replaced by the tubes from another manufacturer that use different colour coding. EFLM therefore supports the worldwide harmonisation of the colour coding for blood collection tube closures and labels in order to reduce the risk of pre-analytical errors and improve the patient safety.

Validation of a general practice audit and data extraction tool.

PubMed

Peiris, David; Agaliotis, Maria; Patel, Bindu; Patel, Anushka

2013-11-01

We assessed how accurately a common general practitioner (GP) audit tool extracts data from two software systems. First, pathology test codes were audited at 33 practices covering nine companies. Second, a manual audit of chronic disease data from 200 random patient records at two practices was compared with audit tool data. Pathology review: all companies assigned correct codes for cholesterol, creatinine and glycated haemoglobin; four companies assigned incorrect codes for albuminuria tests, precluding accurate detection with the audit tool. Case record review: there was strong agreement between the manual audit and the tool for all variables except chronic kidney disease diagnoses, which was due to a tool-related programming error. The audit tool accurately detected most chronic disease data in two GP record systems. The one exception, however, highlights the importance of surveillance systems to promptly identify errors. This will maximise potential for audit tools to improve healthcare quality.

Child Injury Deaths: Comparing Prevention Information from Two Coding Systems

PubMed Central

Schnitzer, Patricia G.; Ewigman, Bernard G.

2006-01-01

Objectives The International Classification of Disease (ICD) external cause of injury E-codes do not sufficiently identify injury circumstances amenable to prevention. The researchers developed an alternative classification system (B-codes) that incorporates behavioral and environmental factors, for use in childhood injury research, and compare the two coding systems in this paper. Methods All fatal injuries among children less than age five that occurred between January 1, 1992, and December 31, 1994, were classified using both B-codes and E-codes. Results E-codes identified the most common causes of injury death: homicide (24%), fires (21%), motor vehicle incidents (21%), drowning (10%), and suffocation (9%). The B-codes further revealed that homicides (51%) resulted from the child being shaken or struck by another person; many fires deaths (42%) resulted from children playing with matches or lighters; drownings (46%) usually occurred in natural bodies of water; and most suffocation deaths (68%) occurred in unsafe sleeping arrangements. Conclusions B-codes identify additional information with specific relevance for prevention of childhood injuries. PMID:15944169

Long Non-Coding RNAs Differentially Expressed between Normal versus Primary Breast Tumor Tissues Disclose Converse Changes to Breast Cancer-Related Protein-Coding Genes

PubMed Central

Reiche, Kristin; Kasack, Katharina; Schreiber, Stephan; Lüders, Torben; Due, Eldri U.; Naume, Bjørn; Riis, Margit; Kristensen, Vessela N.; Horn, Friedemann; Børresen-Dale, Anne-Lise; Hackermüller, Jörg; Baumbusch, Lars O.

2014-01-01

Breast cancer, the second leading cause of cancer death in women, is a highly heterogeneous disease, characterized by distinct genomic and transcriptomic profiles. Transcriptome analyses prevalently assessed protein-coding genes; however, the majority of the mammalian genome is expressed in numerous non-coding transcripts. Emerging evidence supports that many of these non-coding RNAs are specifically expressed during development, tumorigenesis, and metastasis. The focus of this study was to investigate the expression features and molecular characteristics of long non-coding RNAs (lncRNAs) in breast cancer. We investigated 26 breast tumor and 5 normal tissue samples utilizing a custom expression microarray enclosing probes for mRNAs as well as novel and previously identified lncRNAs. We identified more than 19,000 unique regions significantly differentially expressed between normal versus breast tumor tissue, half of these regions were non-coding without any evidence for functional open reading frames or sequence similarity to known proteins. The identified non-coding regions were primarily located in introns (53%) or in the intergenic space (33%), frequently orientated in antisense-direction of protein-coding genes (14%), and commonly distributed at promoter-, transcription factor binding-, or enhancer-sites. Analyzing the most diverse mRNA breast cancer subtypes Basal-like versus Luminal A and B resulted in 3,025 significantly differentially expressed unique loci, including 682 (23%) for non-coding transcripts. A notable number of differentially expressed protein-coding genes displayed non-synonymous expression changes compared to their nearest differentially expressed lncRNA, including an antisense lncRNA strongly anticorrelated to the mRNA coding for histone deacetylase 3 (HDAC3), which was investigated in more detail. Previously identified chromatin-associated lncRNAs (CARs) were predominantly downregulated in breast tumor samples, including CARs located in the protein-coding genes for CALD1, FTX, and HNRNPH1. In conclusion, a number of differentially expressed lncRNAs have been identified with relation to cancer-related protein-coding genes. PMID:25264628

Long non-coding RNAs differentially expressed between normal versus primary breast tumor tissues disclose converse changes to breast cancer-related protein-coding genes.

PubMed

Reiche, Kristin; Kasack, Katharina; Schreiber, Stephan; Lüders, Torben; Due, Eldri U; Naume, Bjørn; Riis, Margit; Kristensen, Vessela N; Horn, Friedemann; Børresen-Dale, Anne-Lise; Hackermüller, Jörg; Baumbusch, Lars O

2014-01-01

Breast cancer, the second leading cause of cancer death in women, is a highly heterogeneous disease, characterized by distinct genomic and transcriptomic profiles. Transcriptome analyses prevalently assessed protein-coding genes; however, the majority of the mammalian genome is expressed in numerous non-coding transcripts. Emerging evidence supports that many of these non-coding RNAs are specifically expressed during development, tumorigenesis, and metastasis. The focus of this study was to investigate the expression features and molecular characteristics of long non-coding RNAs (lncRNAs) in breast cancer. We investigated 26 breast tumor and 5 normal tissue samples utilizing a custom expression microarray enclosing probes for mRNAs as well as novel and previously identified lncRNAs. We identified more than 19,000 unique regions significantly differentially expressed between normal versus breast tumor tissue, half of these regions were non-coding without any evidence for functional open reading frames or sequence similarity to known proteins. The identified non-coding regions were primarily located in introns (53%) or in the intergenic space (33%), frequently orientated in antisense-direction of protein-coding genes (14%), and commonly distributed at promoter-, transcription factor binding-, or enhancer-sites. Analyzing the most diverse mRNA breast cancer subtypes Basal-like versus Luminal A and B resulted in 3,025 significantly differentially expressed unique loci, including 682 (23%) for non-coding transcripts. A notable number of differentially expressed protein-coding genes displayed non-synonymous expression changes compared to their nearest differentially expressed lncRNA, including an antisense lncRNA strongly anticorrelated to the mRNA coding for histone deacetylase 3 (HDAC3), which was investigated in more detail. Previously identified chromatin-associated lncRNAs (CARs) were predominantly downregulated in breast tumor samples, including CARs located in the protein-coding genes for CALD1, FTX, and HNRNPH1. In conclusion, a number of differentially expressed lncRNAs have been identified with relation to cancer-related protein-coding genes.

Utilization of genetic tests: analysis of gene-specific billing in Medicare claims data.

PubMed

Lynch, Julie A; Berse, Brygida; Dotson, W David; Khoury, Muin J; Coomer, Nicole; Kautter, John

2017-08-01

We examined the utilization of precision medicine tests among Medicare beneficiaries through analysis of gene-specific tier 1 and 2 billing codes developed by the American Medical Association in 2012. We conducted a retrospective cross-sectional study. The primary source of data was 2013 Medicare 100% fee-for-service claims. We identified claims billed for each laboratory test, the number of patients tested, expenditures, and the diagnostic codes indicated for testing. We analyzed variations in testing by patient demographics and region of the country. Pharmacogenetic tests were billed most frequently, accounting for 48% of the expenditures for new codes. The most common indications for testing were breast cancer, long-term use of medications, and disorders of lipid metabolism. There was underutilization of guideline-recommended tumor mutation tests (e.g., epidermal growth factor receptor) and substantial overutilization of a test discouraged by guidelines (methylenetetrahydrofolate reductase). Methodology-based tier 2 codes represented 15% of all claims billed with the new codes. The highest rate of testing per beneficiary was in Mississippi and the lowest rate was in Alaska. Gene-specific billing codes significantly improved our ability to conduct population-level research of precision medicine. Analysis of these data in conjunction with clinical records should be conducted to validate findings.Genet Med advance online publication 26 January 2017.

Home energy management (HEM) database: A list with coded attributes of 308 devices commercially available in the US.

PubMed

Pritoni, Marco; Ford, Rebecca; Karlin, Beth; Sanguinetti, Angela

2018-02-01

Policymakers worldwide are currently discussing whether to include home energy management (HEM) products in their portfolio of technologies to reduce carbon emissions and improve grid reliability. However, very little data is available about these products. Here we present the results of an extensive review including 308 HEM products available on the US market in 2015-2016. We gathered these data from publicly available sources such as vendor websites, online marketplaces and other vendor documents. A coding guide was developed iteratively during the data collection and utilized to classify the devices. Each product was coded based on 96 distinct attributes, grouped into 11 categories: Identifying information, Product components, Hardware, Communication, Software, Information - feedback, Information - feedforward, Control, Utility interaction, Additional benefits and Usability. The codes describe product features and functionalities, user interaction and interoperability with other devices. A mix of binary attributes and more descriptive codes allow to sort and group data without losing important qualitative information. The information is stored in a large spreadsheet included with this article, along with an explanatory coding guide. This dataset is analyzed and described in a research article entitled "Categories and functionality of smart home technology for energy management" (Ford et al., 2017) [1].

Inter-individual variation in expression: a missing link in biomarker biology?

PubMed

Little, Peter F R; Williams, Rohan B H; Wilkins, Marc R

2009-01-01

The past decade has seen an explosion of variation data demonstrating that diversity of both protein-coding sequences and of regulatory elements of protein-coding genes is common and of functional importance. In this article, we argue that genetic diversity can no longer be ignored in studies of human biology, even research projects without explicit genetic experimental design, and that this knowledge can, and must, inform research. By way of illustration, we focus on the potential role of genetic data in case-control studies to identify and validate cancer protein biomarkers. We argue that a consideration of genetics, in conjunction with proteomic biomarker discovery projects, should improve the proportion of biomarkers that can accurately classify patients.

RNAcentral: A comprehensive database of non-coding RNA sequences

DOE PAGES

Williams, Kelly Porter; Lau, Britney Yan

2016-10-28

RNAcentral is a database of non-coding RNA (ncRNA) sequences that aggregates data from specialised ncRNA resources and provides a single entry point for accessing ncRNA sequences of all ncRNA types from all organisms. Since its launch in 2014, RNAcentral has integrated twelve new resources, taking the total number of collaborating database to 22, and began importing new types of data, such as modified nucleotides from MODOMICS and PDB. We created new species-specific identifiers that refer to unique RNA sequences within a context of single species. Furthermore, the website has been subject to continuous improvements focusing on text and sequence similaritymore » searches as well as genome browsing functionality.« less

RNAcentral: A comprehensive database of non-coding RNA sequences

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Kelly Porter; Lau, Britney Yan

RNAcentral is a database of non-coding RNA (ncRNA) sequences that aggregates data from specialised ncRNA resources and provides a single entry point for accessing ncRNA sequences of all ncRNA types from all organisms. Since its launch in 2014, RNAcentral has integrated twelve new resources, taking the total number of collaborating database to 22, and began importing new types of data, such as modified nucleotides from MODOMICS and PDB. We created new species-specific identifiers that refer to unique RNA sequences within a context of single species. Furthermore, the website has been subject to continuous improvements focusing on text and sequence similaritymore » searches as well as genome browsing functionality.« less

Identifying Patients with Hypertension: A Case for Auditing Electronic Health Record Data

PubMed Central

Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3–1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5—1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9—1,377.9). PMID:22737097

Nested polynomial trends for the improvement of Gaussian process-based predictors

NASA Astrophysics Data System (ADS)

Perrin, G.; Soize, C.; Marque-Pucheu, S.; Garnier, J.

2017-10-01

The role of simulation keeps increasing for the sensitivity analysis and the uncertainty quantification of complex systems. Such numerical procedures are generally based on the processing of a huge amount of code evaluations. When the computational cost associated with one particular evaluation of the code is high, such direct approaches based on the computer code only, are not affordable. Surrogate models have therefore to be introduced to interpolate the information given by a fixed set of code evaluations to the whole input space. When confronted to deterministic mappings, the Gaussian process regression (GPR), or kriging, presents a good compromise between complexity, efficiency and error control. Such a method considers the quantity of interest of the system as a particular realization of a Gaussian stochastic process, whose mean and covariance functions have to be identified from the available code evaluations. In this context, this work proposes an innovative parametrization of this mean function, which is based on the composition of two polynomials. This approach is particularly relevant for the approximation of strongly non linear quantities of interest from very little information. After presenting the theoretical basis of this method, this work compares its efficiency to alternative approaches on a series of examples.

Improve load balancing and coding efficiency of tiles in high efficiency video coding by adaptive tile boundary

NASA Astrophysics Data System (ADS)

Chan, Chia-Hsin; Tu, Chun-Chuan; Tsai, Wen-Jiin

2017-01-01

High efficiency video coding (HEVC) not only improves the coding efficiency drastically compared to the well-known H.264/AVC but also introduces coding tools for parallel processing, one of which is tiles. Tile partitioning is allowed to be arbitrary in HEVC, but how to decide tile boundaries remains an open issue. An adaptive tile boundary (ATB) method is proposed to select a better tile partitioning to improve load balancing (ATB-LoadB) and coding efficiency (ATB-Gain) with a unified scheme. Experimental results show that, compared to ordinary uniform-space partitioning, the proposed ATB can save up to 17.65% of encoding times in parallel encoding scenarios and can reduce up to 0.8% of total bit rates for coding efficiency.

Error Control Coding Techniques for Space and Satellite Communications

NASA Technical Reports Server (NTRS)

Costello, Daniel J., Jr.; Takeshita, Oscar Y.; Cabral, Hermano A.

1998-01-01

It is well known that the BER performance of a parallel concatenated turbo-code improves roughly as 1/N, where N is the information block length. However, it has been observed by Benedetto and Montorsi that for most parallel concatenated turbo-codes, the FER performance does not improve monotonically with N. In this report, we study the FER of turbo-codes, and the effects of their concatenation with an outer code. Two methods of concatenation are investigated: across several frames and within each frame. Some asymmetric codes are shown to have excellent FER performance with an information block length of 16384. We also show that the proposed outer coding schemes can improve the BER performance as well by eliminating pathological frames generated by the iterative MAP decoding process.

The application of LDPC code in MIMO-OFDM system

NASA Astrophysics Data System (ADS)

Liu, Ruian; Zeng, Beibei; Chen, Tingting; Liu, Nan; Yin, Ninghao

2018-03-01

The combination of MIMO and OFDM technology has become one of the key technologies of the fourth generation mobile communication., which can overcome the frequency selective fading of wireless channel, increase the system capacity and improve the frequency utilization. Error correcting coding introduced into the system can further improve its performance. LDPC (low density parity check) code is a kind of error correcting code which can improve system reliability and anti-interference ability, and the decoding is simple and easy to operate. This paper mainly discusses the application of LDPC code in MIMO-OFDM system.

Population-based drug-related anaphylaxis in children and adolescents captured by South Carolina Emergency Room Hospital Discharge Database (SCERHDD) (2000-2002).

PubMed

West, Suzanne L; D'Aloisio, Aimee A; Ringel-Kulka, Tamar; Waller, Anna E; Clayton Bordley, W

2007-12-01

Anaphylaxis is a life-threatening condition; drug-related anaphylaxis represents approximately 10% of all cases. We assessed the utility of a statewide emergency department (ED) database for identifying drug-related anaphylaxis in children by developing and validating an algorithm composed of ICD-9-CM codes. There were 1 314,760 visits to South Carolina (SC) emergency departments (EDs) for patients <19 years in 2000-2002. We used ICD-9-CM disease or external cause of injury codes (E-codes) that suggested drug-related anaphylaxis or a severe drug-related allergic reaction. We found 50 cases classifiable as probable or possible drug-related anaphylaxis and 13 as drug-related allergic reactions. We used clinical evaluation by two pediatricians as the 'alloyed gold standard'1 for estimating sensitivity, specificity, and positive predictive value (PPV) of our algorithm. ED-treated drug-related anaphylaxis in the SC pediatric population was 1.56/100,000 person-years based on the algorithm and 0.50/100,000 person-years based on clinical evaluation. Assuming the disease codes we used identified all potential anaphylaxis cases in the database, the sensitivity was 1.00 (95%CI: 0.79, 1.00), specificity was 0.28 (95%CI: 0.16, 0.43), and the PPV was 0.32 (0.20, 0.47) for the algorithm. Sensitivity analyses improved the measurement properties of the algorithm. E-codes were invaluable for developing an anaphylaxis algorithm although the frequently used code of E947.9 was often incorrectly applied. We believe that our algorithm may have over-ascertained drug-related anaphylaxis patients seen in an ED, but the clinical evaluation may have under-represented this diagnosis due to limited information on the offending agent in the abstracted ED records. Post-marketing drug surveillance using ED records may be viable if clinicians were to document drug-related anaphylaxis in the charts so that billing codes could be assigned properly. Copyright 2007 John Wiley & Sons, Ltd.

Electronic Fingerprinting for Industry

NASA Technical Reports Server (NTRS)

1995-01-01

Veritec's VeriSystem is a complete identification and tracking system for component traceability, improved manufacturing and processing, and automated shop floor applications. The system includes the Vericode Symbol, a more accurate and versatile alternative to the traditional bar code, that is scanned by charge coupled device (CCD) cameras. The system was developed by Veritec, Rockwell International and Marshall Space Flight Center to identify and track Space Shuttle parts.

Recent improvements of reactor physics codes in MHI

NASA Astrophysics Data System (ADS)

Kosaka, Shinya; Yamaji, Kazuya; Kirimura, Kazuki; Kamiyama, Yohei; Matsumoto, Hideki

2015-12-01

This paper introduces recent improvements for reactor physics codes in Mitsubishi Heavy Industries, Ltd(MHI). MHI has developed a new neutronics design code system Galaxy/Cosmo-S(GCS) for PWR core analysis. After TEPCO's Fukushima Daiichi accident, it is required to consider design extended condition which has not been covered explicitly by the former safety licensing analyses. Under these circumstances, MHI made some improvements for GCS code system. A new resonance calculation model of lattice physics code and homogeneous cross section representative model for core simulator have been developed to apply more wide range core conditions corresponding to severe accident status such like anticipated transient without scram (ATWS) analysis and criticality evaluation of dried-up spent fuel pit. As a result of these improvements, GCS code system has very wide calculation applicability with good accuracy for any core conditions as far as fuel is not damaged. In this paper, the outline of GCS code system is described briefly and recent relevant development activities are presented.

Recent improvements of reactor physics codes in MHI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kosaka, Shinya, E-mail: shinya-kosaka@mhi.co.jp; Yamaji, Kazuya; Kirimura, Kazuki

2015-12-31

This paper introduces recent improvements for reactor physics codes in Mitsubishi Heavy Industries, Ltd(MHI). MHI has developed a new neutronics design code system Galaxy/Cosmo-S(GCS) for PWR core analysis. After TEPCO’s Fukushima Daiichi accident, it is required to consider design extended condition which has not been covered explicitly by the former safety licensing analyses. Under these circumstances, MHI made some improvements for GCS code system. A new resonance calculation model of lattice physics code and homogeneous cross section representative model for core simulator have been developed to apply more wide range core conditions corresponding to severe accident status such like anticipatedmore » transient without scram (ATWS) analysis and criticality evaluation of dried-up spent fuel pit. As a result of these improvements, GCS code system has very wide calculation applicability with good accuracy for any core conditions as far as fuel is not damaged. In this paper, the outline of GCS code system is described briefly and recent relevant development activities are presented.« less

Improving the medical records department processes by lean management.

PubMed

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. The study represents one of the few attempts trying to eliminate wastes in the MRD.

A Spanish version for the new ERA-EDTA coding system for primary renal disease.

PubMed

Zurriaga, Óscar; López-Briones, Carmen; Martín Escobar, Eduardo; Saracho-Rotaeche, Ramón; Moina Eguren, Íñigo; Pallardó Mateu, Luis; Abad Díez, José María; Sánchez Miret, José Ignacio

2015-01-01

The European Renal Association and the European Dialysis and Transplant Association (ERA-EDTA) have issued an English-language new coding system for primary kidney disease (PKD) aimed at solving the problems that were identified in the list of "Primary renal diagnoses" that has been in use for over 40 years. In the context of Registro Español de Enfermos Renales (Spanish Registry of Renal Patients, [REER]), the need for a translation and adaptation of terms, definitions and notes for the new ERA-EDTA codes was perceived in order to help those who have Spanish as their working language when using such codes. Bilingual nephrologists contributed a professional translation and were involved in a terminological adaptation process, which included a number of phases to contrast translation outputs. Codes, paragraphs, definitions and diagnostic criteria were reviewed and agreements and disagreements aroused for each term were labelled. Finally, the version that was accepted by a majority of reviewers was agreed. A wide agreement was reached in the first review phase, with only 5 points of discrepancy remaining, which were agreed on in the final phase. Translation and adaptation into Spanish represent an improvement that will help to introduce and use the new coding system for PKD, as it can help reducing the time devoted to coding and also the period of adaptation of health workers to the new codes. Copyright © 2015 The Authors. Published by Elsevier España, S.L.U. All rights reserved.

Modification and Validation of Conceptual Design Aerodynamic Prediction Method HASC95 With VTXCHN

NASA Technical Reports Server (NTRS)

Albright, Alan E.; Dixon, Charles J.; Hegedus, Martin C.

1996-01-01

A conceptual/preliminary design level subsonic aerodynamic prediction code HASC (High Angle of Attack Stability and Control) has been improved in several areas, validated, and documented. The improved code includes improved methodologies for increased accuracy and robustness, and simplified input/output files. An engineering method called VTXCHN (Vortex Chine) for prediciting nose vortex shedding from circular and non-circular forebodies with sharp chine edges has been improved and integrated into the HASC code. This report contains a summary of modifications, description of the code, user's guide, and validation of HASC. Appendices include discussion of a new HASC utility code, listings of sample input and output files, and a discussion of the application of HASC to buffet analysis.

DCT based interpolation filter for motion compensation in HEVC

NASA Astrophysics Data System (ADS)

Alshin, Alexander; Alshina, Elena; Park, Jeong Hoon; Han, Woo-Jin

2012-10-01

High Efficiency Video Coding (HEVC) draft standard has a challenging goal to improve coding efficiency twice compare to H.264/AVC. Many aspects of the traditional hybrid coding framework were improved during new standard development. Motion compensated prediction, in particular the interpolation filter, is one area that was improved significantly over H.264/AVC. This paper presents the details of the interpolation filter design of the draft HEVC standard. The coding efficiency improvements over H.264/AVC interpolation filter is studied and experimental results are presented, which show a 4.0% average bitrate reduction for Luma component and 11.3% average bitrate reduction for Chroma component. The coding efficiency gains are significant for some video sequences and can reach up 21.7%.

ATLAS offline software performance monitoring and optimization

NASA Astrophysics Data System (ADS)

Chauhan, N.; Kabra, G.; Kittelmann, T.; Langenberg, R.; Mandrysch, R.; Salzburger, A.; Seuster, R.; Ritsch, E.; Stewart, G.; van Eldik, N.; Vitillo, R.; Atlas Collaboration

2014-06-01

In a complex multi-developer, multi-package software environment, such as the ATLAS offline framework Athena, tracking the performance of the code can be a non-trivial task in itself. In this paper we describe improvements in the instrumentation of ATLAS offline software that have given considerable insight into the performance of the code and helped to guide the optimization work. The first tool we used to instrument the code is PAPI, which is a programing interface for accessing hardware performance counters. PAPI events can count floating point operations, cycles, instructions and cache accesses. Triggering PAPI to start/stop counting for each algorithm and processed event results in a good understanding of the algorithm level performance of ATLAS code. Further data can be obtained using Pin, a dynamic binary instrumentation tool. Pin tools can be used to obtain similar statistics as PAPI, but advantageously without requiring recompilation of the code. Fine grained routine and instruction level instrumentation is also possible. Pin tools can additionally interrogate the arguments to functions, like those in linear algebra libraries, so that a detailed usage profile can be obtained. These tools have characterized the extensive use of vector and matrix operations in ATLAS tracking. Currently, CLHEP is used here, which is not an optimal choice. To help evaluate replacement libraries a testbed has been setup allowing comparison of the performance of different linear algebra libraries (including CLHEP, Eigen and SMatrix/SVector). Results are then presented via the ATLAS Performance Management Board framework, which runs daily with the current development branch of the code and monitors reconstruction and Monte-Carlo jobs. This framework analyses the CPU and memory performance of algorithms and an overview of results are presented on a web page. These tools have provided the insight necessary to plan and implement performance enhancements in ATLAS code by identifying the most common operations, with the call parameters well understood, and allowing improvements to be quantified in detail.

Identification of coding and non-coding mutational hotspots in cancer genomes.

PubMed

Piraino, Scott W; Furney, Simon J

2017-01-05

The identification of mutations that play a causal role in tumour development, so called "driver" mutations, is of critical importance for understanding how cancers form and how they might be treated. Several large cancer sequencing projects have identified genes that are recurrently mutated in cancer patients, suggesting a role in tumourigenesis. While the landscape of coding drivers has been extensively studied and many of the most prominent driver genes are well characterised, comparatively less is known about the role of mutations in the non-coding regions of the genome in cancer development. The continuing fall in genome sequencing costs has resulted in a concomitant increase in the number of cancer whole genome sequences being produced, facilitating systematic interrogation of both the coding and non-coding regions of cancer genomes. To examine the mutational landscapes of tumour genomes we have developed a novel method to identify mutational hotspots in tumour genomes using both mutational data and information on evolutionary conservation. We have applied our methodology to over 1300 whole cancer genomes and show that it identifies prominent coding and non-coding regions that are known or highly suspected to play a role in cancer. Importantly, we applied our method to the entire genome, rather than relying on predefined annotations (e.g. promoter regions) and we highlight recurrently mutated regions that may have resulted from increased exposure to mutational processes rather than selection, some of which have been identified previously as targets of selection. Finally, we implicate several pan-cancer and cancer-specific candidate non-coding regions, which could be involved in tumourigenesis. We have developed a framework to identify mutational hotspots in cancer genomes, which is applicable to the entire genome. This framework identifies known and novel coding and non-coding mutional hotspots and can be used to differentiate candidate driver regions from likely passenger regions susceptible to somatic mutation.

Test code for the assessment and improvement of Reynolds stress models

NASA Technical Reports Server (NTRS)

Rubesin, M. W.; Viegas, J. R.; Vandromme, D.; Minh, H. HA

1987-01-01

An existing two-dimensional, compressible flow, Navier-Stokes computer code, containing a full Reynolds stress turbulence model, was adapted for use as a test bed for assessing and improving turbulence models based on turbulence simulation experiments. To date, the results of using the code in comparison with simulated channel flow and over an oscillating flat plate have shown that the turbulence model used in the code needs improvement for these flows. It is also shown that direct simulation of turbulent flows over a range of Reynolds numbers are needed to guide subsequent improvement of turbulence models.

Validation of asthma recording in the Clinical Practice Research Datalink (CPRD)

PubMed Central

Morales, Daniel R; Mullerova, Hana; Smeeth, Liam; Douglas, Ian J; Quint, Jennifer K

2017-01-01

Objectives The optimal method of identifying people with asthma from electronic health records in primary care is not known. The aim of this study is to determine the positive predictive value (PPV) of different algorithms using clinical codes and prescription data to identify people with asthma in the United Kingdom Clinical Practice Research Datalink (CPRD). Methods 684 participants registered with a general practitioner (GP) practice contributing to CPRD between 1 December 2013 and 30 November 2015 were selected according to one of eight predefined potential asthma identification algorithms. A questionnaire was sent to the GPs to confirm asthma status and provide additional information to support an asthma diagnosis. Two study physicians independently reviewed and adjudicated the questionnaires and additional information to form a gold standard for asthma diagnosis. The PPV was calculated for each algorithm. Results 684 questionnaires were sent, of which 494 (72%) were returned and 475 (69%) were complete and analysed. All five algorithms including a specific Read code indicating asthma or non-specific Read code accompanied by additional conditions performed well. The PPV for asthma diagnosis using only a specific asthma code was 86.4% (95% CI 77.4% to 95.4%). Extra information on asthma medication prescription (PPV 83.3%), evidence of reversibility testing (PPV 86.0%) or a combination of all three selection criteria (PPV 86.4%) did not result in a higher PPV. The algorithm using non-specific asthma codes, information on reversibility testing and respiratory medication use scored highest (PPV 90.7%, 95% CI (82.8% to 98.7%), but had a much lower identifiable population. Algorithms based on asthma symptom codes had low PPVs (43.1% to 57.8%)%). Conclusions People with asthma can be accurately identified from UK primary care records using specific Read codes. The inclusion of spirometry or asthma medications in the algorithm did not clearly improve accuracy. Ethics and dissemination The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number15_257) and the approved protocol was made available to the journal and reviewers during peer review. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority Research Ethics Committee (East Midlands—Derby, REC reference number 05/MRE04/87). The results will be submitted for publication and will be disseminated through research conferences and peer-reviewed journals. PMID:28801439

Case Managers' Perspectives On What They Need To Do Their Job

PubMed Central

Eack, Shaun M.; Greeno, Catherine G.; Christian-Michaels, Stephen; Dennis, Amy; Anderson, Carol M.

2013-01-01

Objective To identify the perceived training needs of case managers working on community support teams in a community mental health center serving a semi-rural/suburban area. Methods Semi-structured interviews were conducted with 18 case managers and 3 supervisors to inquire about areas of training need in case management. Interviews were coded and analyzed for common themes regarding training needs and methods of training improvement. Results Identified training needs called for a hands-on, back to basics approach that included education on the symptoms of severe mental illness, co-morbid substance use problems, and methods of engaging consumers. A mentoring model was proposed as a potential vehicle for disseminating knowledge in these domains. Conclusions Case managers identify significant training needs that would address their basic understanding of severe mental illness. Programs targeting these needs may result in improved outcomes for case managers and the individuals with psychiatric disabilities. PMID:19346211

A novel concatenated code based on the improved SCG-LDPC code for optical transmission systems

NASA Astrophysics Data System (ADS)

Yuan, Jian-guo; Xie, Ya; Wang, Lin; Huang, Sheng; Wang, Yong

2013-01-01

Based on the optimization and improvement for the construction method of systematically constructed Gallager (SCG) (4, k) code, a novel SCG low density parity check (SCG-LDPC)(3969, 3720) code to be suitable for optical transmission systems is constructed. The novel SCG-LDPC (6561,6240) code with code rate of 95.1% is constructed by increasing the length of SCG-LDPC (3969,3720) code, and in a way, the code rate of LDPC codes can better meet the high requirements of optical transmission systems. And then the novel concatenated code is constructed by concatenating SCG-LDPC(6561,6240) code and BCH(127,120) code with code rate of 94.5%. The simulation results and analyses show that the net coding gain (NCG) of BCH(127,120)+SCG-LDPC(6561,6240) concatenated code is respectively 2.28 dB and 0.48 dB more than those of the classic RS(255,239) code and SCG-LDPC(6561,6240) code at the bit error rate (BER) of 10-7.

Work-family balance by women GP specialist trainees in Slovenia: a qualitative study.

PubMed

Petek, Davorina; Gajsek, Tadeja; Petek Ster, Marija

2016-01-28

Women physicians face many challenges while balancing their many roles: doctor, specialist trainee, mother and partner. The most opportune biological time for a woman to start a family coincides with a great deal of demands and requirements at work. In this study we explored the options and capabilities of women GP specialist trainees in coordinating their family and career. This is a phenomenological qualitative research. Ten GP specialist trainees from urban and rural areas were chosen by the purposive sampling technique, and semi-structured in-depth interviews were conducted, recorded, transcribed and analysed by using thematic analysis process. Open coding and the book of codes were formed. Finally, we performed the process of code reduction by identifying the themes, which were compared, interpreted and organised in the highest analytical units--categories. One hundred fifty-five codes were identified in the analysis, which were grouped together into eleven themes. The identified themes are: types, causes and consequences of burdens, work as pleasure and positive attitude toward self, priorities, planning and help, and understanding of superiors, disburdening and changing in specialisation. The themes were grouped into four large categories: burdens, empowerment, coordination and needs for improvement. Women specialist trainees encounter intense burdens at work and home due to numerous demands and requirements during their specialisation training. In addition, there is also the issue of the work-family conflict. There are many consequences regarding burden and strain; however, burnout stands out the most. In contrast, reconciliation of work and family life and needs can be successful. The key element is empowerment of women doctors. The foremost necessary systemic solution is the reinforcement of general practitioners in primary health care and their understanding of the specialisation training scheme with more flexible possibilities for time adaptations of specialist training.

An exploratory study of reiki experiences in women who have cancer.

PubMed

Kirshbaum, Marilynne N; Stead, Maxine; Bartys, Serena

2016-04-02

To explore the perceptions and experiences of reiki for women who have cancer and identify outcome measures for an intervention study. A cross-sectional qualitative study of 10 women who had received reiki after cancer treatment was conducted. Interviews were audiotaped, transcribed and coded using framework analysis. Key themes identified were: limited understanding of reiki prior to receiving any reiki; release of emotional strain during reiki-feelings of a release of energy, a clearing of the mind from cancer, inner peace/relaxation, hope, a sense of being cared for; experience of physical sensations during reiki, such as pain relief and tingling; physical, emotional and cognitive improvements after reiki, such as improved sleep, a sense of calm and peace, reduced depression and improved self-confidence. Findings suggest that reiki could be a beneficial tool in the self-management of quality of life issues for women who have cancer.

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice.

PubMed

Lodge, Keri-Michèle; Milnes, David; Gilbody, Simon M

2011-03-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks.Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice.Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed.Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap.Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities.

Compiling a register of patients with moderate or severe learning disabilities: experience at one United Kingdom general practice

PubMed Central

2011-01-01

Background Identifying patients with learning disabilities within primary care is central to initiatives for improving the health of this population. UK general practitioners (GPs) receive additional income for maintaining registers of patients with learning disabilities as part of the Quality and Outcomes Framework (QOF), and may opt to provide Directed Enhanced Services (DES), which requires practices to maintain registers of patients with moderate or severe learning disabilities and offer them annual health checks. Objectives This paper describes the development of a register of patients with moderate or severe learning disabilities at one UK general practice. Methods A Read code search of one UK general practice's electronic medical records was conducted in order to identify patients with learning disabilities. Confirmation of diagnoses was sought by scrutinising records and GP verification. Cross-referencing with the practice QOF register of patients with learning disabilities of any severity, and the local authority's list of clients with learning disabilities, was performed. Results Of 15 001 patients, 229 (1.5%) were identified by the Read code search as possibly having learning disabilities. Scrutiny of records and GP verification confirmed 64 had learning disabilities and 24 did not, but the presence or absence of learning disability remained unclear in 141 cases. Cross-referencing with the QOF register (n=81) and local authority list (n=49) revealed little overlap. Conclusion Identifying learning disability and assessing its severity are tasks GPs may be unfamiliar with, and relying on Read code searches may result in under-detection. Further research is needed to define optimum strategies for identifying, cross-referencing and validating practice-based registers of patients with learning disabilities. PMID:22479290

National Combustion Code Parallel Performance Enhancements

NASA Technical Reports Server (NTRS)

Quealy, Angela; Benyo, Theresa (Technical Monitor)

2002-01-01

The National Combustion Code (NCC) is being developed by an industry-government team for the design and analysis of combustion systems. The unstructured grid, reacting flow code uses a distributed memory, message passing model for its parallel implementation. The focus of the present effort has been to improve the performance of the NCC code to meet combustor designer requirements for model accuracy and analysis turnaround time. Improving the performance of this code contributes significantly to the overall reduction in time and cost of the combustor design cycle. This report describes recent parallel processing modifications to NCC that have improved the parallel scalability of the code, enabling a two hour turnaround for a 1.3 million element fully reacting combustion simulation on an SGI Origin 2000.

Current and anticipated uses of thermalhydraulic and neutronic codes at PSI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aksan, S.N.; Zimmermann, M.A.; Yadigaroglu, G.

1997-07-01

The thermalhydraulic and/or neutronic codes in use at PSI mainly provide the capability to perform deterministic safety analysis for Swiss NPPs and also serve as analysis tools for experimental facilities for LWR and ALWR simulations. In relation to these applications, physical model development and improvements, and assessment of the codes are also essential components of the activities. In this paper, a brief overview is provided on the thermalhydraulic and/or neutronic codes used for safety analysis of LWRs, at PSI, and also of some experiences and applications with these codes. Based on these experiences, additional assessment needs are indicated, together withmore » some model improvement needs. The future needs that could be used to specify both the development of a new code and also improvement of available codes are summarized.« less

Signatures of selection in tilapia revealed by whole genome resequencing.

PubMed

Xia, Jun Hong; Bai, Zhiyi; Meng, Zining; Zhang, Yong; Wang, Le; Liu, Feng; Jing, Wu; Wan, Zi Yi; Li, Jiale; Lin, Haoran; Yue, Gen Hua

2015-09-16

Natural selection and selective breeding for genetic improvement have left detectable signatures within the genome of a species. Identification of selection signatures is important in evolutionary biology and for detecting genes that facilitate to accelerate genetic improvement. However, selection signatures, including artificial selection and natural selection, have only been identified at the whole genome level in several genetically improved fish species. Tilapia is one of the most important genetically improved fish species in the world. Using next-generation sequencing, we sequenced the genomes of 47 tilapia individuals. We identified a total of 1.43 million high-quality SNPs and found that the LD block sizes ranged from 10-100 kb in tilapia. We detected over a hundred putative selective sweep regions in each line of tilapia. Most selection signatures were located in non-coding regions of the tilapia genome. The Wnt signaling, gonadotropin-releasing hormone receptor and integrin signaling pathways were under positive selection in all improved tilapia lines. Our study provides a genome-wide map of genetic variation and selection footprints in tilapia, which could be important for genetic studies and accelerating genetic improvement of tilapia.

A systematic review of validated methods for identifying transfusion-related ABO incompatibility reactions using administrative and claims data.

PubMed

Carnahan, Ryan M; Kee, Vicki R

2012-01-01

This paper aimed to systematically review algorithms to identify transfusion-related ABO incompatibility reactions in administrative data, with a focus on studies that have examined the validity of the algorithms. A literature search was conducted using PubMed, Iowa Drug Information Service database, and Embase. A Google Scholar search was also conducted because of the difficulty identifying relevant studies. Reviews were conducted by two investigators to identify studies using data sources from the USA or Canada because these data sources were most likely to reflect the coding practices of Mini-Sentinel data sources. One study was found that validated International Classification of Diseases (ICD-9-CM) codes representing transfusion reactions. None of these cases were ABO incompatibility reactions. Several studies consistently used ICD-9-CM code 999.6, which represents ABO incompatibility reactions, and a technical report identified the ICD-10 code for these reactions. One study included the E-code E8760 for mismatched blood in transfusion in the algorithm. Another study reported finding no ABO incompatibility reaction codes in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, which contains data of 2.23 million patients who received transfusions, raising questions about the sensitivity of administrative data for identifying such reactions. Two studies reported perfect specificity, with sensitivity ranging from 21% to 83%, for the code identifying allogeneic red blood cell transfusions in hospitalized patients. There is no information to assess the validity of algorithms to identify transfusion-related ABO incompatibility reactions. Further information on the validity of algorithms to identify transfusions would also be useful. Copyright © 2012 John Wiley & Sons, Ltd.

Evaluation of process excellence tools in improving donor flow management in a tertiary care hospital in South India

PubMed Central

Venugopal, Divya; Rafi, Aboobacker Mohamed; Innah, Susheela Jacob; Puthayath, Bibin T.

2017-01-01

BACKGROUND: Process Excellence is a value based approach and focuses on standardizing work processes by eliminating the non-value added processes, identify process improving methodologies and maximize capacity and expertise of the staff. AIM AND OBJECTIVES: To Evaluate the utility of Process Excellence Tools in improving Donor Flow Management in a Tertiary care Hospital by studying the current state of donor movement within the blood bank and providing recommendations for eliminating the wait times and to improve the process and workflow. MATERIALS AND METHODS: The work was done in two phases; The First Phase comprised of on-site observations with the help of an expert trained in Process Excellence Methodology who observed and documented various aspects of donor flow, donor turn around time, total staff details and operator process flow. The Second Phase comprised of constitution of a Team to analyse the data collected. The analyzed data along with the recommendations were presented before an expert hospital committee and the management. RESULTS: Our analysis put forward our strengths and identified potential problems. Donor wait time was reduced by 50% after lean due to better donor management with reorganization of the infrastructure of the donor area. Receptionist tracking showed that 62% of the total time the staff wastes in walking and 22% in other non-value added activities. Defining Duties for each staff reduced the time spent by them in non-value added activities. Implementation of the token system, generation of unique identification code for donors and bar code labeling of the tubes and bags are among the other recommendations. CONCLUSION: Process Excellence is not a programme; it's a culture that transforms an organization and improves its Quality and Efficiency through new attitudes, elimination of wastes and reduction in costs. PMID:28970681

Evaluation of process excellence tools in improving donor flow management in a tertiary care hospital in South India.

PubMed

Venugopal, Divya; Rafi, Aboobacker Mohamed; Innah, Susheela Jacob; Puthayath, Bibin T

2017-01-01

Process Excellence is a value based approach and focuses on standardizing work processes by eliminating the non-value added processes, identify process improving methodologies and maximize capacity and expertise of the staff. To Evaluate the utility of Process Excellence Tools in improving Donor Flow Management in a Tertiary care Hospital by studying the current state of donor movement within the blood bank and providing recommendations for eliminating the wait times and to improve the process and workflow. The work was done in two phases; The First Phase comprised of on-site observations with the help of an expert trained in Process Excellence Methodology who observed and documented various aspects of donor flow, donor turn around time, total staff details and operator process flow. The Second Phase comprised of constitution of a Team to analyse the data collected. The analyzed data along with the recommendations were presented before an expert hospital committee and the management. Our analysis put forward our strengths and identified potential problems. Donor wait time was reduced by 50% after lean due to better donor management with reorganization of the infrastructure of the donor area. Receptionist tracking showed that 62% of the total time the staff wastes in walking and 22% in other non-value added activities. Defining Duties for each staff reduced the time spent by them in non-value added activities. Implementation of the token system, generation of unique identification code for donors and bar code labeling of the tubes and bags are among the other recommendations. Process Excellence is not a programme; it's a culture that transforms an organization and improves its Quality and Efficiency through new attitudes, elimination of wastes and reduction in costs.

FY17 Status Report on the Initial Development of a Constitutive Model for Grade 91 Steel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Messner, M. C.; Phan, V. -T.; Sham, T. -L.

Grade 91 is a candidate structural material for high temperature advanced reactor applications. Existing ASME Section III, Subsection HB, Subpart B simplified design rules based on elastic analysis are setup as conservative screening tools with the intent to supplement these screening rules with full inelastic analysis when required. The Code provides general guidelines for suitable inelastic models but does not provide constitutive model implementations. This report describes the development of an inelastic constitutive model for Gr. 91 steel aimed at fulfilling the ASME Code requirements and being included into a new Section III Code appendix, HBB-Z. A large database ofmore » over 300 experiments on Gr. 91 was collected and converted to a standard XML form. Five families of Gr. 91 material models were identified in the literature. Of these five, two are potentially suitable for use in the ASME code. These two models were implemented and evaluated against the experimental database. Both models have deficiencies so the report develops a framework for developing and calibrating an improved model. This required creating a new modeling method for representing changes in material rate sensitivity across the full ASME allowable temperature range for Gr. 91 structural components: room temperature to 650° C. On top of this framework for rate sensitivity the report describes calibrating a model for work hardening and softening in the material using genetic algorithm optimization. Future work will focus on improving this trial model by including tension/compression asymmetry observed in experiments and necessary to capture material ratcheting under zero mean stress and by improving the optimization and analysis framework.« less

Performance optimisations for distributed analysis in ALICE

NASA Astrophysics Data System (ADS)

Betev, L.; Gheata, A.; Gheata, M.; Grigoras, C.; Hristov, P.

2014-06-01

Performance is a critical issue in a production system accommodating hundreds of analysis users. Compared to a local session, distributed analysis is exposed to services and network latencies, remote data access and heterogeneous computing infrastructure, creating a more complex performance and efficiency optimization matrix. During the last 2 years, ALICE analysis shifted from a fast development phase to the more mature and stable code. At the same time, the frameworks and tools for deployment, monitoring and management of large productions have evolved considerably too. The ALICE Grid production system is currently used by a fair share of organized and individual user analysis, consuming up to 30% or the available resources and ranging from fully I/O-bound analysis code to CPU intensive correlations or resonances studies. While the intrinsic analysis performance is unlikely to improve by a large factor during the LHC long shutdown (LS1), the overall efficiency of the system has still to be improved by an important factor to satisfy the analysis needs. We have instrumented all analysis jobs with "sensors" collecting comprehensive monitoring information on the job running conditions and performance in order to identify bottlenecks in the data processing flow. This data are collected by the MonALISa-based ALICE Grid monitoring system and are used to steer and improve the job submission and management policy, to identify operational problems in real time and to perform automatic corrective actions. In parallel with an upgrade of our production system we are aiming for low level improvements related to data format, data management and merging of results to allow for a better performing ALICE analysis.

Using a data entry clerk to improve data quality in primary care electronic medical records: a pilot study.

PubMed

Greiver, Michelle; Barnsley, Jan; Aliarzadeh, Babak; Krueger, Paul; Moineddin, Rahim; Butt, Debra A; Dolabchian, Edita; Jaakkimainen, Liisa; Keshavjee, Karim; White, David; Kaplan, David

2011-01-01

The quality of electronic medical record (EMR) data is known to be problematic; research on improving these data is needed. The primary objective was to explore the impact of using a data entry clerk to improve data quality in primary care EMRs. The secondary objective was to evaluate the feasibility of implementing this intervention. We used a before and after design for this pilot study. The participants were 13 community based family physicians and four allied health professionals in Toronto, Canada. Using queries programmed by a data manager, a data clerk was tasked with re-entering EMR information as coded or structured data for chronic obstructive pulmonary disease (COPD), smoking, specialist designations and interprofessional encounter headers. We measured data quality before and three to six months after the intervention. We evaluated feasibility by measuring acceptability to clinicians and workload for the clerk. After the intervention, coded COPD entries increased by 38% (P = 0.0001, 95% CI 23 to 51%); identifiable data on smoking categories increased by 27% (P = 0.0001, 95% CI 26 to 29%); referrals with specialist designations increased by 20% (P = 0.0001, 95% CI 16 to 22%); and identifiable interprofessional headers increased by 10% (P = 0.45, 95 CI -3 to 23%). Overall, the intervention was rated as being at least moderately useful and moderately usable. The data entry clerk spent 127 hours restructuring data for 11 729 patients. Utilising a data manager for queries and a data clerk to re-enter data led to improvements in EMR data quality. Clinicians found this approach to be acceptable.

Validation of suicide and self-harm records in the Clinical Practice Research Datalink

PubMed Central

Thomas, Kyla H; Davies, Neil; Metcalfe, Chris; Windmeijer, Frank; Martin, Richard M; Gunnell, David

2013-01-01

Aims The UK Clinical Practice Research Datalink (CPRD) is increasingly being used to investigate suicide-related adverse drug reactions. No studies have comprehensively validated the recording of suicide and nonfatal self-harm in the CPRD. We validated general practitioners' recording of these outcomes using linked Office for National Statistics (ONS) mortality and Hospital Episode Statistics (HES) admission data. Methods We identified cases of suicide and self-harm recorded using appropriate Read codes in the CPRD between 1998 and 2010 in patients aged ≥15 years. Suicides were defined as patients with Read codes for suicide recorded within 95 days of their death. International Classification of Diseases codes were used to identify suicides/hospital admissions for self-harm in the linked ONS and HES data sets. We compared CPRD-derived cases/incidence of suicide and self-harm with those identified from linked ONS mortality and HES data, national suicide incidence rates and published self-harm incidence data. Results Only 26.1% (n = 590) of the ‘true’ (ONS-confirmed) suicides were identified using Read codes. Furthermore, only 55.5% of Read code-identified suicides were confirmed as suicide by the ONS data. Of the HES-identified cases of self-harm, 68.4% were identified in the CPRD using Read codes. The CPRD self-harm rates based on Read codes had similar age and sex distributions to rates observed in self-harm hospital registers, although rates were underestimated in all age groups. Conclusions The CPRD recording of suicide using Read codes is unreliable, with significant inaccuracy (over- and under-reporting). Future CPRD suicide studies should use linked ONS mortality data. The under-reporting of self-harm appears to be less marked. PMID:23216533

Internationalizing professional codes in engineering.

PubMed

Harris, Charles E

2004-07-01

Professional engineering societies which are based in the United States, such as the American Society of Mechanical Engineers (ASME, now ASME International) are recognizing that their codes of ethics must apply to engineers working throughout the world. An examination of the ethical code of the ASME International shows that its provisions pose many problems of application, especially in societies outside the United States. In applying the codes effectively in the international environment, two principal issues must be addressed. First, some Culture Transcending Guidelines must be identified and justified. Nine such guidelines are identified Second, some methods for applying the codes to particular situations must be identified Three such methods are specification, balancing, and finding a creative middle way.

Identifying complications of interventional procedures from UK routine healthcare databases: a systematic search for methods using clinical codes.

PubMed

Keltie, Kim; Cole, Helen; Arber, Mick; Patrick, Hannah; Powell, John; Campbell, Bruce; Sims, Andrew

2014-11-28

Several authors have developed and applied methods to routine data sets to identify the nature and rate of complications following interventional procedures. But, to date, there has been no systematic search for such methods. The objective of this article was to find, classify and appraise published methods, based on analysis of clinical codes, which used routine healthcare databases in a United Kingdom setting to identify complications resulting from interventional procedures. A literature search strategy was developed to identify published studies that referred, in the title or abstract, to the name or acronym of a known routine healthcare database and to complications from procedures or devices. The following data sources were searched in February and March 2013: Cochrane Methods Register, Conference Proceedings Citation Index - Science, Econlit, EMBASE, Health Management Information Consortium, Health Technology Assessment database, MathSciNet, MEDLINE, MEDLINE in-process, OAIster, OpenGrey, Science Citation Index Expanded and ScienceDirect. Of the eligible papers, those which reported methods using clinical coding were classified and summarised in tabular form using the following headings: routine healthcare database; medical speciality; method for identifying complications; length of follow-up; method of recording comorbidity. The benefits and limitations of each approach were assessed. From 3688 papers identified from the literature search, 44 reported the use of clinical codes to identify complications, from which four distinct methods were identified: 1) searching the index admission for specified clinical codes, 2) searching a sequence of admissions for specified clinical codes, 3) searching for specified clinical codes for complications from procedures and devices within the International Classification of Diseases 10th revision (ICD-10) coding scheme which is the methodology recommended by NHS Classification Service, and 4) conducting manual clinical review of diagnostic and procedure codes. The four distinct methods identifying complication from codified data offer great potential in generating new evidence on the quality and safety of new procedures using routine data. However the most robust method, using the methodology recommended by the NHS Classification Service, was the least frequently used, highlighting that much valuable observational data is being ignored.

Network perturbation by recurrent regulatory variants in cancer

PubMed Central

Cho, Ara; Lee, Insuk; Choi, Jung Kyoon

2017-01-01

Cancer driving genes have been identified as recurrently affected by variants that alter protein-coding sequences. However, a majority of cancer variants arise in noncoding regions, and some of them are thought to play a critical role through transcriptional perturbation. Here we identified putative transcriptional driver genes based on combinatorial variant recurrence in cis-regulatory regions. The identified genes showed high connectivity in the cancer type-specific transcription regulatory network, with high outdegree and many downstream genes, highlighting their causative role during tumorigenesis. In the protein interactome, the identified transcriptional drivers were not as highly connected as coding driver genes but appeared to form a network module centered on the coding drivers. The coding and regulatory variants associated via these interactions between the coding and transcriptional drivers showed exclusive and complementary occurrence patterns across tumor samples. Transcriptional cancer drivers may act through an extensive perturbation of the regulatory network and by altering protein network modules through interactions with coding driver genes. PMID:28333928

Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

PubMed

Rowe, Christopher; Vittinghoff, Eric; Santos, Glenn-Milo; Behar, Emily; Turner, Caitlin; Coffin, Phillip O

2017-04-01

Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and specificity of 99.9% (95% CI = 99.8% to 100.0%). Expanding the ICD-9-CM codes to include both nonspecified and general (i.e., without a decimal modifier) drug poisoning and drug abuse codes identified overdose ED visits with a sensitivity of 56.8% (95% CI = 43.6%-72.7%) and specificity of 96.2% (95% CI = 94.8%-97.2%). Additional ICD-9-CM codes not explicitly relevant to opioid overdose were necessary to further enhance sensitivity. Among the 44 overdose ED visits, neither naloxone administration during the visit, whether the patient responded to the naloxone, nor the specific opioids involved were associated with the assignment of an opioid poisoning ICD-9-CM code (p ≥ 0.05). Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies. © 2016 by the Society for Academic Emergency Medicine.

A code-aided carrier synchronization algorithm based on improved nonbinary low-density parity-check codes

NASA Astrophysics Data System (ADS)

Bai, Cheng-lin; Cheng, Zhi-hui

2016-09-01

In order to further improve the carrier synchronization estimation range and accuracy at low signal-to-noise ratio ( SNR), this paper proposes a code-aided carrier synchronization algorithm based on improved nonbinary low-density parity-check (NB-LDPC) codes to study the polarization-division-multiplexing coherent optical orthogonal frequency division multiplexing (PDM-CO-OFDM) system performance in the cases of quadrature phase shift keying (QPSK) and 16 quadrature amplitude modulation (16-QAM) modes. The simulation results indicate that this algorithm can enlarge frequency and phase offset estimation ranges and enhance accuracy of the system greatly, and the bit error rate ( BER) performance of the system is improved effectively compared with that of the system employing traditional NB-LDPC code-aided carrier synchronization algorithm.

Probability Quantization for Multiplication-Free Binary Arithmetic Coding

NASA Technical Reports Server (NTRS)

Cheung, K. -M.

1995-01-01

A method has been developed to improve on Witten's binary arithmetic coding procedure of tracking a high value and a low value. The new method approximates the probability of the less probable symbol, which improves the worst-case coding efficiency.

A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study.

PubMed

McGovern, Andrew Peter; Woodman, Jenny; Allister, Janice; van Vlymen, Jeremy; Liyanage, Harshana; Jones, Simon; Rafi, Imran; de Lusignan, Simon; Gilbert, Ruth

2015-01-14

Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records. Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording. Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern. We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation. This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing.

Accuracy of clinical coding from 1210 appendicectomies in a British district general hospital.

PubMed

Bhangu, Aneel; Nepogodiev, Dmitri; Taylor, Caroline; Durkin, Natalie; Patel, Rajan

2012-01-01

The primary aim of this study was to assess the accuracy of clinical coding in identifying negative appendicectomies. The secondary aim was to analyse trends over time in rates of simple, complex (gangrenous or perforated) and negative appendicectomies. Retrospective review of 1210 patients undergoing emergency appendicectomy during a five year period (2006-2010). Histopathology reports were taken as gold standard for diagnosis and compared to clinical coding lists. Clinical coding is the process by which non-medical administrators apply standardised diagnostic codes to patients, based upon clinical notes at discharge. These codes then contribute to national databases. Statistical analysis included correlation studies and regression analyses. Clinical coding had only moderate correlation with histopathology, with an overall kappa of 0.421. Annual kappa values varied between 0.378 and 0.500. Overall 14% of patients were incorrectly coded as having had appendicitis when in fact they had a histopathologically normal appendix (153/1107), whereas 4% were falsely coded as having received a negative appendicectomy when they had appendicitis (48/1107). There was an overall significant fall and then rise in the rate of simple appendicitis (B coefficient -0.239 (95% confidence interval -0.426, -0.051), p = 0.014) but no change in the rate of complex appendicitis (B coefficient 0.008 (-0.015, 0.031), p = 0.476). Clinical coding for negative appendicectomy was unreliable. Negative rates may be higher than suspected. This has implications for the validity of national database analyses. Using this form of data as a quality indictor for appendicitis should be reconsidered until its quality is improved. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Improvements in the MGA Code Provide Flexibility and Better Error Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ruhter, W D; Kerr, J

2005-05-26

The Multi-Group Analysis (MGA) code is widely used to determine nondestructively the relative isotopic abundances of plutonium by gamma-ray spectrometry. MGA users have expressed concern about the lack of flexibility and transparency in the code. Users often have to ask the code developers for modifications to the code to accommodate new measurement situations, such as additional peaks being present in the plutonium spectrum or expected peaks being absent. We are testing several new improvements to a prototype, general gamma-ray isotopic analysis tool with the intent of either revising or replacing the MGA code. These improvements will give the user themore » ability to modify, add, or delete the gamma- and x-ray energies and branching intensities used by the code in determining a more precise gain and in the determination of the relative detection efficiency. We have also fully integrated the determination of the relative isotopic abundances with the determination of the relative detection efficiency to provide a more accurate determination of the errors in the relative isotopic abundances. We provide details in this paper on these improvements and a comparison of results obtained with current versions of the MGA code.« less

Incorporating the Last Four Digits of Social Security Numbers Substantially Improves Linking Patient Data from De-identified Hospital Claims Databases

PubMed Central

Naessens, James M; Visscher, Sue L; Peterson, Stephanie M; Swanson, Kristi M; Johnson, Matthew G; Rahman, Parvez A; Schindler, Joe; Sonneborn, Mark; Fry, Donald E; Pine, Michael

2015-01-01

Objective Assess algorithms for linking patients across de-identified databases without compromising confidentiality. Data Sources/Study Setting Hospital discharges from 11 Mayo Clinic hospitals during January 2008–September 2012 (assessment and validation data). Minnesota death certificates and hospital discharges from 2009 to 2012 for entire state (application data). Study Design Cross-sectional assessment of sensitivity and positive predictive value (PPV) for four linking algorithms tested by identifying readmissions and posthospital mortality on the assessment data with application to statewide data. Data Collection/Extraction Methods De-identified claims included patient gender, birthdate, and zip code. Assessment records were matched with institutional sources containing unique identifiers and the last four digits of Social Security number (SSNL4). Principal Findings Gender, birthdate, and five-digit zip code identified readmissions with a sensitivity of 98.0 percent and a PPV of 97.7 percent and identified postdischarge mortality with 84.4 percent sensitivity and 98.9 percent PPV. Inclusion of SSNL4 produced nearly perfect identification of readmissions and deaths. When applied statewide, regions bordering states with unavailable hospital discharge data had lower rates. Conclusion Addition of SSNL4 to administrative data, accompanied by appropriate data use and data release policies, can enable trusted repositories to link data with nearly perfect accuracy without compromising patient confidentiality. States maintaining centralized de-identified databases should add SSNL4 to data specifications. PMID:26073819

ICD-10 codes used to identify adverse drug events in administrative data: a systematic review.

PubMed

Hohl, Corinne M; Karpov, Andrei; Reddekopp, Lisa; Doyle-Waters, Mimi; Stausberg, Jürgen

2014-01-01

Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events. We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner. Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156-289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0-59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set. Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area.

ICD-10 codes used to identify adverse drug events in administrative data: a systematic review

PubMed Central

Hohl, Corinne M; Karpov, Andrei; Reddekopp, Lisa; Stausberg, Jürgen

2014-01-01

Background Adverse drug events, the unintended and harmful effects of medications, are important outcome measures in health services research. Yet no universally accepted set of International Classification of Diseases (ICD) revision 10 codes or coding algorithms exists to ensure their consistent identification in administrative data. Our objective was to synthesize a comprehensive set of ICD-10 codes used to identify adverse drug events. Methods We developed a systematic search strategy and applied it to five electronic reference databases. We searched relevant medical journals, conference proceedings, electronic grey literature and bibliographies of relevant studies, and contacted content experts for unpublished studies. One author reviewed the titles and abstracts for inclusion and exclusion criteria. Two authors reviewed eligible full-text articles and abstracted data in duplicate. Data were synthesized in a qualitative manner. Results Of 4241 titles identified, 41 were included. We found a total of 827 ICD-10 codes that have been used in the medical literature to identify adverse drug events. The median number of codes used to search for adverse drug events was 190 (IQR 156–289) with a large degree of variability between studies in the numbers and types of codes used. Authors commonly used external injury (Y40.0–59.9) and disease manifestation codes. Only two papers reported on the sensitivity of their code set. Conclusions Substantial variability exists in the methods used to identify adverse drug events in administrative data. Our work may serve as a point of reference for future research and consensus building in this area. PMID:24222671

77 FR 54663 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

...This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.

Exploring Item Characteristics That Are Related to the Difficulty of TOEFL Dialogue Items. Research Reports. RR-79. RR-04-11

ERIC Educational Resources Information Center

Kostin, Irene

2004-01-01

The purpose of this study is to explore the relationship between a set of item characteristics and the difficulty of TOEFL[R] dialogue items. Identifying characteristics that are related to item difficulty has the potential to improve the efficiency of the item-writing process The study employed 365 TOEFL dialogue items, which were coded on 49…

Enhancing Soundtracks From Old Movies

NASA Technical Reports Server (NTRS)

Frazer, Robert E.

1992-01-01

Proposed system enhances soundtracks of old movies. Signal on optical soundtrack of film digitized and processed to reduce noise and improve quality; timing signals added, and signal recorded on compact disk. Digital comparator and voltage-controlled oscillator synchronizes speed of film-drive motor and compact disk motor. Frame-coded detector reads binary frame-identifying marks on film. Digital comparator generates error signal if marks on film do not match those on compact disk.

A Community-Engaged Research Approach to Improve Mental Health Among Latina Immigrants: ALMA Photovoice.

PubMed

Perez, Georgina; Della Valle, Pamela; Paraghamian, Sarah; Page, Rachel; Ochoa, Janet; Palomo, Fabiana; Suarez, Emilia; Thrasher, Angela; Tran, Anh N; Corbie-Smith, Giselle

2016-05-01

Recent Latina immigrants are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. Existing social and health care policies often do not adequately address the mental health concerns of new Latino populations. Amigas Latinas Motivando el Alma, a community-partnered research project, seeks to improve immigrant Latinas' mental health outcomes. Using Photovoice methodology, promotoras (lay health advisors) reflected on community factors affecting mental health through photography and guided discussion. Discussions were audio-recorded, transcribed, and coded using content analysis to identify salient themes. Promotoras reviewed codes to develop themes that they presented in community forums to reach local policy makers and to increase community awareness. These forums included an exhibit of the promotoras' photographs and discussion of action steps to address community concerns. Themes included transitioning to life in the United States, parenting, education, and combating racism. Nearly 150 stakeholders attended the community forums and proposed responses to promotoras' photographic themes. Our findings suggest that Photovoice provides an opportunity for Latinas and the larger community to identify issues that they find most important and to explore avenues for action and change by creating sustainable partnerships between the community and forum attendees. © 2015 Society for Public Health Education.

Optimization of Particle-in-Cell Codes on RISC Processors

NASA Technical Reports Server (NTRS)

Decyk, Viktor K.; Karmesin, Steve Roy; Boer, Aeint de; Liewer, Paulette C.

1996-01-01

General strategies are developed to optimize particle-cell-codes written in Fortran for RISC processors which are commonly used on massively parallel computers. These strategies include data reorganization to improve cache utilization and code reorganization to improve efficiency of arithmetic pipelines.

Coding algorithms for identifying patients with cirrhosis and hepatitis B or C virus using administrative data.

PubMed

Niu, Bolin; Forde, Kimberly A; Goldberg, David S

2015-01-01

Despite the use of administrative data to perform epidemiological and cost-effectiveness research on patients with hepatitis B or C virus (HBV, HCV), there are no data outside of the Veterans Health Administration validating whether International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes can accurately identify cirrhotic patients with HBV or HCV. The validation of such algorithms is necessary for future epidemiological studies. We evaluated the positive predictive value (PPV) of ICD-9-CM codes for identifying chronic HBV or HCV among cirrhotic patients within the University of Pennsylvania Health System, a large network that includes a tertiary care referral center, a community-based hospital, and multiple outpatient practices across southeastern Pennsylvania and southern New Jersey. We reviewed a random sample of 200 cirrhotic patients with ICD-9-CM codes for HCV and 150 cirrhotic patients with ICD-9-CM codes for HBV. The PPV of 1 inpatient or 2 outpatient HCV codes was 88.0% (168/191, 95% CI: 82.5-92.2%), while the PPV of 1 inpatient or 2 outpatient HBV codes was 81.3% (113/139, 95% CI: 73.8-87.4%). Several variations of the primary coding algorithm were evaluated to determine if different combinations of inpatient and/or outpatient ICD-9-CM codes could increase the PPV of the coding algorithm. ICD-9-CM codes can identify chronic HBV or HCV in cirrhotic patients with a high PPV and can be used in future epidemiologic studies to examine disease burden and the proper allocation of resources. Copyright © 2014 John Wiley & Sons, Ltd.

The Role of Leadership in Safety Performance and Results

NASA Astrophysics Data System (ADS)

Caravello, Halina E.

Employee injury rates in U.S. land-based operations in the energy industry are 2 to 3 times higher relative to other regions in the world. Although a rich literature exists on drivers of safety performance, no previous studies investigated factors influencing this elevated rate. Leadership has been identified as a key contributor to safety outcomes and this grounded theory study drew upon the full range leadership model, situational leadership, and leader-member exchange theories for the conceptual framework. Leadership aspects influencing safety performance were investigated through guided interviews of 27 study participants; data analyses included open and axial coding, and constant comparisons identified higher-level categories. Selective coding integrated categories into the theoretical framework that developed the idealized, transformational leader traits motivating safe behaviors of leading by example, expressing care and concern for employees' well-being, celebrating successes, and communicating the importance of safety (other elements included visibility and commitment). Employee and supervisor participants reported similar views on the idealized leader traits, but low levels of these qualities may be driving elevated injury rates. Identifying these key elements provides the foundation to creating strategies and action plans enabling energy sector companies to prevent employee injuries and fatalities in an industry where tens of thousands of employees are subjected to significant hazards and elevated risks. Creating safer workplaces for U.S. employees by enhancing leaders' skills, building knowledge, and improving behaviors will improve the employees' and their families' lives by reducing the pain and suffering resulting from injuries and fatalities.

Mutant phenotypes for thousands of bacterial genes of unknown function

DOE PAGES

Price, Morgan N.; Wetmore, Kelly M.; Waters, R. Jordan; ...

2018-05-16

One-third of all protein-coding genes from bacterial genomes cannot be annotated with a function. Here, to investigate the functions of these genes, we present genome-wide mutant fitness data from 32 diverse bacteria across dozens of growth conditions. We identified mutant phenotypes for 11,779 protein-coding genes that had not been annotated with a specific function. Many genes could be associated with a specific condition because the gene affected fitness only in that condition, or with another gene in the same bacterium because they had similar mutant phenotypes. Of the poorly annotated genes, 2,316 had associations that have high confidence because theymore » are conserved in other bacteria. By combining these conserved associations with comparative genomics, we identified putative DNA repair proteins; in addition, we propose specific functions for poorly annotated enzymes and transporters and for uncharacterized protein families. Lastly, our study demonstrates the scalability of microbial genetics and its utility for improving gene annotations.« less

Mutant phenotypes for thousands of bacterial genes of unknown function

DOE Office of Scientific and Technical Information (OSTI.GOV)

Price, Morgan N.; Wetmore, Kelly M.; Waters, R. Jordan

One-third of all protein-coding genes from bacterial genomes cannot be annotated with a function. Here, to investigate the functions of these genes, we present genome-wide mutant fitness data from 32 diverse bacteria across dozens of growth conditions. We identified mutant phenotypes for 11,779 protein-coding genes that had not been annotated with a specific function. Many genes could be associated with a specific condition because the gene affected fitness only in that condition, or with another gene in the same bacterium because they had similar mutant phenotypes. Of the poorly annotated genes, 2,316 had associations that have high confidence because theymore » are conserved in other bacteria. By combining these conserved associations with comparative genomics, we identified putative DNA repair proteins; in addition, we propose specific functions for poorly annotated enzymes and transporters and for uncharacterized protein families. Lastly, our study demonstrates the scalability of microbial genetics and its utility for improving gene annotations.« less

Development and validation of an electronic phenotyping algorithm for chronic kidney disease

PubMed Central

Nadkarni, Girish N; Gottesman, Omri; Linneman, James G; Chase, Herbert; Berg, Richard L; Farouk, Samira; Nadukuru, Rajiv; Lotay, Vaneet; Ellis, Steve; Hripcsak, George; Peissig, Peggy; Weng, Chunhua; Bottinger, Erwin P

2014-01-01

Twenty-six million Americans are estimated to have chronic kidney disease (CKD) with increased risk for cardiovascular disease and end stage renal disease. CKD is frequently undiagnosed and patients are unaware, hampering intervention. A tool for accurate and timely identification of CKD from electronic medical records (EMR) could improve healthcare quality and identify patients for research. As members of eMERGE (electronic medical records and genomics) Network, we developed an automated phenotyping algorithm that can be deployed to identify rapidly diabetic and/or hypertensive CKD cases and controls in health systems with EMRs It uses diagnostic codes, laboratory results, medication and blood pressure records, and textual information culled from notes. Validation statistics demonstrated positive predictive values of 96% and negative predictive values of 93.3. Similar results were obtained on implementation by two independent eMERGE member institutions. The algorithm dramatically outperformed identification by ICD-9-CM codes with 63% positive and 54% negative predictive values, respectively. PMID:25954398

Non-coding recurrent mutations in chronic lymphocytic leukaemia.

PubMed

Puente, Xose S; Beà, Silvia; Valdés-Mas, Rafael; Villamor, Neus; Gutiérrez-Abril, Jesús; Martín-Subero, José I; Munar, Marta; Rubio-Pérez, Carlota; Jares, Pedro; Aymerich, Marta; Baumann, Tycho; Beekman, Renée; Belver, Laura; Carrio, Anna; Castellano, Giancarlo; Clot, Guillem; Colado, Enrique; Colomer, Dolors; Costa, Dolors; Delgado, Julio; Enjuanes, Anna; Estivill, Xavier; Ferrando, Adolfo A; Gelpí, Josep L; González, Blanca; González, Santiago; González, Marcos; Gut, Marta; Hernández-Rivas, Jesús M; López-Guerra, Mónica; Martín-García, David; Navarro, Alba; Nicolás, Pilar; Orozco, Modesto; Payer, Ángel R; Pinyol, Magda; Pisano, David G; Puente, Diana A; Queirós, Ana C; Quesada, Víctor; Romeo-Casabona, Carlos M; Royo, Cristina; Royo, Romina; Rozman, María; Russiñol, Nuria; Salaverría, Itziar; Stamatopoulos, Kostas; Stunnenberg, Hendrik G; Tamborero, David; Terol, María J; Valencia, Alfonso; López-Bigas, Nuria; Torrents, David; Gut, Ivo; López-Guillermo, Armando; López-Otín, Carlos; Campo, Elías

2015-10-22

Chronic lymphocytic leukaemia (CLL) is a frequent disease in which the genetic alterations determining the clinicobiological behaviour are not fully understood. Here we describe a comprehensive evaluation of the genomic landscape of 452 CLL cases and 54 patients with monoclonal B-lymphocytosis, a precursor disorder. We extend the number of CLL driver alterations, including changes in ZNF292, ZMYM3, ARID1A and PTPN11. We also identify novel recurrent mutations in non-coding regions, including the 3' region of NOTCH1, which cause aberrant splicing events, increase NOTCH1 activity and result in a more aggressive disease. In addition, mutations in an enhancer located on chromosome 9p13 result in reduced expression of the B-cell-specific transcription factor PAX5. The accumulative number of driver alterations (0 to ≥4) discriminated between patients with differences in clinical behaviour. This study provides an integrated portrait of the CLL genomic landscape, identifies new recurrent driver mutations of the disease, and suggests clinical interventions that may improve the management of this neoplasia.

Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care.

PubMed

Mazul, Mary C; Salm Ward, Trina C; Ngui, Emmanuel M

2017-02-01

Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women's perspectives on barriers and facilitators to receiving PNC in an urban setting. We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes. Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support. Findings suggest important components in an ideal PNC model to engage low-income African-American women.

Deep intronic GPR143 mutation in a Japanese family with ocular albinism

PubMed Central

Naruto, Takuya; Okamoto, Nobuhiko; Masuda, Kiyoshi; Endo, Takao; Hatsukawa, Yoshikazu; Kohmoto, Tomohiro; Imoto, Issei

2015-01-01

Deep intronic mutations are often ignored as possible causes of human disease. Using whole-exome sequencing, we analysed genomic DNAs of a Japanese family with two male siblings affected by ocular albinism and congenital nystagmus. Although mutations or copy number alterations of coding regions were not identified in candidate genes, the novel intronic mutation c.659-131 T > G within GPR143 intron 5 was identified as hemizygous in affected siblings and as heterozygous in the unaffected mother. This mutation was predicted to create a cryptic splice donor site within intron 5 and activate a cryptic acceptor site at 41nt upstream, causing the insertion into the coding sequence of an out-of-frame 41-bp pseudoexon with a premature stop codon in the aberrant transcript, which was confirmed by minigene experiments. This result expands the mutational spectrum of GPR143 and suggests the utility of next-generation sequencing integrated with in silico and experimental analyses for improving the molecular diagnosis of this disease. PMID:26061757

Deep intronic GPR143 mutation in a Japanese family with ocular albinism.

PubMed

Naruto, Takuya; Okamoto, Nobuhiko; Masuda, Kiyoshi; Endo, Takao; Hatsukawa, Yoshikazu; Kohmoto, Tomohiro; Imoto, Issei

2015-06-10

Deep intronic mutations are often ignored as possible causes of human disease. Using whole-exome sequencing, we analysed genomic DNAs of a Japanese family with two male siblings affected by ocular albinism and congenital nystagmus. Although mutations or copy number alterations of coding regions were not identified in candidate genes, the novel intronic mutation c.659-131 T > G within GPR143 intron 5 was identified as hemizygous in affected siblings and as heterozygous in the unaffected mother. This mutation was predicted to create a cryptic splice donor site within intron 5 and activate a cryptic acceptor site at 41nt upstream, causing the insertion into the coding sequence of an out-of-frame 41-bp pseudoexon with a premature stop codon in the aberrant transcript, which was confirmed by minigene experiments. This result expands the mutational spectrum of GPR143 and suggests the utility of next-generation sequencing integrated with in silico and experimental analyses for improving the molecular diagnosis of this disease.

Software analysis handbook: Software complexity analysis and software reliability estimation and prediction

NASA Technical Reports Server (NTRS)

Lee, Alice T.; Gunn, Todd; Pham, Tuan; Ricaldi, Ron

1994-01-01

This handbook documents the three software analysis processes the Space Station Software Analysis team uses to assess space station software, including their backgrounds, theories, tools, and analysis procedures. Potential applications of these analysis results are also presented. The first section describes how software complexity analysis provides quantitative information on code, such as code structure and risk areas, throughout the software life cycle. Software complexity analysis allows an analyst to understand the software structure, identify critical software components, assess risk areas within a software system, identify testing deficiencies, and recommend program improvements. Performing this type of analysis during the early design phases of software development can positively affect the process, and may prevent later, much larger, difficulties. The second section describes how software reliability estimation and prediction analysis, or software reliability, provides a quantitative means to measure the probability of failure-free operation of a computer program, and describes the two tools used by JSC to determine failure rates and design tradeoffs between reliability, costs, performance, and schedule.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

PubMed Central

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N.

2018-01-01

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access. PMID:29552599

Barriers and benefits to using mobile health technology after operation: A qualitative study.

PubMed

Abelson, Jonathan S; Kaufman, Elinore; Symer, Matthew; Peters, Alexander; Charlson, Mary; Yeo, Heather

2017-09-01

Recently, mobile health technology has emerged as a promising avenue for improving physician-patient communication and patient outcomes. The objective of our study was to determine the public's perception of barriers and benefits to using mobile health technology technologies to enhance recovery after operation. We used the Empire State Poll to ask 2 open-ended questions to 800 participants assessing their perceptions of benefits and barriers to use mobile health technology after operation. All responses were coded independently, and any discrepancies were resolved by consensus. We used grounded theory to allow themes to arise from the codes. Interrater reliability was calculated using Cohen's Kappa. Participants identified a range of possible barriers to using mobile health technology apps after operation including: protecting personal health information, technology effectiveness and failure, preference for face-to-face interaction with their surgeon, level of effort required, and ability of the older adults to navigate mobile health technology. Participants identified multiple possible benefits including: better monitoring, improved communication with their surgeon, minimizing follow-up visits, improved convenience, and increased patient knowledge. In the study, 15% of all respondents stated there were no barriers whereas 6% stated there were no benefits. Participants were receptive to the many potential benefits of this technology to enhance not only their relationships with providers and the convenience of access, but also their health outcomes. We must address participants concerns about data security and their fears of losing a personal relationship with their doctor. Copyright © 2017 Elsevier Inc. All rights reserved.

Ontario's emergency department process improvement program: the experience of implementation.

PubMed

Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

2015-06-01

In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful. © 2015 by the Society for Academic Emergency Medicine.

Evaluation of three coding schemes designed for improved data communication

NASA Technical Reports Server (NTRS)

Snelsire, R. W.

1974-01-01

Three coding schemes designed for improved data communication are evaluated. Four block codes are evaluated relative to a quality function, which is a function of both the amount of data rejected and the error rate. The Viterbi maximum likelihood decoding algorithm as a decoding procedure is reviewed. This evaluation is obtained by simulating the system on a digital computer. Short constraint length rate 1/2 quick-look codes are studied, and their performance is compared to general nonsystematic codes.

Automatic Data Traffic Control on DSM Architecture

NASA Technical Reports Server (NTRS)

Frumkin, Michael; Jin, Hao-Qiang; Yan, Jerry; Kwak, Dochan (Technical Monitor)

2000-01-01

We study data traffic on distributed shared memory machines and conclude that data placement and grouping improve performance of scientific codes. We present several methods which user can employ to improve data traffic in his code. We report on implementation of a tool which detects the code fragments causing data congestions and advises user on improvements of data routing in these fragments. The capabilities of the tool include deduction of data alignment and affinity from the source code; detection of the code constructs having abnormally high cache or TLB misses; generation of data placement constructs. We demonstrate the capabilities of the tool on experiments with NAS parallel benchmarks and with a simple computational fluid dynamics application ARC3D.

OPAD-EDIFIS Real-Time Processing

NASA Technical Reports Server (NTRS)

Katsinis, Constantine

1997-01-01

The Optical Plume Anomaly Detection (OPAD) detects engine hardware degradation of flight vehicles through identification and quantification of elemental species found in the plume by analyzing the plume emission spectra in a real-time mode. Real-time performance of OPAD relies on extensive software which must report metal amounts in the plume faster than once every 0.5 sec. OPAD software previously written by NASA scientists performed most necessary functions at speeds which were far below what is needed for real-time operation. The research presented in this report improved the execution speed of the software by optimizing the code without changing the algorithms and converting it into a parallelized form which is executed in a shared-memory multiprocessor system. The resulting code was subjected to extensive timing analysis. The report also provides suggestions for further performance improvement by (1) identifying areas of algorithm optimization, (2) recommending commercially available multiprocessor architectures and operating systems to support real-time execution and (3) presenting an initial study of fault-tolerance requirements.

Update to the NASA Lewis Ice Accretion Code LEWICE

NASA Technical Reports Server (NTRS)

Wright, William B.

1994-01-01

This report is intended as an update to NASA CR-185129 'User's Manual for the NASA Lewis Ice Accretion Prediction Code (LEWICE).' It describes modifications and improvements made to this code as well as changes to the input and output files, interactive input, and graphics output. The comparison of this code to experimental data is shown to have improved as a result of these modifications.

Predictors and Outcomes of Mealtime Emotional Climate in Families With Preschoolers.

PubMed

Saltzman, Jaclyn A; Bost, Kelly K; Musaad, Salma M A; Fiese, Barbara H; Wiley, Angela R

2018-03-01

Mealtime emotional climate (MEC) is related to parent feeding and mental health, and possibly to child food consumption. However, MEC has been inconsistently assessed with a variety of coding schemes and self-report instruments, and has not been examined longitudinally. This study aims to characterize MEC systematically using an observational, count-based coding scheme; identify whether parent feeding or mental health predict MEC; and examine whether MEC predicts child food consumption and weight. A subsample of parents (n = 74) recruited from a larger study completed questionnaires when children were about 37 months, participated in a home visit to videotape a mealtime when children were about 41 months, and completed questionnaires again when children were about 51 months old. Maternal and child positive and negative emotions were coded from videotaped mealtimes. Observational data were submitted to cluster analyses, to identify dyads with similar emotion expression patterns, or MEC. Logistic regression was used to identify predictors of MEC, and Analysis of Covariance was used to examine differences between MEC groups. Dyads were characterized as either Positive Expressers (high positive, low negative emotion) or All Expressers (similar positive and negative emotion). Increased food involvement feeding practices were related to decreased likelihood of being an All Expresser. Positive Expressers reported that their children ate more healthy food, compared with All Expressers. Observed MEC is driven by maternal emotion, and may predict child food consumption. Food involvement may promote positive MEC. Improving MEC may increase child consumption of healthy foods.

Graduate medical education competencies for international health electives: A qualitative study.

PubMed

Nordhues, Hannah C; Bashir, M Usmaan; Merry, Stephen P; Sawatsky, Adam P

2017-11-01

Residency programs offer international health electives (IHEs), providing multiple educational benefits. This study aimed to identify how IHEs fulfill the Accreditation Council for Graduate Medical Education (ACGME) core competencies. We conducted a thematic analysis of post-rotation reflective reports from residents who participated in IHEs through the Mayo International Health Program. We coded reports using a codebook created from the ACGME competencies. Using a constant comparative method, we identified significant themes within each competency. Residents from 40 specialties participated in 377 IHEs in 56 countries from 2001 to 2014. Multiple themes were identified within each of the six ACGME core competencies: Patient Care and Procedural Skills (4), Medical Knowledge (5), Practice-Based Learning and Improvement (3), Interpersonal and Communication Skills (5), Professionalism (4), and Systems-Based Practice and Improvement (3). Themes included improving physical exam and procedural skills, providing care in resource-limited setting, gaining knowledge of tropical and non-tropical diseases, identifying socioeconomic determinants of health, engaging in the education of others, and increasing communication across cultures and multidisciplinary teams. Through IHEs, residents advanced their knowledge, skills, and attitudes in each of the six ACGME competencies. These data can be used for development of IHE competencies and milestones for resident assessment.

Coding pulmonary sepsis and mortality statistics in Rio de Janeiro, RJ.

PubMed

Cardoso, Bruno Baptista; Kale, Pauline Lorena

2016-01-01

This study aimed to describe "pulmonary sepsis" reported as a cause of death, measure its association to pneumonia, and the significance of the coding rules in mortality statistics, including the diagnosis of pneumonia on death certificates (DC) with the mention of pulmonary sepsis in Rio de Janeiro, Brazil, in 2011. DC with mention of pulmonary sepsis was identified, regardless of the underlying cause of death. Medical records related to the certificates with reference to "pulmonary sepsis" were reviewed and physicians were interviewed to measure the association between pulmonary sepsis and pneumonia. A simulation was performed in the mortality data by inserting the International Classification of Diseases (ICD-10) code for pneumonia in the certificates with pulmonary sepsis. "Pulmonary sepsis" constituted 30.9% of reported sepsis and pneumonia was not reported in 51.3% of these DC. Pneumonia was registered in 82.8% of the sample of the medical records. Among physicians interviewed, 93.3% declared pneumonia as the most common cause of "pulmonary sepsis." The simulation of the coding process resulted in a different underlying cause of death for 7.8% of the deaths with sepsis reported and 2.4% of all deaths, regardless the original cause. The conclusion is that "pulmonary sepsis" is frequently associated to pneumonia and that the addition of the ICD-10 code for pneumonia in DC could affect the mortality statistics, highlighting the need to improve mortality coding rules.

Simplex-stochastic collocation method with improved scalability

NASA Astrophysics Data System (ADS)

Edeling, W. N.; Dwight, R. P.; Cinnella, P.

2016-04-01

The Simplex-Stochastic Collocation (SSC) method is a robust tool used to propagate uncertain input distributions through a computer code. However, it becomes prohibitively expensive for problems with dimensions higher than 5. The main purpose of this paper is to identify bottlenecks, and to improve upon this bad scalability. In order to do so, we propose an alternative interpolation stencil technique based upon the Set-Covering problem, and we integrate the SSC method in the High-Dimensional Model-Reduction framework. In addition, we address the issue of ill-conditioned sample matrices, and we present an analytical map to facilitate uniformly-distributed simplex sampling.

Privacy Protection Versus Cluster Detection in Spatial Epidemiology

PubMed Central

Olson, Karen L.; Grannis, Shaun J.; Mandl, Kenneth D.

2006-01-01

Objectives. Patient data that includes precise locations can reveal patients’ identities, whereas data aggregated into administrative regions may preserve privacy and confidentiality. We investigated the effect of varying degrees of address precision (exact latitude and longitude vs the center points of zip code or census tracts) on detection of spatial clusters of cases. Methods. We simulated disease outbreaks by adding supplementary spatially clustered emergency department visits to authentic hospital emergency department syndromic surveillance data. We identified clusters with a spatial scan statistic and evaluated detection rate and accuracy. Results. More clusters were identified, and clusters were more accurately detected, when exact locations were used. That is, these clusters contained at least half of the simulated points and involved few additional emergency department visits. These results were especially apparent when the synthetic clustered points crossed administrative boundaries and fell into multiple zip code or census tracts. Conclusions. The spatial cluster detection algorithm performed better when addresses were analyzed as exact locations than when they were analyzed as center points of zip code or census tracts, particularly when the clustered points crossed administrative boundaries. Use of precise addresses offers improved performance, but this practice must be weighed against privacy concerns in the establishment of public health data exchange policies. PMID:17018828

Patient or treatment centre? Where are efforts invested to improve cancer patients' psychosocial outcomes?

PubMed Central

Carey, ML; Clinton-McHarg, T; Sanson-Fisher, RW; Campbell, S; Douglas, HE

2011-01-01

The psychosocial outcomes of cancer patients may be influenced by individual-level, social and treatment centre predictors. This paper aimed to examine the extent to which individual, social and treatment centre variables have been examined as predictors or targets of intervention for psychosocial outcomes of cancer patients. Medline was searched to find studies in which the psychological outcomes of cancer patient were primary variables. Papers published in English between 1999 and 2009 that reported primary data relevant to psychosocial outcomes for cancer patients were included, with 20% randomly selected for further coding. Descriptive studies were coded for inclusion of individual, social or treatment centre variables. Intervention studies were coded to determine if the unit of intervention was the individual patient, social unit or treatment centre. After random sampling, 412 publications meeting the inclusion criteria were identified, 169 were descriptive and 243 interventions. Of the descriptive papers 95.0% included individual predictors, and 5.0% social predictors. None of the descriptive papers examined treatment centre variables as predictors of psychosocial outcomes. Similarly, none of the interventions evaluated the effectiveness of treatment centre interventions for improving psychosocial outcomes. Potential reasons for the overwhelming dominance of individual predictors and individual-focused interventions in psychosocial literature are discussed. PMID:20646035

Genome re-annotation of the wild strawberry Fragaria vesca using extensive Illumina- and SMRT-based RNA-seq datasets

PubMed Central

Li, Yongping; Wei, Wei; Feng, Jia; Luo, Huifeng; Pi, Mengting; Liu, Zhongchi; Kang, Chunying

2018-01-01

Abstract The genome of the wild diploid strawberry species Fragaria vesca, an ideal model system of cultivated strawberry (Fragaria × ananassa, octoploid) and other Rosaceae family crops, was first published in 2011 and followed by a new assembly (Fvb). However, the annotation for Fvb mainly relied on ab initio predictions and included only predicted coding sequences, therefore an improved annotation is highly desirable. Here, a new annotation version named v2.0.a2 was created for the Fvb genome by a pipeline utilizing one PacBio library, 90 Illumina RNA-seq libraries, and 9 small RNA-seq libraries. Altogether, 18,641 genes (55.6% out of 33,538 genes) were augmented with information on the 5′ and/or 3′ UTRs, 13,168 (39.3%) protein-coding genes were modified or newly identified, and 7,370 genes were found to possess alternative isoforms. In addition, 1,938 long non-coding RNAs, 171 miRNAs, and 51,714 small RNA clusters were integrated into the annotation. This new annotation of F. vesca is substantially improved in both accuracy and integrity of gene predictions, beneficial to the gene functional studies in strawberry and to the comparative genomic analysis of other horticultural crops in Rosaceae family. PMID:29036429

Computer-assisted coding and clinical documentation: first things first.

PubMed

Tully, Melinda; Carmichael, Angela

2012-10-01

Computer-assisted coding tools have the potential to drive improvements in seven areas: Transparency of coding. Productivity (generally by 20 to 25 percent for inpatient claims). Accuracy (by improving specificity of documentation). Cost containment (by reducing overtime expenses, audit fees, and denials). Compliance. Efficiency. Consistency.

Chronic myelogenous leukemia in eastern Pennsylvania: an assessment of registry reporting.

PubMed

Mertz, Kristen J; Buchanich, Jeanine M; Washington, Terri L; Irvin-Barnwell, Elizabeth A; Woytowitz, Donald V; Smith, Roy E

2015-01-01

Chronic myelogenous leukemia (CML) has been reportable to the Pennsylvania Cancer Registry (PCR) since the 1980s, but the completeness of reporting is unknown. This study assessed CML reporting in eastern Pennsylvania where a cluster of another myeloproliferative neoplasm was previously identified. Cases were identified from 2 sources: 1) PCR case reports for residents of Carbon, Luzerne, or Schuylkill County with International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes 9875 (CML, BCR-ABL+), 9863 (CML, NOS), and 9860 (myeloid leukemia) and date of diagnosis 2001-2009, and 2) review of billing records at hematology practices. Participants were interviewed and their medical records were reviewed by board-certified hematologists. PCR reports included 99 cases coded 9875 or 9863 and 9 cases coded 9860; 2 additional cases were identified by review of billing records. Of the 110 identified cases, 93 were mailed consent forms, 23 consented, and 12 medical records were reviewed. Hematologists confirmed 11 of 12 reviewed cases as CML cases; all 11 confirmed cases were BCR/ABL positive, but only 1 was coded as positive (code 9875). Very few unreported CML cases were identified, suggesting relatively complete reporting to the PCR. Cases reviewed were accurately diagnosed, but ICD-0-3 coding often did not reflect BCR-ABL-positive tests. Cancer registry abstracters should look for these test results and code accordingly.

Improving the medical records department processes by lean management

PubMed Central

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862

Clinical and billing review of extracorporeal membrane oxygenation.

PubMed

Blum, James M; Lynch, William R; Coopersmith, Craig M

2015-06-01

Extracorporeal membrane oxygenation (ECMO) is a temporary technique for providing life support for cardiac dysfunction, pulmonary dysfunction, or both. The two forms of ECMO, veno-arterial (VA) and veno-venous (VV), are used to support cardiopulmonary and pulmonary dysfunction, respectively. Historically, ECMO was predominantly used in the neonatal and pediatric populations, as early adult studies failed to improve outcomes. ECMO has become far more common in the adult population because of positive results in published case series and clinical trials during the 2009 influenza A(H1N1) pandemic in 2009 to 2010. Advances in technology that make the technique much easier to implement likely fueled the renewed interest. Although exact criteria for ECMO are not available, patients who are good candidates are generally considered to be relatively young and suffering from acute illness that is believed to be reversible or organ dysfunction that is otherwise treatable. With the increase in the use in the adult population, a number of different codes have been generated to better identify the method of support with distinctly different relative value units assigned to each code from a very simple prior coding scheme. To effectively be reimbursed for use of the technique, it is imperative that the clinician understands the new coding scheme and works with payers to determine what is incorporated into each specific code.

Methods of defining hypertension in electronic medical records: validation against national survey data

PubMed Central

Peng, Mingkai; Chen, Guanmin; Kaplan, Gilaad G.; Lix, Lisa M.; Drummond, Neil; Lucyk, Kelsey; Garies, Stephanie; Lowerison, Mark; Weibe, Samuel; Quan, Hude

2016-01-01

Background Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. Methods We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. Results Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. Conclusions Different definitions should be used for different study purposes. The definition of ‘diagnosis code or two abnormal blood pressure records with a 2-year period’ could be used for hypertension surveillance in THIN. PMID:26547088

Training and support to improve ICD coding quality: A controlled before-and-after impact evaluation.

PubMed

Dyers, Robin; Ward, Grant; Du Plooy, Shane; Fourie, Stephanus; Evans, Juliet; Mahomed, Hassan

2017-05-24

The proposed National Health Insurance policy for South Africa (SA) requires hospitals to maintain high-quality International Statistical Classification of Diseases (ICD) codes for patient records. While considerable strides had been made to improve ICD coding coverage by digitising the discharge process in the Western Cape Province, further intervention was required to improve data quality. The aim of this controlled before-and-after study was to evaluate the impact of a clinician training and support initiative to improve ICD coding quality. To compare ICD coding quality between two central hospitals in the Western Cape before and after the implementation of a training and support initiative for clinicians at one of the sites. The difference in differences in data quality between the intervention site and the control site was calculated. Multiple logistic regression was also used to determine the odds of data quality improvement after the intervention and to adjust for potential differences between the groups. The intervention had a positive impact of 38.0% on ICD coding completeness over and above changes that occurred at the control site. Relative to the baseline, patient records at the intervention site had a 6.6 (95% confidence interval 3.5 - 16.2) adjusted odds ratio of having a complete set of ICD codes for an admission episode after the introduction of the training and support package. The findings on impact on ICD coding accuracy were not significant. There is sufficient pragmatic evidence that a training and support package will have a considerable positive impact on ICD coding completeness in the SA setting.

Improving coding accuracy in an academic practice.

PubMed

Nguyen, Dana; O'Mara, Heather; Powell, Robert

2017-01-01

Practice management has become an increasingly important component of graduate medical education. This applies to every practice environment; private, academic, and military. One of the most critical aspects of practice management is documentation and coding for physician services, as they directly affect the financial success of any practice. Our quality improvement project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess improvement between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not improve overall coding accuracy in a residency practice. Future interventions could focus on educating providers at the individual level.

48 CFR 246.710-70 - Warranty attachment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Enterprise Identifier Code Type 0-9—GS1 Company Prefix. D—CAGE. LB—ATIS-0322000. LH—EHIBCC. RH—HIBCC. UN—DUNS... Guarantor Enterprise Identifier Code Type 0-9—GS1 Company Prefix. D—CAGE. LB—ATIS-0322000. LH—EHIBCC. RH... returns Name ** Address line 1 ** Address line 2 ** City/county ** State/province ** Postal code...

Psychometric Properties of the System for Coding Couples’ Interactions in Therapy - Alcohol

PubMed Central

Owens, Mandy D.; McCrady, Barbara S.; Borders, Adrienne Z.; Brovko, Julie M.; Pearson, Matthew R.

2014-01-01

Few systems are available for coding in-session behaviors for couples in therapy. Alcohol Behavior Couples Therapy (ABCT) is an empirically supported treatment, but little is known about its mechanisms of behavior change. In the current study, an adapted version of the Motivational Interviewing for Significant Others coding system was developed into the System for Coding Couples’ Interactions in Therapy – Alcohol (SCCIT-A), which was used to code couples’ interactions and behaviors during ABCT. Results showed good inter-rater reliability of the SCCIT-A and provided evidence that the SCCIT-A may be a promising measure for understanding couples in therapy. A three factor model of the SCCIT-A was examined (Positive, Negative, and Change Talk/Counter-Change Talk) using a confirmatory factor analysis, but model fit was poor. Due to poor model fit, ratios were computed for Positive/Negative ratings and for Change Talk/Counter-Change Talk codes based on previous research in the couples and Motivational Interviewing literature. Post-hoc analyses examined correlations between specific SCCIT-A codes and baseline characteristics and indicated some concurrent validity. Correlations were run between ratios and baseline characteristics; ratios may be an alternative to using the factors from the SCCIT-A. Reliability and validity analyses suggest that the SCCIT-A has the potential to be a useful measure for coding in-session behaviors of both partners in couples therapy and could be used to identify mechanisms of behavior change for ABCT. Additional research is needed to improve the reliability of some codes and to further develop the SCCIT-A and other measures of couples’ interactions in therapy. PMID:25528049

Occupational self-coding and automatic recording (OSCAR): a novel web-based tool to collect and code lifetime job histories in large population-based studies.

PubMed

De Matteis, Sara; Jarvis, Deborah; Young, Heather; Young, Alan; Allen, Naomi; Potts, James; Darnton, Andrew; Rushton, Lesley; Cullinan, Paul

2017-03-01

Objectives The standard approach to the assessment of occupational exposures is through the manual collection and coding of job histories. This method is time-consuming and costly and makes it potentially unfeasible to perform high quality analyses on occupational exposures in large population-based studies. Our aim was to develop a novel, efficient web-based tool to collect and code lifetime job histories in the UK Biobank, a population-based cohort of over 500 000 participants. Methods We developed OSCAR (occupations self-coding automatic recording) based on the hierarchical structure of the UK Standard Occupational Classification (SOC) 2000, which allows individuals to collect and automatically code their lifetime job histories via a simple decision-tree model. Participants were asked to find each of their jobs by selecting appropriate job categories until they identified their job title, which was linked to a hidden 4-digit SOC code. For each occupation a job title in free text was also collected to estimate Cohen's kappa (κ) inter-rater agreement between SOC codes assigned by OSCAR and an expert manual coder. Results OSCAR was administered to 324 653 UK Biobank participants with an existing email address between June and September 2015. Complete 4-digit SOC-coded lifetime job histories were collected for 108 784 participants (response rate: 34%). Agreement between the 4-digit SOC codes assigned by OSCAR and the manual coder for a random sample of 400 job titles was moderately good [κ=0.45, 95% confidence interval (95% CI) 0.42-0.49], and improved when broader job categories were considered (κ=0.64, 95% CI 0.61-0.69 at a 1-digit SOC-code level). Conclusions OSCAR is a novel, efficient, and reasonably reliable web-based tool for collecting and automatically coding lifetime job histories in large population-based studies. Further application in other research projects for external validation purposes is warranted.

Converting Panax ginseng DNA and chemical fingerprints into two-dimensional barcode.

PubMed

Cai, Yong; Li, Peng; Li, Xi-Wen; Zhao, Jing; Chen, Hai; Yang, Qing; Hu, Hao

2017-07-01

In this study, we investigated how to convert the Panax ginseng DNA sequence code and chemical fingerprints into a two-dimensional code. In order to improve the compression efficiency, GATC2Bytes and digital merger compression algorithms are proposed. HPLC chemical fingerprint data of 10 groups of P. ginseng from Northeast China and the internal transcribed spacer 2 (ITS2) sequence code as the DNA sequence code were ready for conversion. In order to convert such data into a two-dimensional code, the following six steps were performed: First, the chemical fingerprint characteristic data sets were obtained through the inflection filtering algorithm. Second, precompression processing of such data sets is undertaken. Third, precompression processing was undertaken with the P. ginseng DNA (ITS2) sequence codes. Fourth, the precompressed chemical fingerprint data and the DNA (ITS2) sequence code were combined in accordance with the set data format. Such combined data can be compressed by Zlib, an open source data compression algorithm. Finally, the compressed data generated a two-dimensional code called a quick response code (QR code). Through the abovementioned converting process, it can be found that the number of bytes needed for storing P. ginseng chemical fingerprints and its DNA (ITS2) sequence code can be greatly reduced. After GTCA2Bytes algorithm processing, the ITS2 compression rate reaches 75% and the chemical fingerprint compression rate exceeds 99.65% via filtration and digital merger compression algorithm processing. Therefore, the overall compression ratio even exceeds 99.36%. The capacity of the formed QR code is around 0.5k, which can easily and successfully be read and identified by any smartphone. P. ginseng chemical fingerprints and its DNA (ITS2) sequence code can form a QR code after data processing, and therefore the QR code can be a perfect carrier of the authenticity and quality of P. ginseng information. This study provides a theoretical basis for the development of a quality traceability system of traditional Chinese medicine based on a two-dimensional code.

Application discussion of source coding standard in voyage data recorder

NASA Astrophysics Data System (ADS)

Zong, Yonggang; Zhao, Xiandong

2018-04-01

This paper analyzes the disadvantages of the audio and video compression coding technology used by Voyage Data Recorder, and combines the improvement of performance of audio and video acquisition equipment. The thinking of improving the audio and video compression coding technology of the voyage data recorder is proposed, and the feasibility of adopting the new compression coding technology is analyzed from economy and technology two aspects.

Bariatric Surgery Improves Hyperandrogenism, Menstrual Irregularities, and Metabolic Dysfunction Among Women with Polycystic Ovary Syndrome (PCOS).

PubMed

Christ, Jacob P; Falcone, Tommaso

2018-03-02

To characterize the impact of bariatric surgery on reproductive and metabolic features common to polycystic ovary syndrome (PCOS) and to assess the relevance of preoperative evaluations in predicting likelihood of benefit from surgery. A retrospective chart review of records from 930 women who had undergone bariatric surgery at the Cleveland Clinic Foundation from 2009 to 2014 was completed. Cases of PCOS were identified from ICD coding and healthy women with pelvic ultrasound evaluations were identified using Healthcare Common Procedure Coding System coding. Pre- and postoperative anthropometric evaluations, menstrual cyclicity, ovarian volume (OV) as well as markers of hyperandrogenism, dyslipidemia, and dysglycemia were evaluated. Forty-four women with PCOS and 65 controls were evaluated. Both PCOS and non-PCOS had significant reductions in body mass index (BMI) and markers of dyslipidemia postoperatively (p < 0.05). PCOS had significant reductions in androgen levels (p < 0.05) and percent meeting criteria for hyperandrogenism and irregular menses (p < 0.05). OV did not significantly decline in either group postoperatively. Among PCOS, independent of preoperative BMI and age, preoperative OV associated with change in hemoglobin A1c (β 95% (confidence interval) 0.202 (0.011-0.393), p = 0.04) and change in triglycerides (6.681 (1.028-12.334), p = 0.03), and preoperative free testosterone associated with change in total cholesterol (3.744 (0.906-6.583), p = 0.02) and change in non-HDL-C (3.125 (0.453-5.796), p = 0.03). Bariatric surgery improves key diagnostic features seen in women with PCOS and ovarian volume, and free testosterone may have utility in predicting likelihood of metabolic benefit from surgery.

Achieving a Healthy Zoning Policy in Baltimore: Results of a Health Impact Assessment of the TransForm Baltimore Zoning Code Rewrite

PubMed Central

Greiner, Amelia; Fichtenberg, Caroline M.; Feingold, Beth J.; Ellen, Jonathan M.; Jennings, Jacky M.

2013-01-01

Objectives The social determinants of health (SDH) include factors apart from genes and biology that affect population health. Zoning is an urban planning tool that influences neighborhood built environments. We describe the methods and results of a health impact assessment (HIA) of a rezoning effort in Baltimore, Maryland, called TransForm Baltimore. We highlight findings specific to physical activity, violent crime, and obesity. Methods We conducted a multistage HIA of TransForm Baltimore using HIA practice guidelines. Key informant interviews identified focus areas for the quantitative assessment. A literature review and a zoning code analysis evaluated potential impacts on neighborhood factors including physical activity, violent crime, and obesity. We estimated potential impacts in high- and low-poverty neighborhoods. The findings resulted in recommendations to improve the health-promoting potential of TransForm Baltimore. Results Mixed-use and transit-oriented development were key goals of TransForm Baltimore. Health impacts identified by stakeholders included walkability and healthy communities. For Baltimore residents, we estimated that (1) the percentage of people living in districts allowing mixed-use and off-premise alcohol outlets would nearly triple, (2) 18% would live in transit-oriented development zones, and (3) all residents would live in districts with new lighting and landscaping guidelines. Limiting the concentration of off-premise alcohol outlets represented an opportunity to address health promotion. Conclusions Changes to Baltimore's zoning code could improve population health including decreasing violent crime. HIAs are an important platform for applying SDH to public health practice. This HIA specifically linked municipal zoning policy with promoting healthier neighborhoods. PMID:24179284

The impact of online therapeutic feedback on outcome measures in Internet-CBTI for adolescents with insomnia.

PubMed

de Bruin, Eduard Jan; Meijer, Anne Marie

2017-01-01

Guided Internet cognitive behavioral therapy for insomnia (CBTI) offers an effective treatment for adolescents, but little is known about the active ingredients of therapeutic feedback on outcomes. This study aims to identify which factors can be distinguished in written therapeutic feedback in Internet CBTI, and examine whether these factors and participation in a chat session contribute to sleep outcomes. Internet CBTI was applied to 57 adolescents (mean age 15.43 years, SD 1.74, 82.5% girls). Symptoms of insomnia and chronic sleep reduction, and total sleep time, time in bed, and sleep efficiency from seven day sleep logs were measured at baseline, post-treatment, and at two month follow-up. With a coding instrument developed for this study, two independent researchers coded transcripts of the written therapeutic feedback of the Internet CBTI sessions with an event sampling method. Principal component analysis of the initial 17 items from the coding instrument yielded four distinct factors of therapeutic feedback, of which only Sleep expertise seemed to contribute to improvements after Internet CBTI. The other factors, indicating forms of encouragement, and participation in a chat session seemed counterproductive. This first longitudinal study into effects of therapeutic feedback in adolescent Internet CBTI indicated that emphasizing knowledge about sleep might contribute to insomnia improvement. The structured nature of the preprogrammed treatment content, delay of therapeutic feedback due to standardized timing, and unintentional reinforcement of undesirable behavior by giving attention to failures might explain the negative results of encouraging behavior. Further research to identify effective therapeutic factors in Internet therapy is warranted. Copyright © 2016 Elsevier B.V. All rights reserved.

Validation of Carotid Artery Revascularization Coding in Ontario Health Administrative Databases.

PubMed

Hussain, Mohamad A; Mamdani, Muhammad; Saposnik, Gustavo; Tu, Jack V; Turkel-Parrella, David; Spears, Julian; Al-Omran, Mohammed

2016-04-02

The positive predictive value (PPV) of carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedure and post-operative complication coding were assessed in Ontario health administrative databases. Between 1 April 2002 and 31 March 2014, a random sample of 428 patients were identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. A blinded chart review was conducted at two high-volume vascular centers to assess the level of agreement between the administrative records and the corresponding patients' hospital charts. PPV was calculated with 95% confidence intervals (CIs) to estimate the validity of CEA and CAS coding, utilizing hospital charts as the gold standard. Sensitivity of CEA and CAS coding were also assessed by linking two independent databases of 540 CEA-treated patients (Ontario Stroke Registry) and 140 CAS-treated patients (single-center CAS database) to administrative records. PPV for CEA ranged from 99% to 100% and sensitivity ranged from 81.5% to 89.6% using CCI and OHIP codes. A CCI code with a PPV of 87% (95% CI, 78.8-92.9) and sensitivity of 92.9% (95% CI, 87.4-96.1) in identifying CAS was also identified. PPV for post-admission complication diagnosis coding was 71.4% (95% CI, 53.7-85.4) for stroke/transient ischemic attack, and 82.4% (95% CI, 56.6-96.2) for myocardial infarction. Our analysis demonstrated that the codes used in administrative databases accurately identify CEA and CAS-treated patients. Researchers can confidently use administrative data to conduct population-based studies of CEA and CAS.

Coding algorithms for identifying patients with cirrhosis and hepatitis B or C virus using administrative data

PubMed Central

Niu, Bolin; Forde, Kimberly A; Goldberg, David S.

2014-01-01

Background & Aims Despite the use of administrative data to perform epidemiological and cost-effectiveness research on patients with hepatitis B or C virus (HBV, HCV), there are no data outside of the Veterans Health Administration validating whether International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes can accurately identify cirrhotic patients with HBV or HCV. The validation of such algorithms is necessary for future epidemiological studies. Methods We evaluated the positive predictive value (PPV) of ICD-9-CM codes for identifying chronic HBV or HCV among cirrhotic patients within the University of Pennsylvania Health System, a large network that includes a tertiary care referral center, a community-based hospital, and multiple outpatient practices across southeastern Pennsylvania and southern New Jersey. We reviewed a random sample of 200 cirrhotic patients with ICD-9-CM codes for HCV and 150 cirrhotic patients with ICD-9-CM codes for HBV. Results The PPV of 1 inpatient or 2 outpatient HCV codes was 88.0% (168/191, 95% CI: 82.5–92.2%), while the PPV of 1 inpatient or 2 outpatient HBV codes was 81.3% (113/139, 95% CI: 73.8–87.4%). Several variations of the primary coding algorithm were evaluated to determine if different combinations of inpatient and/or outpatient ICD-9-CM codes could increase the PPV of the coding algorithm. Conclusions ICD-9-CM codes can identify chronic HBV or HCV in cirrhotic patients with a high PPV, and can be used in future epidemiologic studies to examine disease burden and the proper allocation of resources. PMID:25335773

Leveraging Code Comments to Improve Software Reliability

ERIC Educational Resources Information Center

Tan, Lin

2009-01-01

Commenting source code has long been a common practice in software development. This thesis, consisting of three pieces of work, made novel use of the code comments written in natural language to improve software reliability. Our solution combines Natural Language Processing (NLP), Machine Learning, Statistics, and Program Analysis techniques to…

Software quality and process improvement in scientific simulation codes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ambrosiano, J.; Webster, R.

1997-11-01

This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

Use, Assessment, and Improvement of the Loci-CHEM CFD Code for Simulation of Combustion in a Single Element GO2/GH2 Injector and Chamber

NASA Technical Reports Server (NTRS)

Westra, Douglas G.; Lin, Jeff; West, Jeff; Tucker, Kevin

2006-01-01

This document is a viewgraph presentation of a paper that documents a continuing effort at Marshall Space Flight Center (MSFC) to use, assess, and continually improve CFD codes to the point of material utility in the design of rocket engine combustion devices. This paper describes how the code is presently being used to simulate combustion in a single element combustion chamber with shear coaxial injectors using gaseous oxygen and gaseous hydrogen propellants. The ultimate purpose of the efforts documented is to assess and further improve the Loci-CHEM code and the implementation of it. Single element shear coaxial injectors were tested as part of the Staged Combustion Injector Technology (SCIT) program, where detailed chamber wall heat fluxes were measured. Data was taken over a range of chamber pressures for propellants injected at both ambient and elevated temperatures. Several test cases are simulated as part of the effort to demonstrate use of the Loci-CHEM CFD code and to enable us to make improvements in the code as needed. The simulations presented also include a grid independence study on hybrid grids. Several two-equation eddy viscosity low Reynolds number turbulence models are also evaluated as part of the study. All calculations are presented with a comparison to the experimental data. Weaknesses of the code relative to test data are discussed and continuing efforts to improve the code are presented.

Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit-Based Algorithms with Diagnosis Codes.

PubMed

Dobson-Belaire, Wendy; Goodfield, Jason; Borrelli, Richard; Liu, Fei Fei; Khan, Zeba M

2018-01-01

Using diagnosis code-based algorithms is the primary method of identifying patient cohorts for retrospective studies; nevertheless, many databases lack reliable diagnosis code information. To develop precise algorithms based on medication claims/prescriber visits (MCs/PVs) to identify psoriasis (PsO) patients and psoriatic patients with arthritic conditions (PsO-AC), a proxy for psoriatic arthritis, in Canadian databases lacking diagnosis codes. Algorithms were developed using medications with narrow indication profiles in combination with prescriber specialty to define PsO and PsO-AC. For a 3-year study period from July 1, 2009, algorithms were validated using the PharMetrics Plus database, which contains both adjudicated medication claims and diagnosis codes. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of the developed algorithms were assessed using diagnosis code as the reference standard. Chosen algorithms were then applied to Canadian drug databases to profile the algorithm-identified PsO and PsO-AC cohorts. In the selected database, 183,328 patients were identified for validation. The highest PPVs for PsO (85%) and PsO-AC (65%) occurred when a predictive algorithm of two or more MCs/PVs was compared with the reference standard of one or more diagnosis codes. NPV and specificity were high (99%-100%), whereas sensitivity was low (≤30%). Reducing the number of MCs/PVs or increasing diagnosis claims decreased the algorithms' PPVs. We have developed an MC/PV-based algorithm to identify PsO patients with a high degree of accuracy, but accuracy for PsO-AC requires further investigation. Such methods allow researchers to conduct retrospective studies in databases in which diagnosis codes are absent. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The optimal code searching method with an improved criterion of coded exposure for remote sensing image restoration

NASA Astrophysics Data System (ADS)

He, Lirong; Cui, Guangmang; Feng, Huajun; Xu, Zhihai; Li, Qi; Chen, Yueting

2015-03-01

Coded exposure photography makes the motion de-blurring a well-posed problem. The integration pattern of light is modulated using the method of coded exposure by opening and closing the shutter within the exposure time, changing the traditional shutter frequency spectrum into a wider frequency band in order to preserve more image information in frequency domain. The searching method of optimal code is significant for coded exposure. In this paper, an improved criterion of the optimal code searching is proposed by analyzing relationship between code length and the number of ones in the code, considering the noise effect on code selection with the affine noise model. Then the optimal code is obtained utilizing the method of genetic searching algorithm based on the proposed selection criterion. Experimental results show that the time consuming of searching optimal code decreases with the presented method. The restoration image is obtained with better subjective experience and superior objective evaluation values.

Validation of an International Classification of Diseases, Ninth Revision Code Algorithm for Identifying Chiari Malformation Type 1 Surgery in Adults.

PubMed

Greenberg, Jacob K; Ladner, Travis R; Olsen, Margaret A; Shannon, Chevis N; Liu, Jingxia; Yarbrough, Chester K; Piccirillo, Jay F; Wellons, John C; Smyth, Matthew D; Park, Tae Sung; Limbrick, David D

2015-08-01

The use of administrative billing data may enable large-scale assessments of treatment outcomes for Chiari Malformation type I (CM-1). However, to utilize such data sets, validated International Classification of Diseases, Ninth Revision (ICD-9-CM) code algorithms for identifying CM-1 surgery are needed. To validate 2 ICD-9-CM code algorithms identifying patients undergoing CM-1 decompression surgery. We retrospectively analyzed the validity of 2 ICD-9-CM code algorithms for identifying adult CM-1 decompression surgery performed at 2 academic medical centers between 2001 and 2013. Algorithm 1 included any discharge diagnosis code of 348.4 (CM-1), as well as a procedure code of 01.24 (cranial decompression) or 03.09 (spinal decompression, or laminectomy). Algorithm 2 restricted this group to patients with a primary diagnosis of 348.4. The positive predictive value (PPV) and sensitivity of each algorithm were calculated. Among 340 first-time admissions identified by Algorithm 1, the overall PPV for CM-1 decompression was 65%. Among the 214 admissions identified by Algorithm 2, the overall PPV was 99.5%. The PPV for Algorithm 1 was lower in the Vanderbilt (59%) cohort, males (40%), and patients treated between 2009 and 2013 (57%), whereas the PPV of Algorithm 2 remained high (≥99%) across subgroups. The sensitivity of Algorithms 1 (86%) and 2 (83%) were above 75% in all subgroups. ICD-9-CM code Algorithm 2 has excellent PPV and good sensitivity to identify adult CM-1 decompression surgery. These results lay the foundation for studying CM-1 treatment outcomes by using large administrative databases.

A Computer Code for Gas Turbine Engine Weight And Disk Life Estimation

NASA Technical Reports Server (NTRS)

Tong, Michael T.; Ghosn, Louis J.; Halliwell, Ian; Wickenheiser, Tim (Technical Monitor)

2002-01-01

Reliable engine-weight estimation at the conceptual design stage is critical to the development of new aircraft engines. It helps to identify the best engine concept amongst several candidates. In this paper, the major enhancements to NASA's engine-weight estimate computer code (WATE) are described. These enhancements include the incorporation of improved weight-calculation routines for the compressor and turbine disks using the finite-difference technique. Furthermore, the stress distribution for various disk geometries was also incorporated, for a life-prediction module to calculate disk life. A material database, consisting of the material data of most of the commonly-used aerospace materials, has also been incorporated into WATE. Collectively, these enhancements provide a more realistic and systematic way to calculate the engine weight. They also provide additional insight into the design trade-off between engine life and engine weight. To demonstrate the new capabilities, the enhanced WATE code is used to perform an engine weight/life trade-off assessment on a production aircraft engine.

Identification of significantly mutated regions across cancer types highlights a rich landscape of functional molecular alterations

PubMed Central

Araya, Carlos L.; Cenik, Can; Reuter, Jason A.; Kiss, Gert; Pande, Vijay S.; Snyder, Michael P.; Greenleaf, William J.

2015-01-01

Cancer sequencing studies have primarily identified cancer-driver genes by the accumulation of protein-altering mutations. An improved method would be annotation-independent, sensitive to unknown distributions of functions within proteins, and inclusive of non-coding drivers. We employed density-based clustering methods in 21 tumor types to detect variably-sized significantly mutated regions (SMRs). SMRs reveal recurrent alterations across a spectrum of coding and non-coding elements, including transcription factor binding sites and untranslated regions mutated in up to ∼15% of specific tumor types. SMRs reveal spatial clustering of mutations at molecular domains and interfaces, often with associated changes in signaling. Mutation frequencies in SMRs demonstrate that distinct protein regions are differentially mutated among tumor types, as exemplified by a linker region of PIK3CA in which biophysical simulations suggest mutations affect regulatory interactions. The functional diversity of SMRs underscores both the varied mechanisms of oncogenic misregulation and the advantage of functionally-agnostic driver identification. PMID:26691984

EEG character identification using stimulus sequences designed to maximize mimimal hamming distance.

PubMed

Fukami, Tadanori; Shimada, Takamasa; Forney, Elliott; Anderson, Charles W

2012-01-01

In this study, we have improved upon the P300 speller Brain-Computer Interface paradigm by introducing a new character encoding method. Our concept in detection of the intended character is not based on a classification of target and nontarget responses, but based on an identifaction of the character which maximize the difference between P300 amplitudes in target and nontarget stimuli. Each bit included in the code corresponds to flashing character, '1', and non-flashing, '0'. Here, the codes were constructed in order to maximize the minimum hamming distance between the characters. Electroencephalography was used to identify the characters using a waveform calculated by adding and subtracting the response of the target and non-target stimulus according the codes respectively. This stimulus presentation method was applied to a 3×3 character matrix, and the results were compared with that of a conventional P300 speller of the same size. Our method reduced the time until the correct character was obtained by 24%.

Formal Process Modeling to Improve Human Decision-Making in Test and Evaluation Acoustic Range Control

DTIC Science & Technology

2017-09-01

AVAILABILITY STATEMENT Approved for public release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) Test and...ambiguities and identify high -value decision points? This thesis explores how formalization of these experience-based decisions as a process model...representing a T&E event may reveal high -value decision nodes where certain decisions carry more weight or potential for impacts to a successful test. The

Determining coding CpG islands by identifying regions significant for pattern statistics on Markov chains.

PubMed

Singer, Meromit; Engström, Alexander; Schönhuth, Alexander; Pachter, Lior

2011-09-23

Recent experimental and computational work confirms that CpGs can be unmethylated inside coding exons, thereby showing that codons may be subjected to both genomic and epigenomic constraint. It is therefore of interest to identify coding CpG islands (CCGIs) that are regions inside exons enriched for CpGs. The difficulty in identifying such islands is that coding exons exhibit sequence biases determined by codon usage and constraints that must be taken into account. We present a method for finding CCGIs that showcases a novel approach we have developed for identifying regions of interest that are significant (with respect to a Markov chain) for the counts of any pattern. Our method begins with the exact computation of tail probabilities for the number of CpGs in all regions contained in coding exons, and then applies a greedy algorithm for selecting islands from among the regions. We show that the greedy algorithm provably optimizes a biologically motivated criterion for selecting islands while controlling the false discovery rate. We applied this approach to the human genome (hg18) and annotated CpG islands in coding exons. The statistical criterion we apply to evaluating islands reduces the number of false positives in existing annotations, while our approach to defining islands reveals significant numbers of undiscovered CCGIs in coding exons. Many of these appear to be examples of functional epigenetic specialization in coding exons.

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

PubMed

Widdifield, Jessica; Bernatsky, Sasha; Paterson, J Michael; Tu, Karen; Ng, Ryan; Thorne, J Carter; Pope, Janet E; Bombardier, Claire

2013-10-01

Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada. We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data. One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with ≥1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date. We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance. Copyright © 2013 by the American College of Rheumatology.

Application of the International Classification of Functioning, Disability, and Health-Children and Youth Version (ICF-CY) to cleft lip and palate.

PubMed

Neumann, Sandra; Romonath, Roswitha

2012-05-01

In recent health policy discussions, the World Health Organization has urged member states to implement the International Classification of Functioning, Disability, and Health: Children and Youth Version in their clinical practice and research. The purpose of this study was to identify codes from the International Classification of Functioning, Disability, and Health: Children and Youth Version relevant for use among children with cleft lip and/or palate, thereby highlighting the potential value of these codes for interprofessional cleft palate-craniofacial teams. The scope of recent published research in the area of cleft lip and/or palate was reviewed and compared with meaningful terms identified from the International Classification of Functioning, Disability, and Health: Children and Youth Version. In a five-step procedure, a consensus-based list of terms was developed that was linked separately to International Classification of Functioning, Disability, and Health: Children and Youth Version categories and codes. This provided a first draft of a core set for use in the cleft lip and/or palate field. Adopting International Classification of Functioning, Disability, and Health: Children and Youth Version domains in cleft lip and/or palate may aid experts in identifying appropriate starting points for assessment, counseling, and therapy. When used as a clinical tool, it encourages health care professionals to go beyond treatment and outcome perspectives that are focused solely on the child and to include the children's environment and their familial/societal context. In order to establish improved, evidence-based interdisciplinary treatments for children with cleft lip and/or palate, more studies are needed that seek to identify all the influencing conditions of activities, children's participation, and barriers/facilitators in their environments.

Establishing the Thematic Framework for a Diabetes-Specific Health-Related Quality of Life Item Bank for Use in an English-Speaking Asian Population

PubMed Central

Koh, Odelia; Lee, Jeannette; Tan, Maudrene L. S.; Tai, E-Shyong; Foo, Ce Jin; Chong, Kok Joon; Goh, Su-Yen; Bee, Yong Mong; Thumboo, Julian; Cheung, Yin-Bun; Singh, Avjeet; Wee, Hwee-Lin

2014-01-01

Aims To establish a thematic framework for a Diabetes Mellitus (DM)-specific health-related quality of life (HRQoL) item bank by identifying important HRQoL themes and content gaps in existing DM-specific HRQoL measures and determining whether Patient-Reported Outcomes Measurement Information System (PROMIS) item banks are useful as a starting point. Methodology English-speaking Type 2 DM patients were recruited from an outpatient specialist clinic in Singapore. Thematic analysis was performed through open coding and axial coding. Items from four existing DM-specific measures and PROMIS Version 1.0 and 2.0 item banks were compared with identified themes and sub-themes. Results 42 patients participated (25 men and 17 women; 28 Chinese, 4 Malay, 8 Indians, 2 other ethnicities). Median age was 53.70 years (IQR45.82–56.97) and the median disease duration was 11.13 (SD9.77) years. 10 subthemes (neutral emotions, coping emotions, empowered to help others, support from family, spend more time with family, relationships, financial burden on family, improved relationship, social support and religion/spirituality) were not covered by existing DM-specific measures. PROMIS covered 5 of 6 themes, 15 of 30 subthemes and 19 of 35 codes identified. Emotional distress (frustration, fear and anxiety) was most frequently mentioned (200 times). Conclusions We had developed a thematic framework for assessing DM-specific HRQoL in a multi-ethnic Asian population, identified new items that needed to be written and confirmed that PROMIS was a useful starting point. We hope that better understanding and measurement of HRQoL of Asian DM patients will translate to better quality of care for them. PMID:25531429

Dissecting the genetics of the human transcriptome identifies novel trait-related trans-eQTLs and corroborates the regulatory relevance of non-protein coding loci†

PubMed Central

Kirsten, Holger; Al-Hasani, Hoor; Holdt, Lesca; Gross, Arnd; Beutner, Frank; Krohn, Knut; Horn, Katrin; Ahnert, Peter; Burkhardt, Ralph; Reiche, Kristin; Hackermüller, Jörg; Löffler, Markus; Teupser, Daniel; Thiery, Joachim; Scholz, Markus

2015-01-01

Genetics of gene expression (eQTLs or expression QTLs) has proved an indispensable tool for understanding biological pathways and pathomechanisms of trait-associated SNPs. However, power of most genome-wide eQTL studies is still limited. We performed a large eQTL study in peripheral blood mononuclear cells of 2112 individuals increasing the power to detect trans-effects genome-wide. Going beyond univariate SNP-transcript associations, we analyse relations of eQTLs to biological pathways, polygenetic effects of expression regulation, trans-clusters and enrichment of co-localized functional elements. We found eQTLs for about 85% of analysed genes, and 18% of genes were trans-regulated. Local eSNPs were enriched up to a distance of 5 Mb to the transcript challenging typically implemented ranges of cis-regulations. Pathway enrichment within regulated genes of GWAS-related eSNPs supported functional relevance of identified eQTLs. We demonstrate that nearest genes of GWAS-SNPs might frequently be misleading functional candidates. We identified novel trans-clusters of potential functional relevance for GWAS-SNPs of several phenotypes including obesity-related traits, HDL-cholesterol levels and haematological phenotypes. We used chromatin immunoprecipitation data for demonstrating biological effects. Yet, we show for strongly heritable transcripts that still little trans-chromosomal heritability is explained by all identified trans-eSNPs; however, our data suggest that most cis-heritability of these transcripts seems explained. Dissection of co-localized functional elements indicated a prominent role of SNPs in loci of pseudogenes and non-coding RNAs for the regulation of coding genes. In summary, our study substantially increases the catalogue of human eQTLs and improves our understanding of the complex genetic regulation of gene expression, pathways and disease-related processes. PMID:26019233

Serial-data correlator/code translator

NASA Technical Reports Server (NTRS)

Morgan, L. E.

1977-01-01

System, consisting of sampling flip flop, memory (either RAM or ROM), and memory buffer, correlates sampled data with predetermined acceptance code patterns, translates acceptable code patterns to nonreturn-to-zero code, and identifies data dropouts.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sigeti, David E.; Pelak, Robert A.

We present a Bayesian statistical methodology for identifying improvement in predictive simulations, including an analysis of the number of (presumably expensive) simulations that will need to be made in order to establish with a given level of confidence that an improvement has been observed. Our analysis assumes the ability to predict (or postdict) the same experiments with legacy and new simulation codes and uses a simple binomial model for the probability, {theta}, that, in an experiment chosen at random, the new code will provide a better prediction than the old. This model makes it possible to do statistical analysis withmore » an absolute minimum of assumptions about the statistics of the quantities involved, at the price of discarding some potentially important information in the data. In particular, the analysis depends only on whether or not the new code predicts better than the old in any given experiment, and not on the magnitude of the improvement. We show how the posterior distribution for {theta} may be used, in a kind of Bayesian hypothesis testing, both to decide if an improvement has been observed and to quantify our confidence in that decision. We quantify the predictive probability that should be assigned, prior to taking any data, to the possibility of achieving a given level of confidence, as a function of sample size. We show how this predictive probability depends on the true value of {theta} and, in particular, how there will always be a region around {theta} = 1/2 where it is highly improbable that we will be able to identify an improvement in predictive capability, although the width of this region will shrink to zero as the sample size goes to infinity. We show how the posterior standard deviation may be used, as a kind of 'plan B metric' in the case that the analysis shows that {theta} is close to 1/2 and argue that such a plan B should generally be part of hypothesis testing. All the analysis presented in the paper is done with a general beta-function prior for {theta}, enabling sequential analysis in which a small number of new simulations may be done and the resulting posterior for {theta} used as a prior to inform the next stage of power analysis.« less

Researcher Perceptions of Ethical Guidelines and Codes of Conduct

PubMed Central

Giorgini, Vincent; Mecca, Jensen T.; Gibson, Carter; Medeiros, Kelsey; Mumford, Michael D.; Connelly, Shane; Devenport, Lynn D.

2014-01-01

Ethical codes of conduct exist in almost every profession. Field-specific codes of conduct have been around for decades, each articulating specific ethical and professional guidelines. However, there has been little empirical research on researchers’ perceptions of these codes of conduct. In the present study, we interviewed faculty members in six research disciplines and identified five themes bearing on the circumstances under which they use ethical guidelines and the underlying reasons for not adhering to such guidelines. We then identify problems with the manner in which codes of conduct in academia are constructed and offer solutions for overcoming these problems. PMID:25635845

A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention.

PubMed

Carter, Eileen J; Pallin, Daniel J; Mandel, Leslie; Sinnette, Corine; Schuur, Jeremiah D

2016-10-01

The aim of this study was to explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs. Hospitals face increasing financial pressures to reduce CAUTI. Urinary catheters, often inserted in the ED, expose patients to CAUTI risk. Nurses are the principal champions of ED CAUTI prevention programs. This was a qualitative analysis from a multisite, comparative case study project. A total of 52 interviews and 9 focus groups were analyzed across 6 enrolled EDs. Using a conventional content analysis, members of the research team coded data and developed site summaries to describe themes that had emerged across transcripts. Subsequently, all codes and site summaries were reviewed to identify the actions of nurse leaders that facilitated clinical nurses' engagement in CAUTI prevention efforts. Nurse leaders were the principal champions of CAUTI prevention programs and successfully engaged clinical nurses in CAUTI prevention efforts by (1) reframing urinary catheters as a source of potential patient harm; (2) empowering clinical nurses to identify and address CAUTI improvement opportunities; (3) fostering a culture of teamwork, which facilitated interdisciplinary communication around urinary catheter appropriateness and alternatives; and (4) holding clinical nurses accountable for CAUTI process and outcome measures. The prevention of CAUTI is an important opportunity for nurse leaders to engage clinical nurses in meaningful improvement efforts. Clinical nurses are best positioned to examine urinary catheter insertion workflow and to suggest improvements in avoiding use and improving placement and maintenance. To engage clinical nurses in CAUTI prevention, nurse leaders should focus on how urinary catheters expose patients to potential harm, involve nurses in designing and implementing practice changes, and provide local data to show the impact of nursing practices on patient outcomes.

From Cues to Nudge: A Knowledge-Based Framework for Surveillance of Healthcare-Associated Infections.

PubMed

Shaban-Nejad, Arash; Mamiya, Hiroshi; Riazanov, Alexandre; Forster, Alan J; Baker, Christopher J O; Tamblyn, Robyn; Buckeridge, David L

2016-01-01

We propose an integrated semantic web framework consisting of formal ontologies, web services, a reasoner and a rule engine that together recommend appropriate level of patient-care based on the defined semantic rules and guidelines. The classification of healthcare-associated infections within the HAIKU (Hospital Acquired Infections - Knowledge in Use) framework enables hospitals to consistently follow the standards along with their routine clinical practice and diagnosis coding to improve quality of care and patient safety. The HAI ontology (HAIO) groups over thousands of codes into a consistent hierarchy of concepts, along with relationships and axioms to capture knowledge on hospital-associated infections and complications with focus on the big four types, surgical site infections (SSIs), catheter-associated urinary tract infection (CAUTI); hospital-acquired pneumonia, and blood stream infection. By employing statistical inferencing in our study we use a set of heuristics to define the rule axioms to improve the SSI case detection. We also demonstrate how the occurrence of an SSI is identified using semantic e-triggers. The e-triggers will be used to improve our risk assessment of post-operative surgical site infections (SSIs) for patients undergoing certain type of surgeries (e.g., coronary artery bypass graft surgery (CABG)).

A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Messina, Louis M; Indes, Jeffrey; FitzGerald, Gordon; Doucet, Danielle R; Simons, Jessica P; Schanzer, Andres

2016-08-01

Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding. Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Correlation approach to identify coding regions in DNA sequences

NASA Technical Reports Server (NTRS)

Ossadnik, S. M.; Buldyrev, S. V.; Goldberger, A. L.; Havlin, S.; Mantegna, R. N.; Peng, C. K.; Simons, M.; Stanley, H. E.

1994-01-01

Recently, it was observed that noncoding regions of DNA sequences possess long-range power-law correlations, whereas coding regions typically display only short-range correlations. We develop an algorithm based on this finding that enables investigators to perform a statistical analysis on long DNA sequences to locate possible coding regions. The algorithm is particularly successful in predicting the location of lengthy coding regions. For example, for the complete genome of yeast chromosome III (315,344 nucleotides), at least 82% of the predictions correspond to putative coding regions; the algorithm correctly identified all coding regions larger than 3000 nucleotides, 92% of coding regions between 2000 and 3000 nucleotides long, and 79% of coding regions between 1000 and 2000 nucleotides. The predictive ability of this new algorithm supports the claim that there is a fundamental difference in the correlation property between coding and noncoding sequences. This algorithm, which is not species-dependent, can be implemented with other techniques for rapidly and accurately locating relatively long coding regions in genomic sequences.

Comparative genomics and transcriptional profiles of Saccharopolyspora erythraea NRRL 2338 and a classically improved erythromycin over-producing strain

PubMed Central

2012-01-01

Background The molecular mechanisms altered by the traditional mutation and screening approach during the improvement of antibiotic-producing microorganisms are still poorly understood although this information is essential to design rational strategies for industrial strain improvement. In this study, we applied comparative genomics to identify all genetic changes occurring during the development of an erythromycin overproducer obtained using the traditional mutate-and- screen method. Results Compared with the parental Saccharopolyspora erythraea NRRL 2338, the genome of the overproducing strain presents 117 deletion, 78 insertion and 12 transposition sites, with 71 insertion/deletion sites mapping within coding sequences (CDSs) and generating frame-shift mutations. Single nucleotide variations are present in 144 CDSs. Overall, the genomic variations affect 227 proteins of the overproducing strain and a considerable number of mutations alter genes of key enzymes in the central carbon and nitrogen metabolism and in the biosynthesis of secondary metabolites, resulting in the redirection of common precursors toward erythromycin biosynthesis. Interestingly, several mutations inactivate genes coding for proteins that play fundamental roles in basic transcription and translation machineries including the transcription anti-termination factor NusB and the transcription elongation factor Efp. These mutations, along with those affecting genes coding for pleiotropic or pathway-specific regulators, affect global expression profile as demonstrated by a comparative analysis of the parental and overproducer expression profiles. Genomic data, finally, suggest that the mutate-and-screen process might have been accelerated by mutations in DNA repair genes. Conclusions This study helps to clarify the mechanisms underlying antibiotic overproduction providing valuable information about new possible molecular targets for rationale strain improvement. PMID:22401291

DOE Office of Scientific and Technical Information (OSTI.GOV)

Atamturktur, Sez; Unal, Cetin; Hemez, Francois

The project proposed to provide a Predictive Maturity Framework with its companion metrics that (1) introduce a formalized, quantitative means to communicate information between interested parties, (2) provide scientifically dependable means to claim completion of Validation and Uncertainty Quantification (VU) activities, and (3) guide the decision makers in the allocation of Nuclear Energy’s resources for code development and physical experiments. The project team proposed to develop this framework based on two complimentary criteria: (1) the extent of experimental evidence available for the calibration of simulation models and (2) the sophistication of the physics incorporated in simulation models. The proposed frameworkmore » is capable of quantifying the interaction between the required number of physical experiments and degree of physics sophistication. The project team has developed this framework and implemented it with a multi-scale model for simulating creep of a core reactor cladding. The multi-scale model is composed of the viscoplastic self-consistent (VPSC) code at the meso-scale, which represents the visco-plastic behavior and changing properties of a highly anisotropic material and a Finite Element (FE) code at the macro-scale to represent the elastic behavior and apply the loading. The framework developed takes advantage of the transparency provided by partitioned analysis, where independent constituent codes are coupled in an iterative manner. This transparency allows model developers to better understand and remedy the source of biases and uncertainties, whether they stem from the constituents or the coupling interface by exploiting separate-effect experiments conducted within the constituent domain and integral-effect experiments conducted within the full-system domain. The project team has implemented this procedure with the multi- scale VPSC-FE model and demonstrated its ability to improve the predictive capability of the model. Within this framework, the project team has focused on optimizing resource allocation for improving numerical models through further code development and experimentation. Related to further code development, we have developed a code prioritization index (CPI) for coupled numerical models. CPI is implemented to effectively improve the predictive capability of the coupled model by increasing the sophistication of constituent codes. In relation to designing new experiments, we investigated the information gained by the addition of each new experiment used for calibration and bias correction of a simulation model. Additionally, the variability of ‘information gain’ through the design domain has been investigated in order to identify the experiment settings where maximum information gain occurs and thus guide the experimenters in the selection of the experiment settings. This idea was extended to evaluate the information gain from each experiment can be improved by intelligently selecting the experiments, leading to the development of the Batch Sequential Design (BSD) technique. Additionally, we evaluated the importance of sufficiently exploring the domain of applicability in experiment-based validation of high-consequence modeling and simulation by developing a new metric to quantify coverage. This metric has also been incorporated into the design of new experiments. Finally, we have proposed a data-aware calibration approach for the calibration of numerical models. This new method considers the complexity of a numerical model (the number of parameters to be calibrated, parameter uncertainty, and form of the model) and seeks to identify the number of experiments necessary to calibrate the model based on the level of sophistication of the physics. The final component in the project team’s work to improve model calibration and validation methods is the incorporation of robustness to non-probabilistic uncertainty in the input parameters. This is an improvement to model validation and uncertainty quantification stemming beyond the originally proposed scope of the project. We have introduced a new metric for incorporating the concept of robustness into experiment-based validation of numerical models. This project has accounted for the graduation of two Ph.D. students (Kendra Van Buren and Josh Hegenderfer) and two M.S. students (Matthew Egeberg and Parker Shields). One of the doctoral students is now working in the nuclear engineering field and the other one is a post-doctoral fellow at the Los Alamos National Laboratory. Additionally, two more Ph.D. students (Garrison Stevens and Tunc Kulaksiz) who are working towards graduation have been supported by this project.« less

Aerothermo-Structural Analysis of Low Cost Composite Nozzle/Inlet Components

NASA Technical Reports Server (NTRS)

Shivakumar, Kuwigai; Challa, Preeli; Sree, Dave; Reddy, D.

1999-01-01

This research is a cooperative effort among the Turbomachinery and Propulsion Division of NASA Glenn, CCMR of NC A&T State University, and the Tuskegee University. The NC A&T is the lead center and Tuskegee University is the participating institution. Objectives of the research were to develop an integrated aerodynamic, thermal and structural analysis code for design of aircraft engine components, such as, nozzles and inlets made of textile composites; conduct design studies on typical inlets for hypersonic transportation vehicles and setup standards test examples and finally manufacture a scaled down composite inlet. These objectives are accomplished through the following seven tasks: (1) identify the relevant public domain codes for all three types of analysis; (2) evaluate the codes for the accuracy of results and computational efficiency; (3) develop aero-thermal and thermal structural mapping algorithms; (4) integrate all the codes into one single code; (5) write a graphical user interface to improve the user friendliness of the code; (6) conduct test studies for rocket based combined-cycle engine inlet; and finally (7) fabricate a demonstration inlet model using textile preform composites. Tasks one, two and six are being pursued. Selected and evaluated NPARC for flow field analysis, CSTEM for in-depth thermal analysis of inlets and nozzles and FRAC3D for stress analysis. These codes have been independently verified for accuracy and performance. In addition, graphical user interface based on micromechanics analysis for laminated as well as textile composites was developed. Demonstration of this code will be made at the conference. A rocket based combined cycle engine was selected for test studies. Flow field analysis of various inlet geometries were studied. Integration of codes is being continued. The codes developed are being applied to a candidate example of trailblazer engine proposed for space transportation. A successful development of the code will provide a simpler, faster and user-friendly tool for conducting design studies of aircraft and spacecraft engines, applicable in high speed civil transport and space missions.

Signatures of selection in tilapia revealed by whole genome resequencing

PubMed Central

Hong Xia, Jun; Bai, Zhiyi; Meng, Zining; Zhang, Yong; Wang, Le; Liu, Feng; Jing, Wu; Yi Wan, Zi; Li, Jiale; Lin, Haoran; Hua Yue, Gen

2015-01-01

Natural selection and selective breeding for genetic improvement have left detectable signatures within the genome of a species. Identification of selection signatures is important in evolutionary biology and for detecting genes that facilitate to accelerate genetic improvement. However, selection signatures, including artificial selection and natural selection, have only been identified at the whole genome level in several genetically improved fish species. Tilapia is one of the most important genetically improved fish species in the world. Using next-generation sequencing, we sequenced the genomes of 47 tilapia individuals. We identified a total of 1.43 million high-quality SNPs and found that the LD block sizes ranged from 10–100 kb in tilapia. We detected over a hundred putative selective sweep regions in each line of tilapia. Most selection signatures were located in non-coding regions of the tilapia genome. The Wnt signaling, gonadotropin-releasing hormone receptor and integrin signaling pathways were under positive selection in all improved tilapia lines. Our study provides a genome-wide map of genetic variation and selection footprints in tilapia, which could be important for genetic studies and accelerating genetic improvement of tilapia. PMID:26373374

Quality Scalability Aware Watermarking for Visual Content.

PubMed

Bhowmik, Deepayan; Abhayaratne, Charith

2016-11-01

Scalable coding-based content adaptation poses serious challenges to traditional watermarking algorithms, which do not consider the scalable coding structure and hence cannot guarantee correct watermark extraction in media consumption chain. In this paper, we propose a novel concept of scalable blind watermarking that ensures more robust watermark extraction at various compression ratios while not effecting the visual quality of host media. The proposed algorithm generates scalable and robust watermarked image code-stream that allows the user to constrain embedding distortion for target content adaptations. The watermarked image code-stream consists of hierarchically nested joint distortion-robustness coding atoms. The code-stream is generated by proposing a new wavelet domain blind watermarking algorithm guided by a quantization based binary tree. The code-stream can be truncated at any distortion-robustness atom to generate the watermarked image with the desired distortion-robustness requirements. A blind extractor is capable of extracting watermark data from the watermarked images. The algorithm is further extended to incorporate a bit-plane discarding-based quantization model used in scalable coding-based content adaptation, e.g., JPEG2000. This improves the robustness against quality scalability of JPEG2000 compression. The simulation results verify the feasibility of the proposed concept, its applications, and its improved robustness against quality scalable content adaptation. Our proposed algorithm also outperforms existing methods showing 35% improvement. In terms of robustness to quality scalable video content adaptation using Motion JPEG2000 and wavelet-based scalable video coding, the proposed method shows major improvement for video watermarking.

[Transposition errors during learning to reproduce a sequence by the right- and the left-hand movements: simulation of positional and movement coding].

PubMed

Liakhovetskiĭ, V A; Bobrova, E V; Skopin, G N

2012-01-01

Transposition errors during the reproduction of a hand movement sequence make it possible to receive important information on the internal representation of this sequence in the motor working memory. Analysis of such errors showed that learning to reproduce sequences of the left-hand movements improves the system of positional coding (coding ofpositions), while learning of the right-hand movements improves the system of vector coding (coding of movements). Learning of the right-hand movements after the left-hand performance involved the system of positional coding "imposed" by the left hand. Learning of the left-hand movements after the right-hand performance activated the system of vector coding. Transposition errors during learning to reproduce movement sequences can be explained by neural network using either vector coding or both vector and positional coding.

Improved Iterative Decoding of Network-Channel Codes for Multiple-Access Relay Channel.

PubMed

Majumder, Saikat; Verma, Shrish

2015-01-01

Cooperative communication using relay nodes is one of the most effective means of exploiting space diversity for low cost nodes in wireless network. In cooperative communication, users, besides communicating their own information, also relay the information of other users. In this paper we investigate a scheme where cooperation is achieved using a common relay node which performs network coding to provide space diversity for two information nodes transmitting to a base station. We propose a scheme which uses Reed-Solomon error correcting code for encoding the information bit at the user nodes and convolutional code as network code, instead of XOR based network coding. Based on this encoder, we propose iterative soft decoding of joint network-channel code by treating it as a concatenated Reed-Solomon convolutional code. Simulation results show significant improvement in performance compared to existing scheme based on compound codes.

An assessment tool to help producers improve cow comfort on their farms.

PubMed

Vasseur, E; Gibbons, J; Rushen, J; Pellerin, D; Pajor, E; Lefebvre, D; de Passillé, A M

2015-01-01

Effective management and an appropriate environment are essential for dairy cattle health and welfare. Codes of practice provide dairy producers with best practice guidance for the care and handling of their cattle. New Canadian recommendations have been established for the dairy industry. The objectives of this study were to develop an on-farm assessment tool that helps producers assess how well they are meeting their code of practice and that identifies management and environment modifications that could improve dairy cow comfort on their farms. The assessment tool addressed critical areas of dairy cow comfort, including accommodation and housing (stall design, space allowance, stall management, pen management, milking parlor, and transfer alleys), feed and water (body condition scoring, nutrition), and health and welfare (lameness, claw health, and hoof-trimming). Targets of good practices were identified from the requirements and recommendations of the code of practice. Each farm received a score for each target, ranging from 0 (target not reached) to 100 (target reached). One hundred tiestall and 110 freestall farms were surveyed in 3 provinces of Canada (Quebec, Ontario, and Alberta). The duration of the assessment, in 2 visits lasting, on average, 8 and 9h (range between freestall and tiestall farms) and 4 and 4.1h, was beyond the targeted 3 to 4h due mainly to the animal-based measures; strategies to reduce the duration of the assessment were discussed. Standard operating procedures were developed to ensure consistency in measuring and recording data. Periodical checks were conducted by trainers to ensure all 15 assessors remained above target agreement of weighted kappa ≥0.6. Average scores for all critical areas ranged from 25 to 89% for freestall farms and from 48 to 95% for tiestall farms. These scores need to be considered with caution when comparing farms because scores could not always be calculated the same way between housing systems. An evaluation report was provided and discussed with each producer, identifying strengths and areas for improvement that could benefit dairy cow comfort on their farms. The producers were convinced of the effectiveness of our tool for assessing cow comfort (freestall: 86%; tiestall: 95%) and in assisting them to make decisions for improvements (freestall: 83%; tiestall: 93%). Our cow comfort assessment tool served as background material for the Dairy Farmers of Canada animal care assessment program. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Development and evaluation of a Naïve Bayesian model for coding causation of workers' compensation claims.

PubMed

Bertke, S J; Meyers, A R; Wurzelbacher, S J; Bell, J; Lampl, M L; Robins, D

2012-12-01

Tracking and trending rates of injuries and illnesses classified as musculoskeletal disorders caused by ergonomic risk factors such as overexertion and repetitive motion (MSDs) and slips, trips, or falls (STFs) in different industry sectors is of high interest to many researchers. Unfortunately, identifying the cause of injuries and illnesses in large datasets such as workers' compensation systems often requires reading and coding the free form accident text narrative for potentially millions of records. To alleviate the need for manual coding, this paper describes and evaluates a computer auto-coding algorithm that demonstrated the ability to code millions of claims quickly and accurately by learning from a set of previously manually coded claims. The auto-coding program was able to code claims as a musculoskeletal disorders, STF or other with approximately 90% accuracy. The program developed and discussed in this paper provides an accurate and efficient method for identifying the causation of workers' compensation claims as a STF or MSD in a large database based on the unstructured text narrative and resulting injury diagnoses. The program coded thousands of claims in minutes. The method described in this paper can be used by researchers and practitioners to relieve the manual burden of reading and identifying the causation of claims as a STF or MSD. Furthermore, the method can be easily generalized to code/classify other unstructured text narratives. Published by Elsevier Ltd.

Efficiency of International Classification of Diseases, Ninth Revision, Billing Code Searches to Identify Emergency Department Visits for Blood or Body Fluid Exposures through a Statewide Multicenter Database

PubMed Central

Rosen, Lisa M.; Liu, Tao; Merchant, Roland C.

2016-01-01

BACKGROUND Blood and body fluid exposures are frequently evaluated in emergency departments (EDs). However, efficient and effective methods for estimating their incidence are not yet established. OBJECTIVE Evaluate the efficiency and accuracy of estimating statewide ED visits for blood or body fluid exposures using International Classification of Diseases, Ninth Revision (ICD-9), code searches. DESIGN Secondary analysis of a database of ED visits for blood or body fluid exposure. SETTING EDs of 11 civilian hospitals throughout Rhode Island from January 1, 1995, through June 30, 2001. PATIENTS Patients presenting to the ED for possible blood or body fluid exposure were included, as determined by prespecified ICD-9 codes. METHODS Positive predictive values (PPVs) were estimated to determine the ability of 10 ICD-9 codes to distinguish ED visits for blood or body fluid exposure from ED visits that were not for blood or body fluid exposure. Recursive partitioning was used to identify an optimal subset of ICD-9 codes for this purpose. Random-effects logistic regression modeling was used to examine variations in ICD-9 coding practices and styles across hospitals. Cluster analysis was used to assess whether the choice of ICD-9 codes was similar across hospitals. RESULTS The PPV for the original 10 ICD-9 codes was 74.4% (95% confidence interval [CI], 73.2%–75.7%), whereas the recursive partitioning analysis identified a subset of 5 ICD-9 codes with a PPV of 89.9% (95% CI, 88.9%–90.8%) and a misclassification rate of 10.1%. The ability, efficiency, and use of the ICD-9 codes to distinguish types of ED visits varied across hospitals. CONCLUSIONS Although an accurate subset of ICD-9 codes could be identified, variations across hospitals related to hospital coding style, efficiency, and accuracy greatly affected estimates of the number of ED visits for blood or body fluid exposure. PMID:22561713

Does a colour-coded blood pressure diary improve blood pressure control for patients in general practice: the CoCo trial.

PubMed

Steurer-Stey, Claudia; Zoller, Marco; Chmiel Moshinsky, Corinne; Senn, Oliver; Rosemann, Thomas

2010-04-14

Insufficient blood pressure control is a frequent problem despite the existence of effective treatment. Insufficient adherence to self-monitoring as well as to therapy is a common reason. Blood pressure self-measurement at home (Home Blood Pressure Measurement, HBPM) has positive effects on treatment adherence and is helpful in achieving the target blood pressure. Only a few studies have investigated whether adherence to HBPM can be improved through simple measures resulting also in better blood pressure control. Improvement of self-monitoring and improved blood pressure control by using a new colour-coded blood pressure diary. Change in systolic and/or diastolic blood pressure 6 months after using the new colour-coded blood pressure diary.Secondary outcome: Adherence to blood pressure self-measurement (number of measurements/entries). Randomised controlled study. 138 adult patients in primary care with uncontrolled hypertension despite therapy. The control group uses a conventional blood pressure diary; the intervention group uses the new colour-coded blood pressure diary (green, yellow, red according a traffic light system). EXPECTED RESULTS/CONCLUSION: The visual separation and entries in three colour-coded areas reflecting risk (green: blood pressure in the target range 140/>90 mmHg, red: blood pressure in danger zone > 180 mmHg/>110 mmHg) lead to better self-monitoring compared with the conventional (non-colour-coded) blood pressure booklet. The colour-coded, visualised information supports improved perception (awareness and interpretation) of blood pressure and triggers correct behaviour, in the means of improved adherence to the recommended treatment as well as better communication between patients and doctors resulting in improved blood pressure control. ClinicalTrials.gov ID NCT01013467.

HBT+: an improved code for finding subhaloes and building merger trees in cosmological simulations

NASA Astrophysics Data System (ADS)

Han, Jiaxin; Cole, Shaun; Frenk, Carlos S.; Benitez-Llambay, Alejandro; Helly, John

2018-02-01

Dark matter subhalos are the remnants of (incomplete) halo mergers. Identifying them and establishing their evolutionary links in the form of merger trees is one of the most important applications of cosmological simulations. The HBT (Hierachical Bound-Tracing) code identifies haloes as they form and tracks their evolution as they merge, simultaneously detecting subhaloes and building their merger trees. Here we present a new implementation of this approach, HBT+ , that is much faster, more user friendly, and more physically complete than the original code. Applying HBT+ to cosmological simulations, we show that both the subhalo mass function and the peak-mass function are well fitted by similar double-Schechter functions. The ratio between the two is highest at the high-mass end, reflecting the resilience of massive subhaloes that experience substantial dynamical friction but limited tidal stripping. The radial distribution of the most-massive subhaloes is more concentrated than the universal radial distribution of lower mass subhaloes. Subhalo finders that work in configuration space tend to underestimate the masses of massive subhaloes, an effect that is stronger in the host centre. This may explain, at least in part, the excess of massive subhaloes in galaxy cluster centres inferred from recent lensing observations. We demonstrate that the peak-mass function is a powerful diagnostic of merger tree defects, and the merger trees constructed using HBT+ do not suffer from the missing or switched links that tend to afflict merger trees constructed from more conventional halo finders. We make the HBT+ code publicly available.

Robotic Gastric Bypass Surgery in the Swiss Health Care System: Analysis of Hospital Costs and Reimbursement.

PubMed

Hagen, Monika E; Rohner, Peter; Jung, Minoa K; Amirghasemi, Nicolas; Buchs, Nicolas C; Fakhro, Jassim; Buehler, Leo; Morel, Philippe

2017-08-01

Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations. Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort. A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001). The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.

HEC Applications on Columbia Project

NASA Technical Reports Server (NTRS)

Taft, Jim

2004-01-01

NASA's Columbia system consists of a cluster of twenty 512 processor SGI Altix systems. Each of these systems is 3 TFLOP/s in peak performance - approximately the same as the entire compute capability at NAS just one year ago. Each 512p system is a single system image machine with one Linunx O5, one high performance file system, and one globally shared memory. The NAS Terascale Applications Group (TAG) is chartered to assist in scaling NASA's mission critical codes to at least 512p in order to significantly improve emergency response during flight operations, as well as provide significant improvements in the codes. and rate of scientific discovery across the scientifc disciplines within NASA's Missions. Recent accomplishments are 4x improvements to codes in the ocean modeling community, 10x performance improvements in a number of computational fluid dynamics codes used in aero-vehicle design, and 5x improvements in a number of space science codes dealing in extreme physics. The TAG group will continue its scaling work to 2048p and beyond (10240 cpus) as the Columbia system becomes fully operational and the upgrades to the SGI NUMAlink memory fabric are in place. The NUMlink uprades dramatically improve system scalability for a single application. These upgrades will allow a number of codes to execute faster at higher fidelity than ever before on any other system, thus increasing the rate of scientific discovery even further

Evaluation of large girth LDPC codes for PMD compensation by turbo equalization.

PubMed

Minkov, Lyubomir L; Djordjevic, Ivan B; Xu, Lei; Wang, Ting; Kueppers, Franko

2008-08-18

Large-girth quasi-cyclic LDPC codes have been experimentally evaluated for use in PMD compensation by turbo equalization for a 10 Gb/s NRZ optical transmission system, and observing one sample per bit. Net effective coding gain improvement for girth-10, rate 0.906 code of length 11936 over maximum a posteriori probability (MAP) detector for differential group delay of 125 ps is 6.25 dB at BER of 10(-6). Girth-10 LDPC code of rate 0.8 outperforms the girth-10 code of rate 0.906 by 2.75 dB, and provides the net effective coding gain improvement of 9 dB at the same BER. It is experimentally determined that girth-10 LDPC codes of length around 15000 approach channel capacity limit within 1.25 dB.

Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

PubMed

Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

2017-10-05

Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A framework for determining improved placement of current energy converters subject to environmental constraints

DOE PAGES

Nelson, Kurt; James, Scott C.; Roberts, Jesse D.; ...

2017-06-05

A modelling framework identifies deployment locations for current-energy-capture devices that maximise power output while minimising potential environmental impacts. The framework, based on the Environmental Fluid Dynamics Code, can incorporate site-specific environmental constraints. Over a 29-day period, energy outputs from three array layouts were estimated for: (1) the preliminary configuration (baseline), (2) an updated configuration that accounted for environmental constraints, (3) and an improved configuration subject to no environmental constraints. Of these layouts, array placement that did not consider environmental constraints extracted the most energy from flow (4.38 MW-hr/day), 19% higher than output from the baseline configuration (3.69 MW-hr/day). Array placementmore » that considered environmental constraints removed 4.27 MW-hr/day of energy (16% more than baseline). In conclusion, this analysis framework accounts for bathymetry and flow-pattern variations that typical experimental studies cannot, demonstrating that it is a valuable tool for identifying improved array layouts for field deployments.« less

Recovery Act: An Integrated Experimental and Numerical Study: Developing a Reaction Transport Model that Couples Chemical Reactions of Mineral Dissolution/Precipitation with Spatial and Temporal Flow Variations.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saar, Martin O.; Seyfried, Jr., William E.; Longmire, Ellen K.

2016-06-24

A total of 12 publications and 23 abstracts were produced as a result of this study. In particular, the compilation of a thermodynamic database utilizing consistent, current thermodynamic data is a major step toward accurately modeling multi-phase fluid interactions with solids. Existing databases designed for aqueous fluids did not mesh well with existing solid phase databases. Addition of a second liquid phase (CO2) magnifies the inconsistencies between aqueous and solid thermodynamic databases. Overall, the combination of high temperature and pressure lab studies (task 1), using a purpose built apparatus, and solid characterization (task 2), using XRCT and more developed technologies,more » allowed observation of dissolution and precipitation processes under CO2 reservoir conditions. These observations were combined with results from PIV experiments on multi-phase fluids (task 3) in typical flow path geometries. The results of the tasks 1, 2, and 3 were compiled and integrated into numerical models utilizing Lattice-Boltzmann simulations (task 4) to realistically model the physical processes and were ultimately folded into TOUGH2 code for reservoir scale modeling (task 5). Compilation of the thermodynamic database assisted comparisons to PIV experiments (Task 3) and greatly improved Lattice Boltzmann (Task 4) and TOUGH2 simulations (Task 5). PIV (Task 3) and experimental apparatus (Task 1) have identified problem areas in TOUGHREACT code. Additional lab experiments and coding work has been integrated into an improved numerical modeling code.« less

The strategic management of organizational knowledge exchange related to hospital quality measurement and reporting.

PubMed

Rangachari, Pavani

2008-01-01

CONTEXT/PURPOSE: With the growing momentum toward hospital quality measurement and reporting by public and private health care payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding accuracy. This study explores the relationship between the organizational knowledge-sharing structure related to quality and hospital coding accuracy for quality measurement. Simultaneously, this study seeks to identify other leadership/management characteristics associated with coding for quality measurement. Drawing upon complexity theory, the literature on "professional complex systems" has put forth various strategies for managing change and turnaround in professional organizations. In so doing, it has emphasized the importance of knowledge creation and organizational learning through interdisciplinary networks. This study integrates complexity, network structure, and "subgoals" theories to develop a framework for knowledge-sharing network effectiveness in professional complex systems. This framework is used to design an exploratory and comparative research study. The sample consists of 4 hospitals, 2 showing "good coding" accuracy for quality measurement and 2 showing "poor coding" accuracy. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Findings of this study indicate that good coding performance is systematically associated with a knowledge-sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment), rather than in density (where everyone is directly connected to everyone else). It also implies that for the hospital organization to adapt to the changing environment of quality transparency, senior leaders must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment.

Implementation of radiation shielding calculation methods. Volume 1: Synopsis of methods and summary of results

NASA Technical Reports Server (NTRS)

Capo, M. A.; Disney, R. K.

1971-01-01

The work performed in the following areas is summarized: (1) Analysis of Realistic nuclear-propelled vehicle was analyzed using the Marshall Space Flight Center computer code package. This code package includes one and two dimensional discrete ordinate transport, point kernel, and single scatter techniques, as well as cross section preparation and data processing codes, (2) Techniques were developed to improve the automated data transfer in the coupled computation method of the computer code package and improve the utilization of this code package on the Univac-1108 computer system. (3) The MSFC master data libraries were updated.

Validity of Administrative Data in Identifying Cancer-related Events in Adolescents and Young Adults: A Population-based Study Using the IMPACT Cohort.

PubMed

Gupta, Sumit; Nathan, Paul C; Baxter, Nancy N; Lau, Cindy; Daly, Corinne; Pole, Jason D

2018-06-01

Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer. We identified all Ontario adolescents and young adults 15-21 years old diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012. Chart abstraction determined the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms determining EOIT based on a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared with chart-abstracted data. The cohort comprised 1404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity, 87.0%; specificity, 93.3%; positive predictive value, 81.5%; negative predictive value, 95.5%). Although administrative data alone did not validly identify cancer-related events, administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.

Deep Learning Methods for Improved Decoding of Linear Codes

NASA Astrophysics Data System (ADS)

Nachmani, Eliya; Marciano, Elad; Lugosch, Loren; Gross, Warren J.; Burshtein, David; Be'ery, Yair

2018-02-01

The problem of low complexity, close to optimal, channel decoding of linear codes with short to moderate block length is considered. It is shown that deep learning methods can be used to improve a standard belief propagation decoder, despite the large example space. Similar improvements are obtained for the min-sum algorithm. It is also shown that tying the parameters of the decoders across iterations, so as to form a recurrent neural network architecture, can be implemented with comparable results. The advantage is that significantly less parameters are required. We also introduce a recurrent neural decoder architecture based on the method of successive relaxation. Improvements over standard belief propagation are also observed on sparser Tanner graph representations of the codes. Furthermore, we demonstrate that the neural belief propagation decoder can be used to improve the performance, or alternatively reduce the computational complexity, of a close to optimal decoder of short BCH codes.

Transcriptome interrogation of human myometrium identifies differentially expressed sense-antisense pairs of protein-coding and long non-coding RNA genes in spontaneous labor at term.

PubMed

Romero, Roberto; Tarca, Adi L; Chaemsaithong, Piya; Miranda, Jezid; Chaiworapongsa, Tinnakorn; Jia, Hui; Hassan, Sonia S; Kalita, Cynthia A; Cai, Juan; Yeo, Lami; Lipovich, Leonard

2014-09-01

To identify differentially expressed long non-coding RNA (lncRNA) genes in human myometrium in women with spontaneous labor at term. Myometrium was obtained from women undergoing cesarean deliveries who were not in labor (n = 19) and women in spontaneous labor at term (n = 20). RNA was extracted and profiled using an Illumina® microarray platform. We have used computational approaches to bound the extent of long non-coding RNA representation on this platform, and to identify co-differentially expressed and correlated pairs of long non-coding RNA genes and protein-coding genes sharing the same genomic loci. We identified co-differential expression and correlation at two genomic loci that contain coding-lncRNA gene pairs: SOCS2-AK054607 and LMCD1-NR_024065 in women in spontaneous labor at term. This co-differential expression and correlation was validated by qRT-PCR, an experimental method completely independent of the microarray analysis. Intriguingly, one of the two lncRNA genes differentially expressed in term labor had a key genomic structure element, a splice site, that lacked evolutionary conservation beyond primates. We provide, for the first time, evidence for coordinated differential expression and correlation of cis-encoded antisense lncRNAs and protein-coding genes with known as well as novel roles in pregnancy in the myometrium of women in spontaneous labor at term.

Identifying personal microbiomes using metagenomic codes

PubMed Central

Franzosa, Eric A.; Huang, Katherine; Meadow, James F.; Gevers, Dirk; Lemon, Katherine P.; Bohannan, Brendan J. M.; Huttenhower, Curtis

2015-01-01

Community composition within the human microbiome varies across individuals, but it remains unknown if this variation is sufficient to uniquely identify individuals within large populations or stable enough to identify them over time. We investigated this by developing a hitting set-based coding algorithm and applying it to the Human Microbiome Project population. Our approach defined body site-specific metagenomic codes: sets of microbial taxa or genes prioritized to uniquely and stably identify individuals. Codes capturing strain variation in clade-specific marker genes were able to distinguish among 100s of individuals at an initial sampling time point. In comparisons with follow-up samples collected 30–300 d later, ∼30% of individuals could still be uniquely pinpointed using metagenomic codes from a typical body site; coincidental (false positive) matches were rare. Codes based on the gut microbiome were exceptionally stable and pinpointed >80% of individuals. The failure of a code to match its owner at a later time point was largely explained by the loss of specific microbial strains (at current limits of detection) and was only weakly associated with the length of the sampling interval. In addition to highlighting patterns of temporal variation in the ecology of the human microbiome, this work demonstrates the feasibility of microbiome-based identifiability—a result with important ethical implications for microbiome study design. The datasets and code used in this work are available for download from huttenhower.sph.harvard.edu/idability. PMID:25964341

Interactive Exploration for Continuously Expanding Neuron Databases.

PubMed

Li, Zhongyu; Metaxas, Dimitris N; Lu, Aidong; Zhang, Shaoting

2017-02-15

This paper proposes a novel framework to help biologists explore and analyze neurons based on retrieval of data from neuron morphological databases. In recent years, the continuously expanding neuron databases provide a rich source of information to associate neuronal morphologies with their functional properties. We design a coarse-to-fine framework for efficient and effective data retrieval from large-scale neuron databases. In the coarse-level, for efficiency in large-scale, we employ a binary coding method to compress morphological features into binary codes of tens of bits. Short binary codes allow for real-time similarity searching in Hamming space. Because the neuron databases are continuously expanding, it is inefficient to re-train the binary coding model from scratch when adding new neurons. To solve this problem, we extend binary coding with online updating schemes, which only considers the newly added neurons and update the model on-the-fly, without accessing the whole neuron databases. In the fine-grained level, we introduce domain experts/users in the framework, which can give relevance feedback for the binary coding based retrieval results. This interactive strategy can improve the retrieval performance through re-ranking the above coarse results, where we design a new similarity measure and take the feedback into account. Our framework is validated on more than 17,000 neuron cells, showing promising retrieval accuracy and efficiency. Moreover, we demonstrate its use case in assisting biologists to identify and explore unknown neurons. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription.

PubMed

Abraham, N S; Cohen, D C; Rivers, B; Richardson, P

2006-07-15

To validate veterans affairs (VA) administrative data for the diagnosis of nonsteroidal anti-inflammatory drug (NSAID)-related upper gastrointestinal events (UGIE) and to develop a diagnostic algorithm. A retrospective study of veterans prescribed an NSAID as identified from the national pharmacy database merged with in-patient and out-patient data, followed by primary chart abstraction. Contingency tables were constructed to allow comparison with a random sample of patients prescribed an NSAID, but without UGIE. Multivariable logistic regression analysis was used to derive a predictive algorithm. Once derived, the algorithm was validated in a separate cohort of veterans. Of 906 patients, 606 had a diagnostic code for UGIE; 300 were a random subsample of 11 744 patients (control). Only 161 had a confirmed UGIE. The positive predictive value (PPV) of diagnostic codes was poor, but improved from 27% to 51% with the addition of endoscopic procedural codes. The strongest predictors of UGIE were an in-patient ICD-9 code for gastric ulcer, duodenal ulcer and haemorrhage combined with upper endoscopy. This algorithm had a PPV of 73% when limited to patients >or=65 years (c-statistic 0.79). Validation of the algorithm revealed a PPV of 80% among patients with an overlapping NSAID prescription. NSAID-related UGIE can be assessed using VA administrative data. The optimal algorithm includes an in-patient ICD-9 code for gastric or duodenal ulcer and gastrointestinal bleeding combined with a procedural code for upper endoscopy.

Objective speech quality assessment and the RPE-LTP coding algorithm in different noise and language conditions.

PubMed

Hansen, J H; Nandkumar, S

1995-01-01

The formulation of reliable signal processing algorithms for speech coding and synthesis require the selection of a prior criterion of performance. Though coding efficiency (bits/second) or computational requirements can be used, a final performance measure must always include speech quality. In this paper, three objective speech quality measures are considered with respect to quality assessment for American English, noisy American English, and noise-free versions of seven languages. The purpose is to determine whether objective quality measures can be used to quantify changes in quality for a given voice coding method, with a known subjective performance level, as background noise or language conditions are changed. The speech coding algorithm chosen is regular-pulse excitation with long-term prediction (RPE-LTP), which has been chosen as the standard voice compression algorithm for the European Digital Mobile Radio system. Three areas are considered for objective quality assessment which include: (i) vocoder performance for American English in a noise-free environment, (ii) speech quality variation for three additive background noise sources, and (iii) noise-free performance for seven languages which include English, Japanese, Finnish, German, Hindi, Spanish, and French. It is suggested that although existing objective quality measures will never replace subjective testing, they can be a useful means of assessing changes in performance, identifying areas for improvement in algorithm design, and augmenting subjective quality tests for voice coding/compression algorithms in noise-free, noisy, and/or non-English applications.

[Quality assurance in coding expertise of hospital cases in the German DRG system. Evaluation of inter-rater reliability in MDK expertise].

PubMed

Huber, H; Brambrink, M; Funk, R; Rieger, M

2012-10-01

The purpose of this study was to evaluate differences in the D-DRG results of a hospital case by 2 independently coding MKD raters. Calculation of the 2-inter-rater reliability was performed by examination of the coding of individual hospital cases. The reasons for the non-agreement of the expert evaluations and suggestions to improve the process are discussed. From the expert evaluation pool of the MDK-WL a random sample of 0.7% of the 57,375 expertises was taken. Distribution equality with the basic total was tested by the χ² test or, respectively, Fisher's exact test. For the total of 402 individual hospital cases, the G-DRG case sums of 2 experts of the MDK were determined independently and the results checked for each individual case for agreement or non-agreement. The corresponding confidence intervals with standard errors were analysed to test if certain major diagnosis categories (MDC) were statistically significantly more affected by differing expertise results than others. In 280 of the total 402 tested hospital cases, the 2 MDK raters independently reached the same G-DRG results; in 122 cases the G-DRG case sums determined by the 2 raters differed (agreement 70%; CI 65.2-74.1). Different DRG results between the 2 experts occurred regularly in the entire MDC spectrum. No MDC chapter in which significant differences between the 2 raters arose could be identified. The results of our study demonstrate an almost 70% agreement in the evaluation of hospital cost accounts by 2 independently operating MDK. This result leaves room for improvement. Optimisation potentials can be recognised on the basis of the results. Potential for improvement was established in combination with regular further training and the expansion of binding internal code recommendations as well as exchange of code-relevant information among experts in internal forums. The presented model is in principle suitable for cross-border examinations within the MDK system with the advantage that further trends could be uncovered by more variety and larger numbers of the randomly selected cases. © Georg Thieme Verlag KG Stuttgart · New York.

The influence of a wall function on turbine blade heat transfer prediction

NASA Technical Reports Server (NTRS)

Whitaker, Kevin W.

1989-01-01

The second phase of a continuing investigation to improve the prediction of turbine blade heat transfer coefficients was completed. The present study specifically investigated how a numeric wall function in the turbulence model of a two-dimensional boundary layer code, STAN5, affected heat transfer prediction capabilities. Several sources of inaccuracy in the wall function were identified and then corrected or improved. Heat transfer coefficient predictions were then obtained using each one of the modifications to determine its effect. Results indicated that the modifications made to the wall function can significantly affect the prediction of heat transfer coefficients on turbine blades. The improvement in accuracy due the modifications is still inconclusive and is still being investigated.

Improvement of single wavelength-based Thai jasmine rice identification with elliptic Fourier descriptor and neural network analysis

NASA Astrophysics Data System (ADS)

Suwansukho, Kajpanya; Sumriddetchkajorn, Sarun; Buranasiri, Prathan

2012-11-01

Instead of considering only the amount of fluorescent signal spatially distributed on the image of milled rice grains this paper shows how our single-wavelength spectral-imaging-based Thai jasmine (KDML105) rice identification system can be improved by analyzing the shape and size of the image of each milled rice variety especially during the image threshold operation. The image of each milled rice variety is expressed as chain codes and elliptic Fourier coefficients. After that, a feed-forward back-propagation neural network model is applied, resulting in an improved average FAR of 11.0% and FRR of 19.0% in identifying KDML105 milled rice from the unwanted four milled rice varieties.

Cryogenic Model Materials

NASA Technical Reports Server (NTRS)

Kimmel, W. M.; Kuhn, N. S.; Berry, R. F.; Newman, J. A.

2001-01-01

An overview and status of current activities seeking alternatives to 200 grade 18Ni Steel CVM alloy for cryogenic wind tunnel models is presented. Specific improvements in material selection have been researched including availability, strength, fracture toughness and potential for use in transonic wind tunnel testing. Potential benefits from utilizing damage tolerant life-prediction methods, recently developed fatigue crack growth codes and upgraded NDE methods are also investigated. Two candidate alloys are identified and accepted for cryogenic/transonic wind tunnel models and hardware.

Aerothermal modeling program, phase 1

NASA Technical Reports Server (NTRS)

Sturgess, G. J.

1983-01-01

The physical modeling embodied in the computational fluid dynamics codes is discussed. The objectives were to identify shortcomings in the models and to provide a program plan to improve the quantitative accuracy. The physical models studied were for: turbulent mass and momentum transport, heat release, liquid fuel spray, and gaseous radiation. The approach adopted was to test the models against appropriate benchmark-quality test cases from experiments in the literature for the constituent flows that together make up the combustor real flow.

An improved method for identification of small non-coding RNAs in bacteria using support vector machine

NASA Astrophysics Data System (ADS)

Barman, Ranjan Kumar; Mukhopadhyay, Anirban; Das, Santasabuj

2017-04-01

Bacterial small non-coding RNAs (sRNAs) are not translated into proteins, but act as functional RNAs. They are involved in diverse biological processes like virulence, stress response and quorum sensing. Several high-throughput techniques have enabled identification of sRNAs in bacteria, but experimental detection remains a challenge and grossly incomplete for most species. Thus, there is a need to develop computational tools to predict bacterial sRNAs. Here, we propose a computational method to identify sRNAs in bacteria using support vector machine (SVM) classifier. The primary sequence and secondary structure features of experimentally-validated sRNAs of Salmonella Typhimurium LT2 (SLT2) was used to build the optimal SVM model. We found that a tri-nucleotide composition feature of sRNAs achieved an accuracy of 88.35% for SLT2. We validated the SVM model also on the experimentally-detected sRNAs of E. coli and Salmonella Typhi. The proposed model had robustly attained an accuracy of 81.25% and 88.82% for E. coli K-12 and S. Typhi Ty2, respectively. We confirmed that this method significantly improved the identification of sRNAs in bacteria. Furthermore, we used a sliding window-based method and identified sRNAs from complete genomes of SLT2, S. Typhi Ty2 and E. coli K-12 with sensitivities of 89.09%, 83.33% and 67.39%, respectively.

A systemic identification approach for primary transcription start site of Arabidopsis miRNAs from multidimensional omics data.

PubMed

You, Qi; Yan, Hengyu; Liu, Yue; Yi, Xin; Zhang, Kang; Xu, Wenying; Su, Zhen

2017-05-01

The 22-nucleotide non-coding microRNAs (miRNAs) are mostly transcribed by RNA polymerase II and are similar to protein-coding genes. Unlike the clear process from stem-loop precursors to mature miRNAs, the primary transcriptional regulation of miRNA, especially in plants, still needs to be further clarified, including the original transcription start site, functional cis-elements and primary transcript structures. Due to several well-characterized transcription signals in the promoter region, we proposed a systemic approach integrating multidimensional "omics" (including genomics, transcriptomics, and epigenomics) data to improve the genome-wide identification of primary miRNA transcripts. Here, we used the model plant Arabidopsis thaliana to improve the ability to identify candidate promoter locations in intergenic miRNAs and to determine rules for identifying primary transcription start sites of miRNAs by integrating high-throughput omics data, such as the DNase I hypersensitive sites, chromatin immunoprecipitation-sequencing of polymerase II and H3K4me3, as well as high throughput transcriptomic data. As a result, 93% of refined primary transcripts could be confirmed by the primer pairs from a previous study. Cis-element and secondary structure analyses also supported the feasibility of our results. This work will contribute to the primary transcriptional regulatory analysis of miRNAs, and the conserved regulatory pattern may be a suitable miRNA characteristic in other plant species.

Identifying Vasopressor and Inotrope Use for Health Services Research

PubMed Central

Fawzy, Ashraf; Bradford, Mark; Lindenauer, Peter K.

2016-01-01

Rationale: Identifying vasopressor and inotrope (vasopressor) use from administrative claims data may provide an important resource to study the epidemiology of shock. Objectives: Determine accuracy of identifying vasopressor use using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) coding. Methods: Using administrative data enriched with pharmacy billing files (Premier, Inc., Charlotte, NC), we identified two cohorts: adult patients admitted with a diagnosis of sepsis from 2010 to 2013 or pulmonary embolism (PE) from 2008 to 2011. Vasopressor administration was obtained using pharmacy billing files (dopamine, dobutamine, epinephrine, milrinone, norepinephrine, phenylephrine, vasopressin) and compared with ICD-9-CM procedure code for vasopressor administration (00.17). We estimated performance characteristics of the ICD-9-CM code and compared patients’ characteristics and mortality rates according to vasopressor identification method. Measurements and Main Results: Using either pharmacy data or the ICD-9-CM procedure code, 29% of 541,144 patients in the sepsis cohort and 5% of 81,588 patients in the PE cohort were identified as receiving a vasopressor. In the sepsis cohort, the ICD-9-CM procedure code had low sensitivity (9.4%; 95% confidence interval, 9.2–9.5), which increased over time. Results were similar in the PE cohort (sensitivity, 5.8%; 95% confidence interval, 5.1–6.6). The ICD-9-CM code exhibited high specificity in the sepsis (99.8%) and PE (100%) cohorts. However, patients identified as receiving vasopressors by ICD-9-CM code had significantly higher unadjusted in-hospital mortality, had more acute organ failures, and were more likely hospitalized in the Northeast and West. Conclusions: The ICD-9-CM procedure code for vasopressor administration has low sensitivity and selects for higher severity of illness in studies of shock. Temporal changes in sensitivity would likely make longitudinal shock surveillance using ICD-9-CM inaccurate. PMID:26653145

Variation in geographic access to chemotherapy by definitions of providers and service locations: a population-based observational study.

PubMed

Schroeder, Mary C; Chapman, Cole G; Nattinger, Matthew C; Halfdanarson, Thorvardur R; Abu-Hejleh, Taher; Tien, Yu-Yu; Brooks, John M

2016-07-18

An aging population, with its associated rise in cancer incidence and strain on the oncology workforce, will continue to motivate patients, healthcare providers and policy makers to better understand the existing and growing challenges of access to chemotherapy. Administrative data, and SEER-Medicare data in particular, have been used to assess patterns of healthcare utilization because of its rich information regarding patients, their treatments, and their providers. To create measures of geographic access to chemotherapy, patients and oncologists must first be identified. Others have noted that identifying chemotherapy providers from Medicare claims is not always straightforward, as providers may report multiple or incorrect specialties and/or practice in multiple locations. Although previous studies have found that specialty codes alone fail to identify all oncologists, none have assessed whether various methods of identifying chemotherapy providers and their locations affect estimates of geographic access to care. SEER-Medicare data was used to identify patients, physicians, and chemotherapy use in this population-based observational study. We compared two measures of geographic access to chemotherapy, local area density and distance to nearest provider, across two definitions of chemotherapy provider (identified by specialty codes or billing codes) and two definitions of chemotherapy service location (where chemotherapy services were proven to be or possibly available) using descriptive statistics. Access measures were mapped for three representative registries. In our sample, 57.2 % of physicians who submitted chemotherapy claims reported a specialty of hematology/oncology or medical oncology. These physicians were associated with 91.0 % of the chemotherapy claims. When providers were identified through billing codes instead of specialty codes, an additional 50.0 % of beneficiaries (from 23.8 % to 35.7 %) resided in the same ZIP code as a chemotherapy provider. Beneficiaries were also 1.3 times closer to a provider, in terms of driving time. Our access measures did not differ significantly across definitions of service location. Measures of geographic access to care were sensitive to definitions of chemotherapy providers; far more providers were identified through billing codes than specialty codes. They were not sensitive to definitions of service locations, as providers, regardless of how they are identified, generally provided chemotherapy at each of their practice locations.

Enhancing Scalability and Efficiency of the TOUGH2_MP for LinuxClusters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Keni; Wu, Yu-Shu

2006-04-17

TOUGH2{_}MP, the parallel version TOUGH2 code, has been enhanced by implementing more efficient communication schemes. This enhancement is achieved through reducing the amount of small-size messages and the volume of large messages. The message exchange speed is further improved by using non-blocking communications for both linear and nonlinear iterations. In addition, we have modified the AZTEC parallel linear-equation solver to nonblocking communication. Through the improvement of code structuring and bug fixing, the new version code is now more stable, while demonstrating similar or even better nonlinear iteration converging speed than the original TOUGH2 code. As a result, the new versionmore » of TOUGH2{_}MP is improved significantly in its efficiency. In this paper, the scalability and efficiency of the parallel code are demonstrated by solving two large-scale problems. The testing results indicate that speedup of the code may depend on both problem size and complexity. In general, the code has excellent scalability in memory requirement as well as computing time.« less

Double coding and mapping using Abbreviated Injury Scale 1998 and 2005: identifying issues for trauma data.

PubMed

Palmer, Cameron S; Niggemeyer, Louise E; Charman, Debra

2010-09-01

The 2005 version of the Abbreviated Injury Scale (AIS05) potentially represents a significant change in injury spectrum classification, due to a substantial increase in the codeset size and alterations to the agreed severity of many injuries compared to the previous version (AIS98). Whilst many trauma registries around the world are moving to adopt AIS05 or its 2008 update (AIS08), its effect on patient classification in existing registries, and the optimum method of comparing existing data collections with new AIS05 collections are unknown. The present study aimed to assess the potential impact of adopting the AIS05 codeset in an established trauma system, and to identify issues associated with this change. A current subset of consecutive major trauma patients admitted to two large hospitals in the Australian state of Victoria were double-coded in AIS98 and AIS05. Assigned codesets were also mapped to the other AIS version using code lists supplied in the AIS05 manual, giving up to four AIS codes per injury sustained. Resulting codesets were assessed for agreement in codes used, injury severity and calculated severity scores. 602 injuries sustained by 109 patients were compared. Adopting AIS05 would lead to a decrease in the number of designated major trauma patients in Victoria, estimated at 22% (95% confidence interval, 15-31%). Differences in AIS level between versions were significantly more likely to occur amongst head and chest injuries. Data mapped to a different codeset performed better in paired comparisons than raw AIS98 and AIS05 codesets, with data mapping of AIS05 codes back to AIS98 giving significantly higher levels of agreement in AIS level, ISS and NISS than other potential comparisons, and resulting in significantly fewer conversion problems than attempting to map AIS98 codes to AIS05. This study provides new insights into AIS codeset change impact. Adoption of AIS05 or AIS08 in established registries will decrease major trauma patient numbers. Code mapping between AIS versions can improve comparisons between datasets in different AIS versions, although the injury profile of a trauma population will affect the degree of comparability. At present, mapping AIS05 data back to AIS98 is recommended. 2009 Elsevier Ltd. All rights reserved.

Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders.

PubMed

Burden, Amanda R; Pukenas, Erin W; Deal, Edward R; Coursin, Douglas B; Dodson, Gregory M; Staman, Gregory W; Gratz, Irwin; Torjman, Marc C

2014-09-01

Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment. At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n  =  26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P  =  .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.

Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes.

PubMed

Blosnich, John R; Cashy, John; Gordon, Adam J; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Fine, Michael J

2018-04-04

Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients' clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity. Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients' clinician text notes were extracted and searched for transgender-related words and phrases. Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22 072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate. Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.

Making an IMPAKT; Improving care of Chronic Kidney Disease patients in the community through collaborative working and utilizing Information Technology.

PubMed

Xu, Gang; Major, Rupert; Shepherd, David; Brunskill, Nigel

2017-01-01

Chronic kidney disease (CKD) is a serious long-term condition, which if left untreated causes significant cardiovascular sequele. It is well recognized management of modifiable risk factors, such as blood pressure (BP), can lead to improved long-term outcomes. A novel information technology (IT) solution presents a possible solution to help clinicians in the community identify and manage at risk patients more efficiently. The IMproving Patient care and Awareness of Kidney disease progression Together (IMPAKT) IT tool was used to identify patients with CKD and uncontrolled hypertension in the community. A CKD nurse utilized the tool at primary care practices to identify patients who warranted potential intervention and disseminated this information to clinical staff. Blood pressure management targets and incidence of coded CKD were used to evaluate the project. Altogether 48 practices participated in an 18 month project from April 2014, and data from 20 practices, with a total adult population of 121,362, was available for analysis. Two full consecutive QI (Quality Improvement) audit cycles were completed. There was an increase in the mean recorded prevalence of coded CKD patients over the course of the project. Similarly, there was an increase in the percentage of patients with BP been recorded and importantly there was an accompanying significant increase in CKD patients achieving BP targets. At the end of the project an additional 345 individuals with CKD achieved better blood pressure control. This could potentially prevent 9 cardiovascular events in the CKD group, translating to a cost saving of £320,000 for the 20 practices involved. The most significant change in clinical markers occurred during cycle 1 of the audit, the improvement was maintained throughout cycle 2 of the audit. Our results show the real-life clinical impact of a relatively simple and easy to implement QI project, to help improve outcomes in patients with CKD. This was achieved through more efficient working by targeting of high-risk groups, and improved communication between primary/secondary care. The project could be adapted for other chronic disease conditions. Despite the recorded improvements in blood pressure management, a large proportion of high-risk patients remained above ideal blood pressure, additional interventions in this area need to be explored. Through collaborative and multi-professional working and utilizing IT resources, we have shown it is possible to deliver measurable and sustainable improvements in blood pressure control for patients with CKD in a real life clinical setting.

Development and Validation of a Natural Language Processing Tool to Identify Patients Treated for Pneumonia across VA Emergency Departments.

PubMed

Jones, B E; South, B R; Shao, Y; Lu, C C; Leng, J; Sauer, B C; Gundlapalli, A V; Samore, M H; Zeng, Q

2018-01-01

Identifying pneumonia using diagnosis codes alone may be insufficient for research on clinical decision making. Natural language processing (NLP) may enable the inclusion of cases missed by diagnosis codes. This article (1) develops a NLP tool that identifies the clinical assertion of pneumonia from physician emergency department (ED) notes, and (2) compares classification methods using diagnosis codes versus NLP against a gold standard of manual chart review to identify patients initially treated for pneumonia. Among a national population of ED visits occurring between 2006 and 2012 across the Veterans Affairs health system, we extracted 811 physician documents containing search terms for pneumonia for training, and 100 random documents for validation. Two reviewers annotated span- and document-level classifications of the clinical assertion of pneumonia. An NLP tool using a support vector machine was trained on the enriched documents. We extracted diagnosis codes assigned in the ED and upon hospital discharge and calculated performance characteristics for diagnosis codes, NLP, and NLP plus diagnosis codes against manual review in training and validation sets. Among the training documents, 51% contained clinical assertions of pneumonia; in the validation set, 9% were classified with pneumonia, of which 100% contained pneumonia search terms. After enriching with search terms, the NLP system alone demonstrated a recall/sensitivity of 0.72 (training) and 0.55 (validation), and a precision/positive predictive value (PPV) of 0.89 (training) and 0.71 (validation). ED-assigned diagnostic codes demonstrated lower recall/sensitivity (0.48 and 0.44) but higher precision/PPV (0.95 in training, 1.0 in validation); the NLP system identified more "possible-treated" cases than diagnostic coding. An approach combining NLP and ED-assigned diagnostic coding classification achieved the best performance (sensitivity 0.89 and PPV 0.80). System-wide application of NLP to clinical text can increase capture of initial diagnostic hypotheses, an important inclusion when studying diagnosis and clinical decision-making under uncertainty. Schattauer GmbH Stuttgart.

Automated Coding Software: Development and Use to Enhance Anti-Fraud Activities*

PubMed Central

Garvin, Jennifer H.; Watzlaf, Valerie; Moeini, Sohrab

2006-01-01

This descriptive research project identified characteristics of automated coding systems that have the potential to detect improper coding and to minimize improper or fraudulent coding practices in the setting of automated coding used with the electronic health record (EHR). Recommendations were also developed for software developers and users of coding products to maximize anti-fraud practices. PMID:17238546

Non-technical skills for obstetricians conducting forceps and vacuum deliveries: qualitative analysis by interviews and video recordings.

PubMed

Bahl, Rachna; Murphy, Deirdre J; Strachan, Bryony

2010-06-01

Non-technical skills are cognitive and social skills required in an operational task. These skills have been identified and taught in the surgical domain but are of particular relevance to obstetrics where the patient is awake, the partner is present and the clinical circumstances are acute and often stressful. The aim of this study was to define the non-technical skills of an operative vaginal delivery (forceps or vacuum) to facilitate transfer of skills from expert obstetricians to trainee obstetricians. Qualitative study using interviews and video recordings. The study was conducted at two university teaching hospitals (St. Michael's Hospital, Bristol and Ninewells Hospital, Dundee). Participants included 10 obstetricians and eight midwives identified as experts in conducting or supporting operative vaginal deliveries. Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting forceps and vacuum deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by the three researchers and then compared for consistency of interpretation. The experts reviewed the coded data for respondent validation and clarification. The themes that emerged were used to identify the non-technical skills required for conducting an operative vaginal delivery. The final skills list was classified into seven main categories. Four categories (situational awareness, decision making, task management, and team work and communication) were similar to the categories identified in surgery. Three further categories unique to obstetrics were also identified (professional relationship with the woman, maintaining professional behaviour and cross-monitoring of performance). This explicitly defined skills taxonomy could aid trainees' understanding of the non-technical skills to be considered when conducting an operative vaginal delivery and potentially reduce morbidity and improve the experience of delivery for the mother. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

CFD Code Development for Combustor Flows

NASA Technical Reports Server (NTRS)

Norris, Andrew

2003-01-01

During the lifetime of this grant, work has been performed in the areas of model development, code development, code validation and code application. For model development, this has included the PDF combustion module, chemical kinetics based on thermodynamics, neural network storage of chemical kinetics, ILDM chemical kinetics and assumed PDF work. Many of these models were then implemented in the code, and in addition many improvements were made to the code, including the addition of new chemistry integrators, property evaluation schemes, new chemistry models and turbulence-chemistry interaction methodology. Validation of all new models and code improvements were also performed, while application of the code to the ZCET program and also the NPSS GEW combustor program were also performed. Several important items remain under development, including the NOx post processing, assumed PDF model development and chemical kinetic development. It is expected that this work will continue under the new grant.

Improving membrane protein expression and function using genomic edits

DOE PAGES

Jensen, Heather M.; Eng, Thomas; Chubukov, Victor; ...

2017-10-12

Expression of membrane proteins often leads to growth inhibition and perturbs central metabolism and this burden varies with the protein being overexpressed. There are also known strain backgrounds that allow greater expression of membrane proteins but that differ in efficacy across proteins. Here, we hypothesized that for any membrane protein, it may be possible to identify a modified strain background where its expression can be accommodated with less burden. To directly test this hypothesis, we used a bar-coded transposon insertion library in tandem with cell sorting to assess genome-wide impact of gene deletions on membrane protein expression. The expression ofmore » five membrane proteins (CyoB, CydB, MdlB, YidC, and LepI) and one soluble protein (GST), each fused to GFP, was examined. We identified Escherichia coli mutants that demonstrated increased membrane protein expression relative to that in wild type. For two of the proteins (CyoB and CydB), we conducted functional assays to confirm that the increase in protein expression also led to phenotypic improvement in function. This study represents a systematic approach to broadly identify genetic loci that can be used to improve membrane protein expression, and our method can be used to improve expression of any protein that poses a cellular burden.« less

Improving membrane protein expression and function using genomic edits

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jensen, Heather M.; Eng, Thomas; Chubukov, Victor

Expression of membrane proteins often leads to growth inhibition and perturbs central metabolism and this burden varies with the protein being overexpressed. There are also known strain backgrounds that allow greater expression of membrane proteins but that differ in efficacy across proteins. Here, we hypothesized that for any membrane protein, it may be possible to identify a modified strain background where its expression can be accommodated with less burden. To directly test this hypothesis, we used a bar-coded transposon insertion library in tandem with cell sorting to assess genome-wide impact of gene deletions on membrane protein expression. The expression ofmore » five membrane proteins (CyoB, CydB, MdlB, YidC, and LepI) and one soluble protein (GST), each fused to GFP, was examined. We identified Escherichia coli mutants that demonstrated increased membrane protein expression relative to that in wild type. For two of the proteins (CyoB and CydB), we conducted functional assays to confirm that the increase in protein expression also led to phenotypic improvement in function. This study represents a systematic approach to broadly identify genetic loci that can be used to improve membrane protein expression, and our method can be used to improve expression of any protein that poses a cellular burden.« less

Side information in coded aperture compressive spectral imaging

NASA Astrophysics Data System (ADS)

Galvis, Laura; Arguello, Henry; Lau, Daniel; Arce, Gonzalo R.

2017-02-01

Coded aperture compressive spectral imagers sense a three-dimensional cube by using two-dimensional projections of the coded and spectrally dispersed source. These imagers systems often rely on FPA detectors, SLMs, micromirror devices (DMDs), and dispersive elements. The use of the DMDs to implement the coded apertures facilitates the capture of multiple projections, each admitting a different coded aperture pattern. The DMD allows not only to collect the sufficient number of measurements for spectrally rich scenes or very detailed spatial scenes but to design the spatial structure of the coded apertures to maximize the information content on the compressive measurements. Although sparsity is the only signal characteristic usually assumed for reconstruction in compressing sensing, other forms of prior information such as side information have been included as a way to improve the quality of the reconstructions. This paper presents the coded aperture design in a compressive spectral imager with side information in the form of RGB images of the scene. The use of RGB images as side information of the compressive sensing architecture has two main advantages: the RGB is not only used to improve the reconstruction quality but to optimally design the coded apertures for the sensing process. The coded aperture design is based on the RGB scene and thus the coded aperture structure exploits key features such as scene edges. Real reconstructions of noisy compressed measurements demonstrate the benefit of the designed coded apertures in addition to the improvement in the reconstruction quality obtained by the use of side information.

Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making.

PubMed

Izadi, Sonya; Pachur, Thorsten; Wheeler, Courtney; McGuire, Jaclyn; Waters, Erika A

2017-10-01

To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

Prediction of plant lncRNA by ensemble machine learning classifiers.

PubMed

Simopoulos, Caitlin M A; Weretilnyk, Elizabeth A; Golding, G Brian

2018-05-02

In plants, long non-protein coding RNAs are believed to have essential roles in development and stress responses. However, relative to advances on discerning biological roles for long non-protein coding RNAs in animal systems, this RNA class in plants is largely understudied. With comparatively few validated plant long non-coding RNAs, research on this potentially critical class of RNA is hindered by a lack of appropriate prediction tools and databases. Supervised learning models trained on data sets of mostly non-validated, non-coding transcripts have been previously used to identify this enigmatic RNA class with applications largely focused on animal systems. Our approach uses a training set comprised only of empirically validated long non-protein coding RNAs from plant, animal, and viral sources to predict and rank candidate long non-protein coding gene products for future functional validation. Individual stochastic gradient boosting and random forest classifiers trained on only empirically validated long non-protein coding RNAs were constructed. In order to use the strengths of multiple classifiers, we combined multiple models into a single stacking meta-learner. This ensemble approach benefits from the diversity of several learners to effectively identify putative plant long non-coding RNAs from transcript sequence features. When the predicted genes identified by the ensemble classifier were compared to those listed in GreeNC, an established plant long non-coding RNA database, overlap for predicted genes from Arabidopsis thaliana, Oryza sativa and Eutrema salsugineum ranged from 51 to 83% with the highest agreement in Eutrema salsugineum. Most of the highest ranking predictions from Arabidopsis thaliana were annotated as potential natural antisense genes, pseudogenes, transposable elements, or simply computationally predicted hypothetical protein. Due to the nature of this tool, the model can be updated as new long non-protein coding transcripts are identified and functionally verified. This ensemble classifier is an accurate tool that can be used to rank long non-protein coding RNA predictions for use in conjunction with gene expression studies. Selection of plant transcripts with a high potential for regulatory roles as long non-protein coding RNAs will advance research in the elucidation of long non-protein coding RNA function.

Pediatric severe sepsis in U.S. children's hospitals.

PubMed

Balamuth, Fran; Weiss, Scott L; Neuman, Mark I; Scott, Halden; Brady, Patrick W; Paul, Raina; Farris, Reid W D; McClead, Richard; Hayes, Katie; Gaieski, David; Hall, Matt; Shah, Samir S; Alpern, Elizabeth R

2014-11-01

To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Observational cohort study from 2004 to 2012. Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Children 18 years old or younger. We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9th edition, Clinical Modification-based coding strategies: 1) combinations of International Classification of Diseases, 9th edition, Clinical Modification codes for infection plus organ dysfunction (combination code cohort); 2) International Classification of Diseases, 9th edition, Clinical Modification codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and ICU length of stay, and mortality. Outcomes were compared between the two cohorts examining aggregate differences over the study period and trends over time. The combination code cohort identified 176,124 hospitalizations (3.1% of all hospitalizations), whereas the sepsis code cohort identified 25,236 hospitalizations (0.45%), a seven-fold difference. Between 2004 and 2012, the prevalence of sepsis increased from 3.7% to 4.4% using the combination code cohort and from 0.4% to 0.7% using the sepsis code cohort (p < 0.001 for trend in each cohort). Length of stay (hospital and ICU) and costs decreased in both cohorts over the study period (p < 0.001). Overall, hospital mortality was higher in the sepsis code cohort than the combination code cohort (21.2% [95% CI, 20.7-21.8] vs 8.2% [95% CI, 8.0-8.3]). Over the 9-year study period, there was an absolute reduction in mortality of 10.9% (p < 0.001) in the sepsis code cohort and 3.8% (p < 0.001) in the combination code cohort. Prevalence of pediatric severe sepsis increased in the studied U.S. children's hospitals over the past 9 years, whereas resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to seven-fold depending on the strategy used for case ascertainment.

Pediatric Severe Sepsis in US Children’s Hospitals

PubMed Central

Balamuth, Fran; Weiss, Scott L.; Neuman, Mark I.; Scott, Halden; Brady, Patrick W.; Paul, Raina; Farris, Reid W.D.; McClead, Richard; Hayes, Katie; Gaieski, David; Hall, Matt; Shah, Samir S.; Alpern, Elizabeth R.

2014-01-01

Objective To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. Design Observational cohort study from 2004–2012. Setting Forty-four pediatric hospitals contributing data to the Pediatric Health Information Systems database. Patients Children ≤18 years of age. Measurements and Main Results We identified patients with severe sepsis or septic shock by using two International Classification of Diseases, 9th edition-Clinical Modification (ICD9-CM) based coding strategies: 1) combinations of ICD9-CM codes for infection plus organ dysfunction (combination code cohort); 2) ICD9-CM codes for severe sepsis and septic shock (sepsis code cohort). Outcomes included prevalence of severe sepsis, as well as hospital and intensive care unit (ICU) length of stay (LOS), and mortality. Outcomes were compared between the two cohorts examining aggregate differences over the study period and trends over time. The combination code cohort identified, 176,124 hospitalizations (3.1% of all hospitalizations), while the sepsis code cohort identified 25,236 hospitalizations (0.45%), a 7-fold difference. Between 2004 and 2012, the prevalence of sepsis increased from 3.7% to 4.4% using the combination code cohort and from 0.4% to 0.7% using the sepsis code cohort (p<0.001 for trend in each cohort). LOS (hospital and ICU) and costs decreased in both cohorts over the study period (p<0.001). Overall hospital mortality was higher in the sepsis code cohort than the combination code cohort (21.2%, (95% CI: 20.7–21.8 vs. 8.2%,(95% CI: 8.0–8.3). Over the 9 year study period, there was an absolute reduction in mortality of 10.9% (p<0.001) in the sepsis code cohort and 3.8% (p<0.001) in the combination code cohort. Conclusions Prevalence of pediatric severe sepsis increased in the studied US children’s hospitals over the past 9 years, though resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to 7-fold depending on the strategy used for case ascertainment. PMID:25162514

Developing Electronic Health Record Algorithms That Accurately Identify Patients With Systemic Lupus Erythematosus.

PubMed

Barnado, April; Casey, Carolyn; Carroll, Robert J; Wheless, Lee; Denny, Joshua C; Crofford, Leslie J

2017-05-01

To study systemic lupus erythematosus (SLE) in the electronic health record (EHR), we must accurately identify patients with SLE. Our objective was to develop and validate novel EHR algorithms that use International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification codes, laboratory testing, and medications to identify SLE patients. We used Vanderbilt's Synthetic Derivative, a de-identified version of the EHR, with 2.5 million subjects. We selected all individuals with at least 1 SLE ICD-9 code (710.0), yielding 5,959 individuals. To create a training set, 200 subjects were randomly selected for chart review. A subject was defined as a case if diagnosed with SLE by a rheumatologist, nephrologist, or dermatologist. Positive predictive values (PPVs) and sensitivity were calculated for combinations of code counts of the SLE ICD-9 code, a positive antinuclear antibody (ANA), ever use of medications, and a keyword of "lupus" in the problem list. The algorithms with the highest PPV were each internally validated using a random set of 100 individuals from the remaining 5,759 subjects. The algorithm with the highest PPV at 95% in the training set and 91% in the validation set was 3 or more counts of the SLE ICD-9 code, ANA positive (≥1:40), and ever use of both disease-modifying antirheumatic drugs and steroids, while excluding individuals with systemic sclerosis and dermatomyositis ICD-9 codes. We developed and validated the first EHR algorithm that incorporates laboratory values and medications with the SLE ICD-9 code to identify patients with SLE accurately. © 2016, American College of Rheumatology.

Triangulating case-finding tools for patient safety surveillance: a cross-sectional case study of puncture/laceration.

PubMed

Taylor, Jennifer A; Gerwin, Daniel; Morlock, Laura; Miller, Marlene R

2011-12-01

To evaluate the need for triangulating case-finding tools in patient safety surveillance. This study applied four case-finding tools to error-associated patient safety events to identify and characterise the spectrum of events captured by these tools, using puncture or laceration as an example for in-depth analysis. Retrospective hospital discharge data were collected for calendar year 2005 (n=48,418) from a large, urban medical centre in the USA. The study design was cross-sectional and used data linkage to identify the cases captured by each of four case-finding tools. Three case-finding tools (International Classification of Diseases external (E) and nature (N) of injury codes, Patient Safety Indicators (PSI)) were applied to the administrative discharge data to identify potential patient safety events. The fourth tool was Patient Safety Net, a web-based voluntary patient safety event reporting system. The degree of mutual exclusion among detection methods was substantial. For example, when linking puncture or laceration on unique identifiers, out of 447 potential events, 118 were identical between PSI and E-codes, 152 were identical between N-codes and E-codes and 188 were identical between PSI and N-codes. Only 100 events that were identified by PSI, E-codes and N-codes were identical. Triangulation of multiple tools through data linkage captures potential patient safety events most comprehensively. Existing detection tools target patient safety domains differently, and consequently capture different occurrences, necessitating the integration of data from a combination of tools to fully estimate the total burden.

Methods of defining hypertension in electronic medical records: validation against national survey data.

PubMed

Peng, Mingkai; Chen, Guanmin; Kaplan, Gilaad G; Lix, Lisa M; Drummond, Neil; Lucyk, Kelsey; Garies, Stephanie; Lowerison, Mark; Weibe, Samuel; Quan, Hude

2016-09-01

Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. Different definitions should be used for different study purposes. The definition of 'diagnosis code or two abnormal blood pressure records with a 2-year period' could be used for hypertension surveillance in THIN. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Exome chip meta-analysis identifies novel loci and East Asian-specific coding variants that contribute to lipid levels and coronary artery disease.

PubMed

Lu, Xiangfeng; Peloso, Gina M; Liu, Dajiang J; Wu, Ying; Zhang, He; Zhou, Wei; Li, Jun; Tang, Clara Sze-Man; Dorajoo, Rajkumar; Li, Huaixing; Long, Jirong; Guo, Xiuqing; Xu, Ming; Spracklen, Cassandra N; Chen, Yang; Liu, Xuezhen; Zhang, Yan; Khor, Chiea Chuen; Liu, Jianjun; Sun, Liang; Wang, Laiyuan; Gao, Yu-Tang; Hu, Yao; Yu, Kuai; Wang, Yiqin; Cheung, Chloe Yu Yan; Wang, Feijie; Huang, Jianfeng; Fan, Qiao; Cai, Qiuyin; Chen, Shufeng; Shi, Jinxiu; Yang, Xueli; Zhao, Wanting; Sheu, Wayne H-H; Cherny, Stacey Shawn; He, Meian; Feranil, Alan B; Adair, Linda S; Gordon-Larsen, Penny; Du, Shufa; Varma, Rohit; Chen, Yii-Der Ida; Shu, Xiao-Ou; Lam, Karen Siu Ling; Wong, Tien Yin; Ganesh, Santhi K; Mo, Zengnan; Hveem, Kristian; Fritsche, Lars G; Nielsen, Jonas Bille; Tse, Hung-Fat; Huo, Yong; Cheng, Ching-Yu; Chen, Y Eugene; Zheng, Wei; Tai, E Shyong; Gao, Wei; Lin, Xu; Huang, Wei; Abecasis, Goncalo; Kathiresan, Sekar; Mohlke, Karen L; Wu, Tangchun; Sham, Pak Chung; Gu, Dongfeng; Willer, Cristen J

2017-12-01

Most genome-wide association studies have been of European individuals, even though most genetic variation in humans is seen only in non-European samples. To search for novel loci associated with blood lipid levels and clarify the mechanism of action at previously identified lipid loci, we used an exome array to examine protein-coding genetic variants in 47,532 East Asian individuals. We identified 255 variants at 41 loci that reached chip-wide significance, including 3 novel loci and 14 East Asian-specific coding variant associations. After a meta-analysis including >300,000 European samples, we identified an additional nine novel loci. Sixteen genes were identified by protein-altering variants in both East Asians and Europeans, and thus are likely to be functional genes. Our data demonstrate that most of the low-frequency or rare coding variants associated with lipids are population specific, and that examining genomic data across diverse ancestries may facilitate the identification of functional genes at associated loci.

Exome chip meta-analysis identifies novel loci and East Asian-specific coding variants contributing to lipid levels and coronary artery disease

PubMed Central

Lu, Xiangfeng; Peloso, Gina M; Liu, Dajiang J.; Wu, Ying; Zhang, He; Zhou, Wei; Li, Jun; Tang, Clara Sze-man; Dorajoo, Rajkumar; Li, Huaixing; Long, Jirong; Guo, Xiuqing; Xu, Ming; Spracklen, Cassandra N.; Chen, Yang; Liu, Xuezhen; Zhang, Yan; Khor, Chiea Chuen; Liu, Jianjun; Sun, Liang; Wang, Laiyuan; Gao, Yu-Tang; Hu, Yao; Yu, Kuai; Wang, Yiqin; Cheung, Chloe Yu Yan; Wang, Feijie; Huang, Jianfeng; Fan, Qiao; Cai, Qiuyin; Chen, Shufeng; Shi, Jinxiu; Yang, Xueli; Zhao, Wanting; Sheu, Wayne H.-H.; Cherny, Stacey Shawn; He, Meian; Feranil, Alan B.; Adair, Linda S.; Gordon-Larsen, Penny; Du, Shufa; Varma, Rohit; da Chen, Yii-Der I; Shu, XiaoOu; Lam, Karen Siu Ling; Wong, Tien Yin; Ganesh, Santhi K.; Mo, Zengnan; Hveem, Kristian; Fritsche, Lars; Nielsen, Jonas Bille; Tse, Hung-fat; Huo, Yong; Cheng, Ching-Yu; Chen, Y. Eugene; Zheng, Wei; Tai, E Shyong; Gao, Wei; Lin, Xu; Huang, Wei; Abecasis, Goncalo; Consortium, GLGC; Kathiresan, Sekar; Mohlke, Karen L.; Wu, Tangchun; Sham, Pak Chung; Gu, Dongfeng; Willer, Cristen J

2017-01-01

Most genome-wide association studies have been conducted in European individuals, even though most genetic variation in humans is seen only in non-European samples. To search for novel loci associated with blood lipid levels and clarify the mechanism of action at previously identified lipid loci, we examined protein-coding genetic variants in 47,532 East Asian individuals using an exome array. We identified 255 variants at 41 loci reaching chip-wide significance, including 3 novel loci and 14 East Asian-specific coding variant associations. After meta-analysis with > 300,000 European samples, we identified an additional 9 novel loci. The same 16 genes were identified by the protein-altering variants in both East Asians and Europeans, likely pointing to the functional genes. Our data demonstrate that most of the low-frequency or rare coding variants associated with lipids are population-specific, and that examining genomic data across diverse ancestries may facilitate the identification of functional genes at associated loci. PMID:29083407

Throughput of Coded Optical CDMA Systems with AND Detectors

NASA Astrophysics Data System (ADS)

Memon, Kehkashan A.; Umrani, Fahim A.; Umrani, A. W.; Umrani, Naveed A.

2012-09-01

Conventional detection techniques used in optical code-division multiple access (OCDMA) systems are not optimal and result in poor bit error rate performance. This paper analyzes the coded performance of optical CDMA systems with AND detectors for enhanced throughput efficiencies and improved error rate performance. The results show that the use of AND detectors significantly improve the performance of an optical channel.

Development and evaluation of a Naïve Bayesian model for coding causation of workers’ compensation claims☆

PubMed Central

Bertke, S. J.; Meyers, A. R.; Wurzelbacher, S. J.; Bell, J.; Lampl, M. L.; Robins, D.

2015-01-01

Introduction Tracking and trending rates of injuries and illnesses classified as musculoskeletal disorders caused by ergonomic risk factors such as overexertion and repetitive motion (MSDs) and slips, trips, or falls (STFs) in different industry sectors is of high interest to many researchers. Unfortunately, identifying the cause of injuries and illnesses in large datasets such as workers’ compensation systems often requires reading and coding the free form accident text narrative for potentially millions of records. Method To alleviate the need for manual coding, this paper describes and evaluates a computer auto-coding algorithm that demonstrated the ability to code millions of claims quickly and accurately by learning from a set of previously manually coded claims. Conclusions The auto-coding program was able to code claims as a musculoskeletal disorders, STF or other with approximately 90% accuracy. Impact on industry The program developed and discussed in this paper provides an accurate and efficient method for identifying the causation of workers’ compensation claims as a STF or MSD in a large database based on the unstructured text narrative and resulting injury diagnoses. The program coded thousands of claims in minutes. The method described in this paper can be used by researchers and practitioners to relieve the manual burden of reading and identifying the causation of claims as a STF or MSD. Furthermore, the method can be easily generalized to code/classify other unstructured text narratives. PMID:23206504

Identification of long non-coding RNA and mRNA expression in βΒ2-crystallin knockout mice.

PubMed

Jia, Yin; Xiong, Kang; Ren, Han-Xiao; Li, Wen-Jie

2018-05-01

βΒ2-crystallin (CRYBB2) is expressed at an increased level in the postnatal lens cortex and is associated with cataracts. Improved understanding of the underlying biology of cataracts is likely to be critical for the development of early detection strategies and new therapeutics. The present study aimed to identify long non-coding RNAs (lncRNAs) and mRNAs associated with CRYBB2 knockdown (KO)-induced cataracts. RNAs from 3 non-treated mice and 3 CRYBB2 KO mice were analyzed using the Affymetrix GeneChip Mouse Gene 2.0 ST array. A total of 149 lncRNAs and 803 mRNAs were identified to have upregulated expression, including Snora73b, Klk1b22 and Rnu3a, while the expression levels of 180 lncRNAs and 732 mRNAs were downregulated in CRYBB2 KO mice, including Snord82, Snhg9 and Foxn3. This lncRNA and mRNA expression profile of mice with CRYBB2 KO provides a basis for studying the genetic mechanisms of cataract progression.

Development of a technique using MCNPX code for determination of nitrogen content of explosive materials using prompt gamma neutron activation analysis method

NASA Astrophysics Data System (ADS)

Nasrabadi, M. N.; Bakhshi, F.; Jalali, M.; Mohammadi, A.

2011-12-01

Nuclear-based explosive detection methods can detect explosives by identifying their elemental components, especially nitrogen. Thermal neutron capture reactions have been used for detecting prompt gamma 10.8 MeV following radioactive neutron capture by 14N nuclei. We aimed to study the feasibility of using field-portable prompt gamma neutron activation analysis (PGNAA) along with improved nuclear equipment to detect and identify explosives, illicit substances or landmines. A 252Cf radio-isotopic source was embedded in a cylinder made of high-density polyethylene (HDPE) and the cylinder was then placed in another cylindrical container filled with water. Measurements were performed on high nitrogen content compounds such as melamine (C3H6N6). Melamine powder in a HDPE bottle was placed underneath the vessel containing water and the neutron source. Gamma rays were detected using two NaI(Tl) crystals. The results were simulated with MCNP4c code calculations. The theoretical calculations and experimental measurements were in good agreement indicating that this method can be used for detection of explosives and illicit drugs.

Validity of administrative coding in identifying patients with upper urinary tract calculi.

PubMed

Semins, Michelle J; Trock, Bruce J; Matlaga, Brian R

2010-07-01

Administrative databases are increasingly used for epidemiological investigations. We performed a study to assess the validity of ICD-9 codes for upper urinary tract stone disease in an administrative database. We retrieved the records of all inpatients and outpatients at Johns Hopkins Hospital between November 2007 and October 2008 with an ICD-9 code of 592, 592.0, 592.1 or 592.9 as one of the first 3 diagnosis codes. A random number generator selected 100 encounters for further review. We considered a patient to have a true diagnosis of an upper tract stone if the medical records specifically referenced a kidney stone event, or included current or past treatment for a kidney stone. Descriptive and comparative analyses were performed. A total of 8,245 encounters coded as upper tract calculus were identified and 100 were randomly selected for review. Two patients could not be identified within the electronic medical record and were excluded from the study. The positive predictive value of using all ICD-9 codes for an upper tract calculus (592, 592.0, 592.1) to identify subjects with renal or ureteral stones was 95.9%. For 592.0 only the positive predictive value was 85%. However, although the positive predictive value for 592.1 only was 100%, 26 subjects (76%) with a ureteral stone were not appropriately billed with this code. ICD-9 coding for urinary calculi is likely to be sufficiently valid to be useful in studies using administrative data to analyze stone disease. However, ICD-9 coding is not a reliable means to distinguish between subjects with renal and ureteral calculi. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Extensions and improvements on XTRAN3S

NASA Technical Reports Server (NTRS)

Borland, C. J.

1989-01-01

Improvements to the XTRAN3S computer program are summarized. Work on this code, for steady and unsteady aerodynamic and aeroelastic analysis in the transonic flow regime has concentrated on the following areas: (1) Maintenance of the XTRAN3S code, including correction of errors, enhancement of operational capability, and installation on the Cray X-MP system; (2) Extension of the vectorization concepts in XTRAN3S to include additional areas of the code for improved execution speed; (3) Modification of the XTRAN3S algorithm for improved numerical stability for swept, tapered wing cases and improved computational efficiency; and (4) Extension of the wing-only version of XTRAN3S to include pylon and nacelle or external store capability.

"There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

PubMed

Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

2012-01-01

We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

Efficient Genome-wide Association in Biobanks Using Topic Modeling Identifies Multiple Novel Disease Loci

PubMed Central

McCoy, Thomas H; Castro, Victor M; Snapper, Leslie A; Hart, Kamber L; Perlis, Roy H

2017-01-01

Biobanks and national registries represent a powerful tool for genomic discovery, but rely on diagnostic codes that can be unreliable and fail to capture relationships between related diagnoses. We developed an efficient means of conducting genome-wide association studies using combinations of diagnostic codes from electronic health records for 10,845 participants in a biobanking program at two large academic medical centers. Specifically, we applied latent Dirichilet allocation to fit 50 disease topics based on diagnostic codes, then conducted a genome-wide common-variant association for each topic. In sensitivity analysis, these results were contrasted with those obtained from traditional single-diagnosis phenome-wide association analysis, as well as those in which only a subset of diagnostic codes were included per topic. In meta-analysis across three biobank cohorts, we identified 23 disease-associated loci with p < 1e-15, including previously associated autoimmune disease loci. In all cases, observed significant associations were of greater magnitude than single phenome-wide diagnostic codes, and incorporation of less strongly loading diagnostic codes enhanced association. This strategy provides a more efficient means of identifying phenome-wide associations in biobanks with coded clinical data. PMID:28861588

Expectations and perceptions of primary healthcare professionals regarding their own continuous education in Catalonia (Spain): a qualitative study.

PubMed

Mundet-Tuduri, Xavier; Crespo, Ramon; Fernandez-Coll, Ma Luisa; Saumell, Montserrat; Millan-Mata, Flor; Cardona, Àngels; Codern-Bové, Núria

2017-11-15

The planning and execution of continuous education in an organization that provides health services is a complex process. The objectives, learning sequences, and implementation strategies should all be oriented to improving the health of the population. The aim of this study was to analyse the expectations and perceptions of continuous educations by primary healthcare professionals (physicians and nurses) and identify aspects that hinder or encourage the process. A qualitative study with 5 focus groups made up of 25 primary healthcare professionals from the Catalan Health Institute, Barcelona (Catalonia, Spain). The focus groups were audio-recorded and the results transcribed. The analysis involved: a) Reading of the data looking for meanings b) Coding of the data by themes and extracting categories c) Reviewing and refining codes and categories d) Reconstruction of the data providing an explanatory framework for the meanings e) Discussion about the interpretations of the findings and f) Discussed with relevant professionals from PHC (physicians and nurses)"Data regarding thematic content were analyzed with the support of Atlasti 5.1 software. The health needs of the population were often at the core of the learning processes but the participants' views did not always spontaneously refer to improvements in these issues. Common themes that could hinder learning and where identified, including contextual aspects such as work constraints (timetables, places being covered during training) and funding policies. New learning strategies to improve the effectiveness of continuous education were proposed such as the exchange of knowledge, the activation of personal commitment to change, and the improvement of organizational aspects. The primary healthcare professionals in our study viewed continuous education as a professional necessity and would like to translate the knowledge acquired to improving the health of the population. Nevertheless, professional, structural, and organizational issues impede the process.

Speeding Up Ecological and Evolutionary Computations in R; Essentials of High Performance Computing for Biologists

PubMed Central

Visser, Marco D.; McMahon, Sean M.; Merow, Cory; Dixon, Philip M.; Record, Sydne; Jongejans, Eelke

2015-01-01

Computation has become a critical component of research in biology. A risk has emerged that computational and programming challenges may limit research scope, depth, and quality. We review various solutions to common computational efficiency problems in ecological and evolutionary research. Our review pulls together material that is currently scattered across many sources and emphasizes those techniques that are especially effective for typical ecological and environmental problems. We demonstrate how straightforward it can be to write efficient code and implement techniques such as profiling or parallel computing. We supply a newly developed R package (aprof) that helps to identify computational bottlenecks in R code and determine whether optimization can be effective. Our review is complemented by a practical set of examples and detailed Supporting Information material (S1–S3 Texts) that demonstrate large improvements in computational speed (ranging from 10.5 times to 14,000 times faster). By improving computational efficiency, biologists can feasibly solve more complex tasks, ask more ambitious questions, and include more sophisticated analyses in their research. PMID:25811842

The IRAS Minor Planet Survey

NASA Technical Reports Server (NTRS)

Tedesco, Edward F.; Veeder, Glenn J.; Fowler, John W.; Chillemi, Joseph R.

1992-01-01

This report documents the program and data used to identify known asteroids observed by the Infrared Astronomical Satellite (IRAS) and to compute albedos and diameters from their IRAS fluxes. It also presents listings of the results obtained. These results supplant those in the IRAS Asteroid and Comet Survey, 1986. The present version used new and improved asteroid orbital elements for 4679 numbered asteroids and 2632 additional asteroids for which at least two-opposition elements were available as of mid-1991. It employed asteroid absolute magnitudes on the International Astronomical Union system adopted in 1991. In addition, the code was modified to increase the reliability of associating asteroids with IRAS sources and rectify several shortcomings in the final data products released in 1986. Association reliability was improved by decreasing the position difference between an IRAS source and a predicted asteroid position required for an association. The shortcomings addressed included the problem of flux overestimation for low SNR sources and the systematic difference in albedos and diameters among the three wavelength bands (12, 25, and 60 micrometers). Several minor bugs in the original code were also corrected.

Quality Control of The Miniature Exoplanet Radio Velocity Array(MINERVA)

NASA Astrophysics Data System (ADS)

Rivera García, Kevin O.; Eastman, Jason D.

2017-01-01

The MINiature Exoplanet Radial Velocity Array, also known as MINERVA , is a network of four robotic 0.7 meter telescopes that is conducting a Radial Velocity survey of the nearest, brightest stars in search of small and rocky exoplanets. The robotic telescope array is located in Fred Lawrence Whipple Observatory in Arizona. MINERVA began science operations in 2015 and we are constantly improving its observing efficiency. We will describe performance statistics that we have developed in Python to proactively identify problems before they impede observations. We have written code to monitor the pointing error for each telescope to ensure it will always be able to acquire a target in the 3 arcminute field of view of its acquisition camera, but there are still some issues that need to be identified. The end goal for this research is to automatically address any common malfunction that may cause the observation to fail and ultimately improve our observing efficiency.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, Kurt; James, Scott C.; Roberts, Jesse D.

A modelling framework identifies deployment locations for current-energy-capture devices that maximise power output while minimising potential environmental impacts. The framework, based on the Environmental Fluid Dynamics Code, can incorporate site-specific environmental constraints. Over a 29-day period, energy outputs from three array layouts were estimated for: (1) the preliminary configuration (baseline), (2) an updated configuration that accounted for environmental constraints, (3) and an improved configuration subject to no environmental constraints. Of these layouts, array placement that did not consider environmental constraints extracted the most energy from flow (4.38 MW-hr/day), 19% higher than output from the baseline configuration (3.69 MW-hr/day). Array placementmore » that considered environmental constraints removed 4.27 MW-hr/day of energy (16% more than baseline). In conclusion, this analysis framework accounts for bathymetry and flow-pattern variations that typical experimental studies cannot, demonstrating that it is a valuable tool for identifying improved array layouts for field deployments.« less

Healthcare Access for Iraqi Refugee Children in Texas: Persistent Barriers, Potential Solutions, and Policy Implications.

PubMed

Vermette, David; Shetgiri, Rashmi; Al Zuheiri, Haidar; Flores, Glenn

2015-10-01

To identify access barriers to healthcare and potential interventions to improve access for Iraqi refugee children. Four focus groups were conducted using consecutive sampling of Iraqi refugee parents residing in the US for 8 months to 5 years. Eight key-informant interviews also were conducted with employees of organizations serving Iraqi refugee families, recruited using snowball sampling. Focus groups and interviews were audiotaped, transcribed, and analyzed using margin coding and grounded theory. Iraqi refugees identified provider availability, Medicaid maintenance and renewal, language issues, and inadequate recognition of post-traumatic stress disorder as barriers to care for their children. Interviewees cited loss of case-management services and difficulties in understanding the Medicaid renewal process as barriers. Potential interventions to improve access include community-oriented efforts to educate parents on Medicaid renewal, obtaining services, and accessing specialists. Given the enduring nature of language and Medicaid renewal barriers, policies addressing eligibility alone are insufficient.

Is a Genome a Codeword of an Error-Correcting Code?

PubMed Central

Kleinschmidt, João H.; Silva-Filho, Márcio C.; Bim, Edson; Herai, Roberto H.; Yamagishi, Michel E. B.; Palazzo, Reginaldo

2012-01-01

Since a genome is a discrete sequence, the elements of which belong to a set of four letters, the question as to whether or not there is an error-correcting code underlying DNA sequences is unavoidable. The most common approach to answering this question is to propose a methodology to verify the existence of such a code. However, none of the methodologies proposed so far, although quite clever, has achieved that goal. In a recent work, we showed that DNA sequences can be identified as codewords in a class of cyclic error-correcting codes known as Hamming codes. In this paper, we show that a complete intron-exon gene, and even a plasmid genome, can be identified as a Hamming code codeword as well. Although this does not constitute a definitive proof that there is an error-correcting code underlying DNA sequences, it is the first evidence in this direction. PMID:22649495

Interface requirements to couple thermal-hydraulic codes to 3D neutronic codes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Langenbuch, S.; Austregesilo, H.; Velkov, K.

1997-07-01

The present situation of thermalhydraulics codes and 3D neutronics codes is briefly described and general considerations for coupling of these codes are discussed. Two different basic approaches of coupling are identified and their relative advantages and disadvantages are discussed. The implementation of the coupling for 3D neutronics codes in the system ATHLET is presented. Meanwhile, this interface is used for coupling three different 3D neutronics codes.

The disclosure of diagnosis codes can breach research participants' privacy.

PubMed

Loukides, Grigorios; Denny, Joshua C; Malin, Bradley

2010-01-01

De-identified clinical data in standardized form (eg, diagnosis codes), derived from electronic medical records, are increasingly combined with research data (eg, DNA sequences) and disseminated to enable scientific investigations. This study examines whether released data can be linked with identified clinical records that are accessible via various resources to jeopardize patients' anonymity, and the ability of popular privacy protection methodologies to prevent such an attack. The study experimentally evaluates the re-identification risk of a de-identified sample of Vanderbilt's patient records involved in a genome-wide association study. It also measures the level of protection from re-identification, and data utility, provided by suppression and generalization. Privacy protection is quantified using the probability of re-identifying a patient in a larger population through diagnosis codes. Data utility is measured at a dataset level, using the percentage of retained information, as well as its description, and at a patient level, using two metrics based on the difference between the distribution of Internal Classification of Disease (ICD) version 9 codes before and after applying privacy protection. More than 96% of 2800 patients' records are shown to be uniquely identified by their diagnosis codes with respect to a population of 1.2 million patients. Generalization is shown to reduce further the percentage of de-identified records by less than 2%, and over 99% of the three-digit ICD-9 codes need to be suppressed to prevent re-identification. Popular privacy protection methods are inadequate to deliver a sufficiently protected and useful result when sharing data derived from complex clinical systems. The development of alternative privacy protection models is thus required.

Performance of data-compression codes in channels with errors. Final report, October 1986-January 1987

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1987-10-01

Huffman codes, comma-free codes, and block codes with shift indicators are important candidate-message compression codes for improving the efficiency of communications systems. This study was undertaken to determine if these codes could be used to increase the thruput of the fixed very-low-frequency (FVLF) communication system. This applications involves the use of compression codes in a channel with errors.

Improved convolutional coding

NASA Technical Reports Server (NTRS)

Doland, G. D.

1970-01-01

Convolutional coding, used to upgrade digital data transmission under adverse signal conditions, has been improved by a method which ensures data transitions, permitting bit synchronizer operation at lower signal levels. Method also increases decoding ability by removing ambiguous condition.

Sifting, sorting and saturating data in a grounded theory study of information use by practice nurses: a worked example.

PubMed

Hoare, Karen J; Mills, Jane; Francis, Karen

2012-12-01

The terminology used to analyse data in a grounded theory study can be confusing. Different grounded theorists use a variety of terms which all have similar meanings. In the following study, we use terms adopted by Charmaz including: initial, focused and axial coding. Initial codes are used to analyse data with an emphasis on identifying gerunds, a verb acting as a noun. If initial codes are relevant to the developing theory, they are grouped with similar codes into categories. Categories become saturated when there are no new codes identified in the data. Axial codes are used to link categories together into a grounded theory process. Memo writing accompanies this data sifting and sorting. The following article explains how one initial code became a category providing a worked example of the grounded theory method of constant comparative analysis. The interplay between coding and categorization is facilitated by the constant comparative method. © 2012 Wiley Publishing Asia Pty Ltd.

The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department.

PubMed

Schoenfeld, Elizabeth M; Goff, Sarah L; Elia, Tala R; Khordipour, Errel R; Poronsky, Kye E; Nault, Kelly A; Lindenauer, Peter K; Mazor, Kathleen M

2016-12-01

Shared decision making (SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department (ED), little is known about emergency physicians' (EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase "shared decision making," but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance of individual outcomes: of eight potential research outcomes participants endorsed, no single outcome was endorsed by even half of the physicians interviewed. Emergency physicians identified many factors that motivated them to use SDM. This study informs current research on SDM in the ED, particularly regarding the motivations of the physician-as-stakeholder. © 2016 by the Society for Academic Emergency Medicine.

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework.

PubMed

Little, Elizabeth A; Presseau, Justin; Eccles, Martin P

2015-06-17

Behavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change. There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication. A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted. Nine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included "memory, attention and decision processes", "knowledge", "environmental context and resources", "social influences" and "beliefs about consequences". Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size. When explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.

41 CFR 101-27.205 - Shelf-life codes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Shelf-life codes. 101-27...-Management of Shelf-Life Materials § 101-27.205 Shelf-life codes. Shelf-life items shall be identified by use of a one-digit code to provide for uniform coding of shelf-life materials by all agencies. (a) The...

41 CFR 101-27.205 - Shelf-life codes.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Shelf-life codes. 101-27...-Management of Shelf-Life Materials § 101-27.205 Shelf-life codes. Shelf-life items shall be identified by use of a one-digit code to provide for uniform coding of shelf-life materials by all agencies. (a) The...

41 CFR 101-27.205 - Shelf-life codes.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 2 2014-07-01 2012-07-01 true Shelf-life codes. 101-27...-Management of Shelf-Life Materials § 101-27.205 Shelf-life codes. Shelf-life items shall be identified by use of a one-digit code to provide for uniform coding of shelf-life materials by all agencies. (a) The...

41 CFR 101-27.205 - Shelf-life codes.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 2 2013-07-01 2012-07-01 true Shelf-life codes. 101-27...-Management of Shelf-Life Materials § 101-27.205 Shelf-life codes. Shelf-life items shall be identified by use of a one-digit code to provide for uniform coding of shelf-life materials by all agencies. (a) The...

41 CFR 101-27.205 - Shelf-life codes.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 2 2012-07-01 2012-07-01 false Shelf-life codes. 101-27...-Management of Shelf-Life Materials § 101-27.205 Shelf-life codes. Shelf-life items shall be identified by use of a one-digit code to provide for uniform coding of shelf-life materials by all agencies. (a) The...

Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study.

PubMed

Stevenson, K; Baker, R; Farooqi, A; Sorrie, R; Khunti, K

2001-02-01

In quality improvement activities such as audit, some general practices succeed in improving care and some do not. With audit of care likely to be one of the major tools in clinical governance, it would be helpful to establish what features of primary health care teams are associated with successful audit in general practice. The aim of the present study was to identify those features of primary health care teams that were associated with successful quality improvement during systematic audit of diabetes care. Semi-structured tape-recorded interviews were carried out with lead GPs and practice nurses in 18 general practices in Leicestershire that had the opportunity to improve their care and had completed two data collections in a multipractice audit of diabetes care. The interviewees were asked to describe their practice's approach to audit and the transcripts were coded for common features and judged for strength of feeling by blinded independent raters. Features common to practices that had, and those that had not, managed to improve diabetes care were identified. Six features were identified reliably in the transcripts by blinded independent raters. Four were significantly associated with the successful improvement of care. Success was more likely in teams in which: the GP or nurse felt personally involved in the audit; they perceived their teamwork as good; they had recognized the need for systematic plans to address obstacles to quality improvement; and their teams had a positive attitude to continued monitoring of care. A positive attitude to audit and a personal interest in the disease were not associated with improvement in care. Success in improving diabetes care is associated with certain organizational features of primary health care teams. Experimental studies are required to determine whether the development of teamwork enables practice teams to identify and overcome systematically the obstacles to improved quality of patient care that face them.

A descriptive study of women presenting to an obstetric triage unit with no prenatal care.

PubMed

Knight, Erin; Morris, Margaret; Heaman, Maureen

2014-03-01

To describe women presenting to an obstetric triage unit with no prenatal care (PNC), to identify gaps in care, and to compare care provided to World Health Organization (WHO) standards. We reviewed the charts of women who gave birth at Women's Hospital in Winnipeg and were discharged between April 1, 2008, and March 31, 2011, and identified those whose charts were coded with ICD-10 code Z35.3 (inadequate PNC) or who had fewer than 2 PNC visits. Three hundred eighty-two charts were identified, and sociodemographic characteristics, PNC history, investigations, and pregnancy outcomes were recorded. The care provided was compared with WHO guidelines. One hundred nine women presented to the obstetric triage unit with no PNC; 96 (88.1%) were in the third trimester. Only 39 women (35.8%) received subsequent PNC, with care falling short of WHO standards. Gaps in PNC included missing time-sensitive screening tests, mid-stream urine culture, and Chlamydia and gonorrhea testing. The mean maternal age was 26.1 years, and 93 women (85.3%) were multigravidas. More than one half of the women (51.4%) were involved with Child and Family Services, 64.2% smoked, 33.0% drank alcohol, and 32.1% used illicit drugs during pregnancy. Two thirds of the women (66.2%) lived in inner-city Winnipeg. Only 63.0% of neonates showed growth appropriate for gestational age. Two pregnancies ended in stillbirth; there was one neonatal death, and over one third of the births were preterm. Most women who present with no PNC do so late in pregnancy, proceed to deliver with little or no additional PNC, and have high rates of adverse outcomes. Thus, efforts to improve PNC must focus on facilitating earlier entry into care. This would also improve compliance with WHO guidelines for continuing care. Treatment protocols could improve gaps in obtaining urine culture and in Chlamydia and gonorrhea testing.

Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation

PubMed Central

Riddell, Lynn; Lim, Karen; Byrne, Linda K; Nowson, Caryl; Rigo, Manuela; Szymlek-Gay, Ewa A; Booth, Alison O

2015-01-01

Background Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. PMID:26416479

Photoionization and High Density Gas

NASA Technical Reports Server (NTRS)

Kallman, T.; Bautista, M.; White, Nicholas E. (Technical Monitor)

2002-01-01

We present results of calculations using the XSTAR version 2 computer code. This code is loosely based on the XSTAR v.1 code which has been available for public use for some time. However it represents an improvement and update in several major respects, including atomic data, code structure, user interface, and improved physical description of ionization/excitation. In particular, it now is applicable to high density situations in which significant excited atomic level populations are likely to occur. We describe the computational techniques and assumptions, and present sample runs with particular emphasis on high density situations.

Engine dynamic analysis with general nonlinear finite element codes. Part 2: Bearing element implementation overall numerical characteristics and benchmaking

NASA Technical Reports Server (NTRS)

Padovan, J.; Adams, M.; Fertis, J.; Zeid, I.; Lam, P.

1982-01-01

Finite element codes are used in modelling rotor-bearing-stator structure common to the turbine industry. Engine dynamic simulation is used by developing strategies which enable the use of available finite element codes. benchmarking the elements developed are benchmarked by incorporation into a general purpose code (ADINA); the numerical characteristics of finite element type rotor-bearing-stator simulations are evaluated through the use of various types of explicit/implicit numerical integration operators. Improving the overall numerical efficiency of the procedure is improved.

Coding for spread spectrum packet radios

NASA Technical Reports Server (NTRS)

Omura, J. K.

1980-01-01

Packet radios are often expected to operate in a radio communication network environment where there tends to be man made interference signals. To combat such interference, spread spectrum waveforms are being considered for some applications. The use of convolutional coding with Viterbi decoding to further improve the performance of spread spectrum packet radios is examined. At 0.00001 bit error rates, improvements in performance of 4 db to 5 db can easily be achieved with such coding without any change in data rate nor spread spectrum bandwidth. This coding gain is more dramatic in an interference environment.

Nuclear Data Uncertainty Propagation to Reactivity Coefficients of a Sodium Fast Reactor

NASA Astrophysics Data System (ADS)

Herrero, J. J.; Ochoa, R.; Martínez, J. S.; Díez, C. J.; García-Herranz, N.; Cabellos, O.

2014-04-01

The assessment of the uncertainty levels on the design and safety parameters for the innovative European Sodium Fast Reactor (ESFR) is mandatory. Some of these relevant safety quantities are the Doppler and void reactivity coefficients, whose uncertainties are quantified. Besides, the nuclear reaction data where an improvement will certainly benefit the design accuracy are identified. This work has been performed with the SCALE 6.1 codes suite and its multigroups cross sections library based on ENDF/B-VII.0 evaluation.

An improved lambda-scheme for one-dimensional flows

NASA Technical Reports Server (NTRS)

Moretti, G.; Dipiano, M. T.

1983-01-01

A code for the calculation of one-dimensional flows is presented, which combines a simple and efficient version of the lambda-scheme with tracking of discontinuities. The latter is needed to identify points where minor departures from the basic integration scheme are applied to prevent infiltration of numerical errors. Such a tracking is obtained via a systematic application of Boolean algebra. It is, therefore, very efficient. Fifteen examples are presented and discussed in detail. The results are exceptionally good. All discontinuites are captured within one mesh interval.

Improvements and applications of COBRA-TF for stand-alone and coupled LWR safety analyses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Avramova, M.; Cuervo, D.; Ivanov, K.

2006-07-01

The advanced thermal-hydraulic subchannel code COBRA-TF has been recently improved and applied for stand-alone and coupled LWR core calculations at the Pennsylvania State Univ. in cooperation with AREVA NP GmbH (Germany)) and the Technical Univ. of Madrid. To enable COBRA-TF for academic and industrial applications including safety margins evaluations and LWR core design analyses, the code programming, numerics, and basic models were revised and substantially improved. The code has undergone through an extensive validation, verification, and qualification program. (authors)

A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

PubMed

Gawel, Marcie; Emerson, Beth; Giuliano, John S; Rosenberg, Alana; Minges, Karl E; Feder, Shelli; Violano, Pina; Morrell, Patricia; Petersen, Judy; Christison-Lagay, Emily; Auerbach, Marc

2018-02-01

Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

A Strategy for Reusing the Data of Electronic Medical Record Systems for Clinical Research.

PubMed

Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Tsuda, Tsutomu; Takeda, Toshihiro; Okada, Katsuki; Murata, Taizo; Mihara, Naoki

2016-01-01

There is a great need to reuse data stored in electronic medical records (EMR) databases for clinical research. We previously reported the development of a system in which progress notes and case report forms (CRFs) were simultaneously recorded using a template in the EMR in order to exclude redundant data entry. To make the data collection process more efficient, we are developing a system in which the data originally stored in the EMR database can be populated within a frame in a template. We developed interface plugin modules that retrieve data from the databases of other EMR applications. A universal keyword written in a template master is converted to a local code using a data conversion table, then the objective data is retrieved from the corresponding database. The template element data, which are entered by a template, are stored in the template element database. To retrieve the data entered by other templates, the objective data is designated by the template element code with the template code, or by the concept code if it is written for the element. When the application systems in the EMR generate documents, they also generate a PDF file and a corresponding document profile XML, which includes important data, and send them to the document archive server and the data sharing saver, respectively. In the data sharing server, the data are represented by an item with an item code with a document class code and its value. By linking a concept code to an item identifier, an objective data can be retrieved by designating a concept code. We employed a flexible strategy in which a unique identifier for a hospital is initially attached to all of the data that the hospital generates. The identifier is secondarily linked with concept codes. The data that are not linked with a concept code can also be retrieved using the unique identifier of the hospital. This strategy makes it possible to reuse any of a hospital's data.

A reduced complexity highly power/bandwidth efficient coded FQPSK system with iterative decoding

NASA Technical Reports Server (NTRS)

Simon, M. K.; Divsalar, D.

2001-01-01

Based on a representation of FQPSK as a trellis-coded modulation, this paper investigates the potential improvement in power efficiency obtained from the application of simple outer codes to form a concatenated coding arrangement with iterative decoding.

Exploring a QoS Driven Scheduling Approach for Peer-to-Peer Live Streaming Systems with Network Coding

PubMed Central

Cui, Laizhong; Lu, Nan; Chen, Fu

2014-01-01

Most large-scale peer-to-peer (P2P) live streaming systems use mesh to organize peers and leverage pull scheduling to transmit packets for providing robustness in dynamic environment. The pull scheduling brings large packet delay. Network coding makes the push scheduling feasible in mesh P2P live streaming and improves the efficiency. However, it may also introduce some extra delays and coding computational overhead. To improve the packet delay, streaming quality, and coding overhead, in this paper are as follows. we propose a QoS driven push scheduling approach. The main contributions of this paper are: (i) We introduce a new network coding method to increase the content diversity and reduce the complexity of scheduling; (ii) we formulate the push scheduling as an optimization problem and transform it to a min-cost flow problem for solving it in polynomial time; (iii) we propose a push scheduling algorithm to reduce the coding overhead and do extensive experiments to validate the effectiveness of our approach. Compared with previous approaches, the simulation results demonstrate that packet delay, continuity index, and coding ratio of our system can be significantly improved, especially in dynamic environments. PMID:25114968

Developmental Origins, Epigenetics, and Equity: Moving Upstream.

PubMed

Wallack, Lawrence; Thornburg, Kent

2016-05-01

The Developmental Origins of Health and Disease and the related science of epigenetics redefines the meaning of what constitutes upstream approaches to significant social and public health problems. An increasingly frequent concept being expressed is "When it comes to your health, your zip code may be more important than your genetic code". Epigenetics explains how the environment-our zip code-literally gets under our skin, creates biological changes that increase our vulnerability for disease, and even children's prospects for social success, over their life course and into future generations. This science requires us to rethink where disease comes from and the best way to promote health. It identifies the most fundamental social equity issue in our society: that initial social and biological disadvantage, established even prior to birth, and linked to the social experience of prior generations, is made worse by adverse environments throughout the life course. But at the same time, it provides hope because it tells us that a concerted focus on using public policy to improve our social, physical, and economic environments can ultimately change our biology and the trajectory of health and social success into future generations.

Use of the Spine Adverse Events Severity System (SAVES) in patients with traumatic spinal cord injury. A comparison with institutional ICD-10 coding for the identification of acute care adverse events.

PubMed

Street, J T; Thorogood, N P; Cheung, A; Noonan, V K; Chen, J; Fisher, C G; Dvorak, M F

2013-06-01

Observational cohort comparison. To compare the previously validated Spine Adverse Events Severity system (SAVES) with International Classification of Diseases, Tenth Revision codes (ICD-10) codes for identifying adverse events (AEs) in patients with traumatic spinal cord injury (TSCI). Quaternary Care Spine Program. Patients discharged between 2006 and 2010 were identified from our prospective registry. Two consecutive cohorts were created based on the system used to record acute care AEs; one used ICD-10 coding by hospital coders and the other used SAVES data prospectively collected by a multidisciplinary clinical team. The ICD-10 codes were appropriately mapped to the SAVES. There were 212 patients in the ICD-10 cohort and 173 patients in the SAVES cohort. Analyses were adjusted to account for the different sample sizes, and the two cohorts were comparable based on age, gender and motor score. The SAVES system identified twice as many AEs per person as ICD-10 coding. Fifteen unique AEs were more reliably identified using SAVES, including neuropathic pain (32 × more; P<0.001), urinary tract infections (1.4 × ; P<0.05), pressure sores (2.9 × ; P<0.001) and intra-operative AEs (2.3 × ; P<0.05). Eight of these 15 AEs more frequently identified by SAVES significantly impacted length of stay (P<0.05). Risk factors such as patient age and severity of paralysis were more reliably correlated to AEs collected through SAVES than ICD-10. Implementation of the SAVES system for patients with TSCI captured more individuals experiencing AEs and more AEs per person compared with ICD-10 codes. This study demonstrates the utility of prospectively collecting AE data using validated tools.

Identifying work-related motor vehicle crashes in multiple databases.

PubMed

Thomas, Andrea M; Thygerson, Steven M; Merrill, Ray M; Cook, Lawrence J

2012-01-01

To compare and estimate the magnitude of work-related motor vehicle crashes in Utah using 2 probabilistically linked statewide databases. Data from 2006 and 2007 motor vehicle crash and hospital databases were joined through probabilistic linkage. Summary statistics and capture-recapture were used to describe occupants injured in work-related motor vehicle crashes and estimate the size of this population. There were 1597 occupants in the motor vehicle crash database and 1673 patients in the hospital database identified as being in a work-related motor vehicle crash. We identified 1443 occupants with at least one record from either the motor vehicle crash or hospital database indicating work-relatedness that linked to any record in the opposing database. We found that 38.7 percent of occupants injured in work-related motor vehicle crashes identified in the motor vehicle crash database did not have a primary payer code of workers' compensation in the hospital database and 40.0 percent of patients injured in work-related motor vehicle crashes identified in the hospital database did not meet our definition of a work-related motor vehicle crash in the motor vehicle crash database. Depending on how occupants injured in work-related motor crashes are identified, we estimate the population to be between 1852 and 8492 in Utah for the years 2006 and 2007. Research on single databases may lead to biased interpretations of work-related motor vehicle crashes. Combining 2 population based databases may still result in an underestimate of the magnitude of work-related motor vehicle crashes. Improved coding of work-related incidents is needed in current databases.

Development and implementation of a 'Mental Health Finder' software tool within an electronic medical record system.

PubMed

Swan, D; Hannigan, A; Higgins, S; McDonnell, R; Meagher, D; Cullen, W

2017-02-01

In Ireland, as in many other healthcare systems, mental health service provision is being reconfigured with a move toward more care in the community, and particularly primary care. Recording and surveillance systems for mental health information and activities in primary care are needed for service planning and quality improvement. We describe the development and initial implementation of a software tool ('mental health finder') within a widely used primary care electronic medical record system (EMR) in Ireland to enable large-scale data collection on the epidemiology and management of mental health and substance use problems among patients attending general practice. In collaboration with the Irish Primary Care Research Network (IPCRN), we developed the 'Mental Health Finder' as a software plug-in to a commonly used primary care EMR system to facilitate data collection on mental health diagnoses and pharmacological treatments among patients. The finder searches for and identifies patients based on diagnostic coding and/or prescribed medicines. It was initially implemented among a convenience sample of six GP practices. Prevalence of mental health and substance use problems across the six practices, as identified by the finder, was 9.4% (range 6.9-12.7%). 61.9% of identified patients were female; 25.8% were private patients. One-third (33.4%) of identified patients were prescribed more than one class of psychotropic medication. Of the patients identified by the finder, 89.9% were identifiable via prescribing data, 23.7% via diagnostic coding. The finder is a feasible and promising methodology for large-scale data collection on mental health problems in primary care.

Surface code implementation of block code state distillation.

PubMed

Fowler, Austin G; Devitt, Simon J; Jones, Cody

2013-01-01

State distillation is the process of taking a number of imperfect copies of a particular quantum state and producing fewer better copies. Until recently, the lowest overhead method of distilling states produced a single improved [formula: see text] state given 15 input copies. New block code state distillation methods can produce k improved [formula: see text] states given 3k + 8 input copies, potentially significantly reducing the overhead associated with state distillation. We construct an explicit surface code implementation of block code state distillation and quantitatively compare the overhead of this approach to the old. We find that, using the best available techniques, for parameters of practical interest, block code state distillation does not always lead to lower overhead, and, when it does, the overhead reduction is typically less than a factor of three.

Surface code implementation of block code state distillation

PubMed Central

Fowler, Austin G.; Devitt, Simon J.; Jones, Cody

2013-01-01

State distillation is the process of taking a number of imperfect copies of a particular quantum state and producing fewer better copies. Until recently, the lowest overhead method of distilling states produced a single improved |A〉 state given 15 input copies. New block code state distillation methods can produce k improved |A〉 states given 3k + 8 input copies, potentially significantly reducing the overhead associated with state distillation. We construct an explicit surface code implementation of block code state distillation and quantitatively compare the overhead of this approach to the old. We find that, using the best available techniques, for parameters of practical interest, block code state distillation does not always lead to lower overhead, and, when it does, the overhead reduction is typically less than a factor of three. PMID:23736868

Summary of papers on current and anticipated uses of thermal-hydraulic codes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caruso, R.

1997-07-01

The author reviews a range of recent papers which discuss possible uses and future development needs for thermal/hydraulic codes in the nuclear industry. From this review, eight common recommendations are extracted. They are: improve the user interface so that more people can use the code, so that models are easier and less expensive to prepare and maintain, and so that the results are scrutable; design the code so that it can easily be coupled to other codes, such as core physics, containment, fission product behaviour during severe accidents; improve the numerical methods to make the code more robust and especiallymore » faster running, particularly for low pressure transients; ensure that future code development includes assessment of code uncertainties as integral part of code verification and validation; provide extensive user guidelines or structure the code so that the `user effect` is minimized; include the capability to model multiple fluids (gas and liquid phase); design the code in a modular fashion so that new models can be added easily; provide the ability to include detailed or simplified component models; build on work previously done with other codes (RETRAN, RELAP, TRAC, CATHARE) and other code validation efforts (CSAU, CSNI SET and IET matrices).« less

Xylose utilizing Zymomonas mobilis with improved ethanol production in biomass hydrolysate medium

DOEpatents

Caimi, Perry G; Hitz, William D; Viitanen, Paul V; Stieglitz, Barry

2013-10-29

Xylose-utilizing, ethanol producing strains of Zymomonas mobilis with improved performance in medium comprising biomass hydrolysate were isolated using an adaptation process. Independently isolated strains were found to have independent mutations in the same coding region. Mutation in this coding may be engineered to confer the improved phenotype.

Xylose utilizing zymomonas mobilis with improved ethanol production in biomass hydrolysate medium

DOEpatents

Caimi, Perry G; Hitz, William D; Stieglitz, Barry; Viitanen, Paul V

2013-07-02

Xylose-utilizing, ethanol producing strains of Zymomonas mobilis with improved performance in medium comprising biomass hydrolysate were isolated using an adaptation process. Independently isolated strains were found to have independent mutations in the same coding region. Mutation in this coding may be engineered to confer the improved phenotype.

Improvements of MCOR: A Monte Carlo depletion code system for fuel assembly reference calculations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tippayakul, C.; Ivanov, K.; Misu, S.

2006-07-01

This paper presents the improvements of MCOR, a Monte Carlo depletion code system for fuel assembly reference calculations. The improvements of MCOR were initiated by the cooperation between the Penn State Univ. and AREVA NP to enhance the original Penn State Univ. MCOR version in order to be used as a new Monte Carlo depletion analysis tool. Essentially, a new depletion module using KORIGEN is utilized to replace the existing ORIGEN-S depletion module in MCOR. Furthermore, the online burnup cross section generation by the Monte Carlo calculation is implemented in the improved version instead of using the burnup cross sectionmore » library pre-generated by a transport code. Other code features have also been added to make the new MCOR version easier to use. This paper, in addition, presents the result comparisons of the original and the improved MCOR versions against CASMO-4 and OCTOPUS. It was observed in the comparisons that there were quite significant improvements of the results in terms of k{sub inf}, fission rate distributions and isotopic contents. (authors)« less

Evaluation in industry of a draft code of practice for manual handling.

PubMed

Ashby, Liz; Tappin, David; Bentley, Tim

2004-05-01

This paper reports findings from a study which evaluated the draft New Zealand Code of Practice for Manual Handling. The evaluation assessed the ease of use, applicability and validity of the Code and in particular the associated manual handling hazard assessment tools, within New Zealand industry. The Code was studied in a sample of eight companies from four sectors of industry. Subjective feedback and objective findings indicated that the Code was useful, applicable and informative. The manual handling hazard assessment tools incorporated in the Code could be adequately applied by most users, with risk assessment outcomes largely consistent with the findings of researchers using more specific ergonomics methodologies. However, some changes were recommended to the risk assessment tools to improve usability and validity. The evaluation concluded that both the Code and the tools within it would benefit from simplification, improved typography and layout, and industry-specific information on manual handling hazards.

Validity of Diagnostic Codes for Acute Stroke in Administrative Databases: A Systematic Review

PubMed Central

McCormick, Natalie; Bhole, Vidula; Lacaille, Diane; Avina-Zubieta, J. Antonio

2015-01-01

Objective To conduct a systematic review of studies reporting on the validity of International Classification of Diseases (ICD) codes for identifying stroke in administrative data. Methods MEDLINE and EMBASE were searched (inception to February 2015) for studies: (a) Using administrative data to identify stroke; or (b) Evaluating the validity of stroke codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), or Kappa scores) for stroke, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2015) of original papers. Studies solely evaluating codes for transient ischaemic attack were excluded. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Results Seventy-seven studies published from 1976–2015 were included. The sensitivity of ICD-9 430-438/ICD-10 I60-I69 for any cerebrovascular disease was ≥ 82% in most [≥ 50%] studies, and specificity and NPV were both ≥ 95%. The PPV of these codes for any cerebrovascular disease was ≥ 81% in most studies, while the PPV specifically for acute stroke was ≤ 68%. In at least 50% of studies, PPVs were ≥ 93% for subarachnoid haemorrhage (ICD-9 430/ICD-10 I60), 89% for intracerebral haemorrhage (ICD-9 431/ICD-10 I61), and 82% for ischaemic stroke (ICD-9 434/ICD-10 I63 or ICD-9 434&436). For in-hospital deaths, sensitivity was 55%. For cerebrovascular disease or acute stroke as a cause-of-death on death certificates, sensitivity was ≤ 71% in most studies while PPV was ≥ 87%. Conclusions While most cases of prevalent cerebrovascular disease can be detected using 430-438/I60-I69 collectively, acute stroke must be defined using more specific codes. Most in-hospital deaths and death certificates with stroke as a cause-of-death correspond to true stroke deaths. Linking vital statistics and hospitalization data may improve the ascertainment of fatal stroke. PMID:26292280

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children

PubMed Central

Davis, Kristen L.

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants (n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality. PMID:28607563

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children.

PubMed

Davis, Kristen L; Brann, Lynn S

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants ( n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality.

“There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

PubMed Central

Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

2012-01-01

Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

Assessment of the Effects of Entrainment and Wind Shear on Nuclear Cloud Rise Modeling

NASA Astrophysics Data System (ADS)

Zalewski, Daniel; Jodoin, Vincent

2001-04-01

Accurate modeling of nuclear cloud rise is critical in hazard prediction following a nuclear detonation. This thesis recommends improvements to the model currently used by DOD. It considers a single-term versus a three-term entrainment equation, the value of the entrainment and eddy viscous drag parameters, as well as the effect of wind shear in the cloud rise following a nuclear detonation. It examines departures from the 1979 version of the Department of Defense Land Fallout Interpretive Code (DELFIC) with the current code used in the Hazard Prediction and Assessment Capability (HPAC) code version 3.2. The recommendation for a single-term entrainment equation, with constant value parameters, without wind shear corrections, and without cloud oscillations is based on both a statistical analysis using 67 U.S. nuclear atmospheric test shots and the physical representation of the modeling. The statistical analysis optimized the parameter values of interest for four cases: the three-term entrainment equation with wind shear and without wind shear as well as the single-term entrainment equation with and without wind shear. The thesis then examines the effect of cloud oscillations as a significant departure in the code. Modifications to user input atmospheric tables are identified as a potential problem in the calculation of stabilized cloud dimensions in HPAC.

Monitoring the use and outcomes of new devices and procedures: how does coding affect what Hospital Episode Statistics contribute? Lessons from 12 emerging procedures 2006-10.

PubMed

Patrick, Hannah; Sims, Andrew; Burn, Julie; Bousfield, Derek; Colechin, Elaine; Reay, Christopher; Alderson, Neil; Goode, Stephen; Cunningham, David; Campbell, Bruce

2013-03-01

New devices and procedures are often introduced into health services when the evidence base for their efficacy and safety is limited. The authors sought to assess the availability and accuracy of routinely collected Hospital Episodes Statistics (HES) data in the UK and their potential contribution to the monitoring of new procedures. Four years of HES data (April 2006-March 2010) were analysed to identify episodes of hospital care involving a sample of 12 new interventional procedures. HES data were cross checked against other relevant sources including national or local registers and manufacturers' information. HES records were available for all 12 procedures during the entire study period. Comparative data sources were available from national (5), local (2) and manufacturer (2) registers. Factors found to affect comparisons were miscoding, alternative coding and inconsistent use of subsidiary codes. The analysis of provider coverage showed that HES is sensitive at detecting centres which carry out procedures, but specificity is poor in some cases. Routinely collected HES data have the potential to support quality improvements and evidence-based commissioning of devices and procedures in health services but achievement of this potential depends upon the accurate coding of procedures.

The role of the PIRT process in identifying code improvements and executing code development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wilson, G.E.; Boyack, B.E.

1997-07-01

In September 1988, the USNRC issued a revised ECCS rule for light water reactors that allows, as an option, the use of best estimate (BE) plus uncertainty methods in safety analysis. The key feature of this licensing option relates to quantification of the uncertainty in the determination that an NPP has a {open_quotes}low{close_quotes} probability of violating the safety criteria specified in 10 CFR 50. To support the 1988 licensing revision, the USNRC and its contractors developed the CSAU evaluation methodology to demonstrate the feasibility of the BE plus uncertainty approach. The PIRT process, Step 3 in the CSAU methodology, wasmore » originally formulated to support the BE plus uncertainty licensing option as executed in the CSAU approach to safety analysis. Subsequent work has shown the PIRT process to be a much more powerful tool than conceived in its original form. Through further development and application, the PIRT process has shown itself to be a robust means to establish safety analysis computer code phenomenological requirements in their order of importance to such analyses. Used early in research directed toward these objectives, PIRT results also provide the technical basis and cost effective organization for new experimental programs needed to improve the safety analysis codes for new applications. The primary purpose of this paper is to describe the generic PIRT process, including typical and common illustrations from prior applications. The secondary objective is to provide guidance to future applications of the process to help them focus, in a graded approach, on systems, components, processes and phenomena that have been common in several prior applications.« less

Validation of psoriatic arthritis diagnoses in electronic medical records using natural language processing

PubMed Central

Cai, Tianxi; Karlson, Elizabeth W.

2013-01-01

Objectives To test whether data extracted from full text patient visit notes from an electronic medical record (EMR) would improve the classification of PsA compared to an algorithm based on codified data. Methods From the > 1,350,000 adults in a large academic EMR, all 2318 patients with a billing code for PsA were extracted and 550 were randomly selected for chart review and algorithm training. Using codified data and phrases extracted from narrative data using natural language processing, 31 predictors were extracted and three random forest algorithms trained using coded, narrative, and combined predictors. The receiver operator curve (ROC) was used to identify the optimal algorithm and a cut point was chosen to achieve the maximum sensitivity possible at a 90% positive predictive value (PPV). The algorithm was then used to classify the remaining 1768 charts and finally validated in a random sample of 300 cases predicted to have PsA. Results The PPV of a single PsA code was 57% (95%CI 55%–58%). Using a combination of coded data and NLP the random forest algorithm reached a PPV of 90% (95%CI 86%–93%) at sensitivity of 87% (95% CI 83% – 91%) in the training data. The PPV was 93% (95%CI 89%–96%) in the validation set. Adding NLP predictors to codified data increased the area under the ROC (p < 0.001). Conclusions Using NLP with text notes from electronic medical records improved the performance of the prediction algorithm significantly. Random forests were a useful tool to accurately classify psoriatic arthritis cases to enable epidemiological research. PMID:20701955

Helium: lifting high-performance stencil kernels from stripped x86 binaries to halide DSL code

DOE PAGES

Mendis, Charith; Bosboom, Jeffrey; Wu, Kevin; ...

2015-06-03

Highly optimized programs are prone to bit rot, where performance quickly becomes suboptimal in the face of new hardware and compiler techniques. In this paper we show how to automatically lift performance-critical stencil kernels from a stripped x86 binary and generate the corresponding code in the high-level domain-specific language Halide. Using Halide's state-of-the-art optimizations targeting current hardware, we show that new optimized versions of these kernels can replace the originals to rejuvenate the application for newer hardware. The original optimized code for kernels in stripped binaries is nearly impossible to analyze statically. Instead, we rely on dynamic traces to regeneratemore » the kernels. We perform buffer structure reconstruction to identify input, intermediate and output buffer shapes. Here, we abstract from a forest of concrete dependency trees which contain absolute memory addresses to symbolic trees suitable for high-level code generation. This is done by canonicalizing trees, clustering them based on structure, inferring higher-dimensional buffer accesses and finally by solving a set of linear equations based on buffer accesses to lift them up to simple, high-level expressions. Helium can handle highly optimized, complex stencil kernels with input-dependent conditionals. We lift seven kernels from Adobe Photoshop giving a 75 % performance improvement, four kernels from Irfan View, leading to 4.97 x performance, and one stencil from the mini GMG multigrid benchmark netting a 4.25 x improvement in performance. We manually rejuvenated Photoshop by replacing eleven of Photoshop's filters with our lifted implementations, giving 1.12 x speedup without affecting the user experience.« less

The Maximal C³ Self-Complementary Trinucleotide Circular Code X in Genes of Bacteria, Archaea, Eukaryotes, Plasmids and Viruses.

PubMed

Michel, Christian J

2017-04-18

In 1996, a set X of 20 trinucleotides was identified in genes of both prokaryotes and eukaryotes which has on average the highest occurrence in reading frame compared to its two shifted frames. Furthermore, this set X has an interesting mathematical property as X is a maximal C 3 self-complementary trinucleotide circular code. In 2015, by quantifying the inspection approach used in 1996, the circular code X was confirmed in the genes of bacteria and eukaryotes and was also identified in the genes of plasmids and viruses. The method was based on the preferential occurrence of trinucleotides among the three frames at the gene population level. We extend here this definition at the gene level. This new statistical approach considers all the genes, i.e., of large and small lengths, with the same weight for searching the circular code X . As a consequence, the concept of circular code, in particular the reading frame retrieval, is directly associated to each gene. At the gene level, the circular code X is strengthened in the genes of bacteria, eukaryotes, plasmids, and viruses, and is now also identified in the genes of archaea. The genes of mitochondria and chloroplasts contain a subset of the circular code X . Finally, by studying viral genes, the circular code X was found in DNA genomes, RNA genomes, double-stranded genomes, and single-stranded genomes.

Local statistics adaptive entropy coding method for the improvement of H.26L VLC coding

NASA Astrophysics Data System (ADS)

Yoo, Kook-yeol; Kim, Jong D.; Choi, Byung-Sun; Lee, Yung Lyul

2000-05-01

In this paper, we propose an adaptive entropy coding method to improve the VLC coding efficiency of H.26L TML-1 codec. First of all, we will show that the VLC coding presented in TML-1 does not satisfy the sibling property of entropy coding. Then, we will modify the coding method into the local statistics adaptive one to satisfy the property. The proposed method based on the local symbol statistics dynamically changes the mapping relationship between symbol and bit pattern in the VLC table according to sibling property. Note that the codewords in the VLC table of TML-1 codec is not changed. Since this changed mapping relationship also derived in the decoder side by using the decoded symbols, the proposed VLC coding method does not require any overhead information. The simulation results show that the proposed method gives about 30% and 37% reduction in average bit rate for MB type and CBP information, respectively.

Accuracy of clinical coding for procedures in oral and maxillofacial surgery.

PubMed

Khurram, S A; Warner, C; Henry, A M; Kumar, A; Mohammed-Ali, R I

2016-10-01

Clinical coding has important financial implications, and discrepancies in the assigned codes can directly affect the funding of a department and hospital. Over the last few years, numerous oversights have been noticed in the coding of oral and maxillofacial (OMF) procedures. To establish the accuracy and completeness of coding, we retrospectively analysed the records of patients during two time periods: March to May 2009 (324 patients), and January to March 2014 (200 patients). Two investigators independently collected and analysed the data to ensure accuracy and remove bias. A large proportion of operations were not assigned all the relevant codes, and only 32% - 33% were correct in both cycles. To our knowledge, this is the first reported audit of clinical coding in OMFS, and it highlights serious shortcomings that have substantial financial implications. Better input by the surgical team and improved communication between the surgical and coding departments will improve accuracy. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Future regional transport aircraft market, constraints, and technology stimuli

NASA Technical Reports Server (NTRS)

Harvey, W. Don; Foreman, Brent

1992-01-01

This report provides updated information on the current market and operating environment and identifies interlinking technical possibilities for competitive future commuter-type transport aircraft. The conclusions on the market and operating environment indicate that the regional airlines are moving toward more modern and effective fleets with greater passenger capacity and comfort, reduced noise levels, increased speed, and longer range. This direction leads to a nearly 'seamless' service and continued code-sharing agreements with the major carriers. Whereas the benefits from individual technologies may be small, the overall integration in existing and new aircraft designs can produce improvements in direct operating cost and competitiveness. Production costs are identified as being equally important as pure technical advances.

75 FR 46903 - Notice of Proposed Changes to the National Handbook of Conservation Practices for the Natural...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-04

... Treatment (Code 521D), Pond Sealing or Lining--Soil Dispersant Treatment (Code 521B), Salinity and Sodic Soil Management (Code 610), Stream Habitat Improvement and Management (Code 395), Vertical Drain (Code... the criteria section; an expansion of the considerations section to include fish and wildlife and soil...

Caregiver and patient reported outcomes after repair of cleft lip and/or palate in the Philippines.

PubMed

Sharp, Helen M; Canady, John W; Ligot, Fernando A C; Hague, Rebecca A; Gutierrez, Johcille; Gutierrez, Johnny

2008-03-01

To establish the feasibility of conducting outcomes research among patients treated during a medical mission and to identify the salient outcomes for patients and caregivers in one region of the Philippines. Prospective structured interview conducted in or near participants' homes on the island of Cebu, Philippines. Individuals who had surgery at least 6 months earlier within the study region were eligible. Recipients of surgery were located from surgical records and by word of mouth. (1) Proportion of individuals located. (2) Primary outcomes of oral cleft repair identified for the sample. Of 99 people on a surgical list, 52 (53%) were located, eight were excluded (ineligible, unavailable, or inaccessible), and 44 agreed to participate in the study. Ten participants were identified via word of mouth. Seventy-five interviews were conducted (21 caregiver-patient pairs, one adolescent, and 32 caregivers of a child <7 years). Nearly all participants (99%) would encourage others to pursue surgery. Open-ended questions were coded to identify primary outcomes: improved speech (52%), improved eating (25%), social benefits (14%), and improved appearance (6%). Caregivers (50%) and patients (68%) reported that improved speech was the most important change after surgery. Patients and caregivers ascribe positive changes related to cleft surgery. Outcomes research requires cooperation with local professionals who can communicate effectively. These data serve to demonstrate feasibility and as a model for future studies of treatment outcomes in follow-up to international medical missions.

Mobile, hybrid Compton/coded aperture imaging for detection, identification and localization of gamma-ray sources at stand-off distances

NASA Astrophysics Data System (ADS)

Tornga, Shawn R.

The Stand-off Radiation Detection System (SORDS) program is an Advanced Technology Demonstration (ATD) project through the Department of Homeland Security's Domestic Nuclear Detection Office (DNDO) with the goal of detection, identification and localization of weak radiological sources in the presence of large dynamic backgrounds. The Raytheon-SORDS Tri-Modal Imager (TMI) is a mobile truck-based, hybrid gamma-ray imaging system able to quickly detect, identify and localize, radiation sources at standoff distances through improved sensitivity while minimizing the false alarm rate. Reconstruction of gamma-ray sources is performed using a combination of two imaging modalities; coded aperture and Compton scatter imaging. The TMI consists of 35 sodium iodide (NaI) crystals 5x5x2 in3 each, arranged in a random coded aperture mask array (CA), followed by 30 position sensitive NaI bars each 24x2.5x3 in3 called the detection array (DA). The CA array acts as both a coded aperture mask and scattering detector for Compton events. The large-area DA array acts as a collection detector for both Compton scattered events and coded aperture events. In this thesis, developed coded aperture, Compton and hybrid imaging algorithms will be described along with their performance. It will be shown that multiple imaging modalities can be fused to improve detection sensitivity over a broader energy range than either alone. Since the TMI is a moving system, peripheral data, such as a Global Positioning System (GPS) and Inertial Navigation System (INS) must also be incorporated. A method of adapting static imaging algorithms to a moving platform has been developed. Also, algorithms were developed in parallel with detector hardware, through the use of extensive simulations performed with the Geometry and Tracking Toolkit v4 (GEANT4). Simulations have been well validated against measured data. Results of image reconstruction algorithms at various speeds and distances will be presented as well as localization capability. Utilizing imaging information will show signal-to-noise gains over spectroscopic algorithms alone.

Speech coding at low to medium bit rates

NASA Astrophysics Data System (ADS)

Leblanc, Wilfred Paul

1992-09-01

Improved search techniques coupled with improved codebook design methodologies are proposed to improve the performance of conventional code-excited linear predictive coders for speech. Improved methods for quantizing the short term filter are developed by employing a tree search algorithm and joint codebook design to multistage vector quantization. Joint codebook design procedures are developed to design locally optimal multistage codebooks. Weighting during centroid computation is introduced to improve the outlier performance of the multistage vector quantizer. Multistage vector quantization is shown to be both robust against input characteristics and in the presence of channel errors. Spectral distortions of about 1 dB are obtained at rates of 22-28 bits/frame. Structured codebook design procedures for excitation in code-excited linear predictive coders are compared to general codebook design procedures. Little is lost using significant structure in the excitation codebooks while greatly reducing the search complexity. Sparse multistage configurations are proposed for reducing computational complexity and memory size. Improved search procedures are applied to code-excited linear prediction which attempt joint optimization of the short term filter, the adaptive codebook, and the excitation. Improvements in signal to noise ratio of 1-2 dB are realized in practice.

Cracking the code: the accuracy of coding shoulder procedures and the repercussions.

PubMed

Clement, N D; Murray, I R; Nie, Y X; McBirnie, J M

2013-05-01

Coding of patients' diagnosis and surgical procedures is subject to error levels of up to 40% with consequences on distribution of resources and financial recompense. Our aim was to explore and address reasons behind coding errors of shoulder diagnosis and surgical procedures and to evaluate a potential solution. A retrospective review of 100 patients who had undergone surgery was carried out. Coding errors were identified and the reasons explored. A coding proforma was designed to address these errors and was prospectively evaluated for 100 patients. The financial implications were also considered. Retrospective analysis revealed the correct primary diagnosis was assigned in 54 patients (54%) had an entirely correct diagnosis, and only 7 (7%) patients had a correct procedure code assigned. Coders identified indistinct clinical notes and poor clarity of procedure codes as reasons for errors. The proforma was significantly more likely to assign the correct diagnosis (odds ratio 18.2, p < 0.0001) and the correct procedure code (odds ratio 310.0, p < 0.0001). Using the proforma resulted in a £28,562 increase in revenue for the 100 patients evaluated relative to the income generated from the coding department. High error levels for coding are due to misinterpretation of notes and ambiguity of procedure codes. This can be addressed by allowing surgeons to assign the diagnosis and procedure using a simplified list that is passed directly to coding.

Group visits for chronic illness management: implementation challenges and recommendations.

PubMed

Jones, Katherine R; Kaewluang, Napatsawan; Lekhak, Nirmala

2014-01-01

The group visit approach to improve chronic illness self-management appears promising in terms of selected outcomes, but little information is available about best ways to organize and implement group visits. This literature review of 84 articles identified group visit implementation challenges, including lack of a group visit billing code, inadequate administrative support and resources, difficult participant recruitment and retention, and logistical issues such as space and scheduling. Recommendations for future implementation initiatives were also abstracted from the literature. Patients and providers can benefit from well-planned and well-conducted group visits. These benefits include greater patient and provider satisfaction, reduced overall utilization, improved clinical outcomes, and greater provider efficiency and productivity.

Performance Measures in Neurosurgical Patient Care: Differing Applications of Patient Safety Indicators.

PubMed

Moghavem, Nuriel; McDonald, Kathryn; Ratliff, John K; Hernandez-Boussard, Tina

2016-04-01

Patient Safety Indicators (PSIs) are administratively coded identifiers of potentially preventable adverse events. These indicators are used for multiple purposes, including benchmarking and quality improvement efforts. Baseline PSI evaluation in high-risk surgeries is fundamental to both purposes. Determine PSI rates and their impact on other outcomes in patients undergoing cranial neurosurgery compared with other surgeries. The Agency for Healthcare Research and Quality (AHRQ) PSI software was used to flag adverse events and determine risk-adjusted rates (RAR). Regression models were built to assess the association between PSIs and important patient outcomes. We identified cranial neurosurgeries based on International Classification of Diseases, Ninth Revision, Clinical Modification codes in California, Florida, New York, Arkansas, and Mississippi State Inpatient Databases, AHRQ, 2010-2011. PSI development, 30-day all-cause readmission, length of stay, hospital costs, and inpatient mortality. A total of 48,424 neurosurgical patients were identified. Procedure indication was strongly associated with PSI development. The neurosurgical population had significantly higher RAR of most PSIs evaluated compared with other surgical patients. Development of a PSI was strongly associated with increased length of stay and hospital cost and, in certain PSIs, increased inpatient mortality and 30-day readmission. In this population-based study, certain accountability measures proposed for use as value-based payment modifiers show higher RAR in neurosurgery patients compared with other surgical patients and were subsequently associated with poor outcomes. Our results indicate that for quality improvement efforts, the current AHRQ risk-adjustment models should be viewed in clinically meaningful stratified subgroups: for profiling and pay-for-performance applications, additional factors should be included in the risk-adjustment models. Further evaluation of PSIs in additional high-risk surgeries is needed to better inform the use of these metrics.

Development of a risk prediction model among professional hockey players with visible signs of concussion.

PubMed

Bruce, Jared M; Echemendia, Ruben J; Meeuwisse, Willem; Hutchison, Michael G; Aubry, Mark; Comper, Paul

2017-04-04

Little research examines how to best identify concussed athletes. The purpose of the present study was to develop a preliminary risk decision model that uses visible signs (VS) and mechanisms of injury (MOI) to predict the likelihood of subsequent concussion diagnosis. Coders viewed and documented VS and associated MOI for all NHL games over the course of the 2013-2014 and 2014-2015 regular seasons. After coding was completed, player concussions were identified from the NHL injury surveillance system and it was determined whether players exhibiting VS were subsequently diagnosed with concussions by club medical staff as a result of the coded event. Among athletes exhibiting VS, suspected loss of consciousness, motor incoordination or balance problems, being in a fight, having an initial hit from another player's shoulder and having a secondary hit on the ice were all associated with increased risk of subsequent concussion diagnosis. In contrast, having an initial hit with a stick was associated with decreased risk of subsequent concussion diagnosis. A risk prediction model using a combination of the above VS and MOI was superior to approaches that relied on individual VS and associated MOI (sensitivity=81%, specificity=72%, positive predictive value=26%). Combined use of VS and MOI significantly improves a clinician's ability to identify players who need to be evaluated for possible concussion. A preliminary concussion prediction log has been developed from these data. Pending prospective validation, the use of these methods may improve early concussion detection and evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Identification of Hospitalizations for Intentional Self-Harm when E-Codes are Incompletely Recorded

PubMed Central

Patrick, Amanda R.; Miller, Matthew; Barber, Catherine W.; Wang, Philip S.; Canning, Claire F.; Schneeweiss, Sebastian

2010-01-01

Context Suicidal behavior has gained attention as an adverse outcome of prescription drug use. Hospitalizations for intentional self-harm, including suicide, can be identified in administrative claims databases using external cause of injury codes (E-codes). However, rates of E-code completeness in US government and commercial claims databases are low due to issues with hospital billing software. Objective To develop an algorithm to identify intentional self-harm hospitalizations using recorded injury and psychiatric diagnosis codes in the absence of E-code reporting. Methods We sampled hospitalizations with an injury diagnosis (ICD-9 800–995) from 2 databases with high rates of E-coding completeness: 1999–2001 British Columbia, Canada data and the 2004 U.S. Nationwide Inpatient Sample. Our gold standard for intentional self-harm was a diagnosis of E950-E958. We constructed algorithms to identify these hospitalizations using information on type of injury and presence of specific psychiatric diagnoses. Results The algorithm that identified intentional self-harm hospitalizations with high sensitivity and specificity was a diagnosis of poisoning; toxic effects; open wound to elbow, wrist, or forearm; or asphyxiation; plus a diagnosis of depression, mania, personality disorder, psychotic disorder, or adjustment reaction. This had a sensitivity of 63%, specificity of 99% and positive predictive value (PPV) of 86% in the Canadian database. Values in the US data were 74%, 98%, and 73%. PPV was highest (80%) in patients under 25 and lowest those over 65 (44%). Conclusions The proposed algorithm may be useful for researchers attempting to study intentional self-harm in claims databases with incomplete E-code reporting, especially among younger populations. PMID:20922709

A survey to identify the clinical coding and classification systems currently in use across Europe.

PubMed

de Lusignan, S; Minmagh, C; Kennedy, J; Zeimet, M; Bommezijn, H; Bryant, J

2001-01-01

This is a survey to identify what clinical coding systems are currently in use across the European Union, and the states seeking membership to it. We sought to identify what systems are currently used and to what extent they were subject to local adaptation. Clinical coding should facilitate identifying key medical events in a computerised medical record, and aggregating information across groups of records. The emerging new driver is as the enabler of the life-long computerised medical record. A prerequisite for this level of functionality is the transfer of information between different computer systems. This transfer can be facilitated either by working on the interoperability problems between disparate systems or by harmonising the underlying data. This paper examines the extent to which the latter has occurred across Europe. Literature and Internet search. Requests for information via electronic mail to pan-European mailing lists of health informatics professionals. Coding systems are now a de facto part of health information systems across Europe. There are relatively few coding systems in existence across Europe. ICD9 and ICD 10, ICPC and Read were the most established. However the local adaptation of these classification systems either on a by country or by computer software manufacturer basis; significantly reduces the ability for the meaning coded with patients computer records to be easily transferred from one medical record system to another. There is no longer any debate as to whether a coding or classification system should be used. Convergence of different classifications systems should be encouraged. Countries and computer manufacturers within the EU should be encouraged to stop making local modifications to coding and classification systems, as this practice risks significantly slowing progress towards easy transfer of records between computer systems.

Clinical application of ICF key codes to evaluate patients with dysphagia following stroke

PubMed Central

Dong, Yi; Zhang, Chang-Jie; Shi, Jie; Deng, Jinggui; Lan, Chun-Na

2016-01-01

Abstract This study was aimed to identify and evaluate the International Classification of Functioning (ICF) key codes for dysphagia in stroke patients. Thirty patients with dysphagia after stroke were enrolled in our study. To evaluate the ICF dysphagia scale, 6 scales were used as comparisons, namely the Barthel Index (BI), Repetitive Saliva Swallowing Test (RSST), Kubota Water Swallowing Test (KWST), Frenchay Dysarthria Assessment, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Multiple regression analysis was performed to quantitate the relationship between the ICF scale and the other 7 scales. In addition, 60 ICF scales were analyzed by the least absolute shrinkage and selection operator (LASSO) method. A total of 21 ICF codes were identified, which were closely related with the other scales. These included 13 codes from Body Function, 1 from Body Structure, 3 from Activities and Participation, and 4 from Environmental Factors. A topographic network map with 30 ICF key codes was also generated to visualize their relationships. The number of ICF codes identified is in line with other well-established evaluation methods. The network topographic map generated here could be used as an instruction tool in future evaluations. We also found that attention functions and biting were critical codes of these scales, and could be used as treatment targets. PMID:27661012

Utilization Rates of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: A 2012 Calculation for a Midwestern Health Referral Region

PubMed Central

Hoang, Allen; Shen, Changyu; Zheng, James; Taylor, Stanley; Groh, William J; Rosenman, Marc; Buxton, Alfred E.; Chen, Peng-Sheng

2014-01-01

Background Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective To establish the ICD UR in central Indiana. Methods A query run on two hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD-eligibility and utilization were determined from chart review. Results We identified 1,863 patients with at least one low-EF study. Two cohorts were analyzed: 1,672 patients without, and 191 patients with, ICD-9-CM procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% CI 28–49%). URs were 48% for males (95% CI 34–61%), 21% for females (95% CI 16–26%, p=0.0002 vs males), 40% for whites (95% CI 27–53%), and 37% for blacks (95% CI 28–46%, p=0.66 vs whites). Conclusions The ICD UR is 38% among patients meeting Class I indications, suggesting further opportunities to improve guideline compliance. Furthermore, this study illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review. PMID:24566233

Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: a 2012 calculation for a midwestern health referral region.

PubMed

Hoang, Allen; Shen, Changyu; Zheng, James; Taylor, Stanley; Groh, William J; Rosenman, Marc; Buxton, Alfred E; Chen, Peng-Sheng

2014-05-01

Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. The purpose of this study was to establish the ICD UR in central Indiana. A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD eligibility and utilization were determined from chart review. We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P = .0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P = .66 vs whites). ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Coding in Stroke and Other Cerebrovascular Diseases.

PubMed

Korb, Pearce J; Jones, William

2017-02-01

Accurate coding is critical for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.

GAMERA - The New Magnetospheric Code

NASA Astrophysics Data System (ADS)

Lyon, J.; Sorathia, K.; Zhang, B.; Merkin, V. G.; Wiltberger, M. J.; Daldorff, L. K. S.

2017-12-01

The Lyon-Fedder-Mobarry (LFM) code has been a main-line magnetospheric simulation code for 30 years. The code base, designed in the age of memory to memory vector ma- chines,is still in wide use for science production but needs upgrading to ensure the long term sustainability. In this presentation, we will discuss our recent efforts to update and improve that code base and also highlight some recent results. The new project GAM- ERA, Grid Agnostic MHD for Extended Research Applications, has kept the original design characteristics of the LFM and made significant improvements. The original de- sign included high order numerical differencing with very aggressive limiting, the ability to use arbitrary, but logically rectangular, grids, and maintenance of div B = 0 through the use of the Yee grid. Significant improvements include high-order upwinding and a non-clipping limiter. One other improvement with wider applicability is an im- proved averaging technique for the singularities in polar and spherical grids. The new code adopts a hybrid structure - multi-threaded OpenMP with an overarching MPI layer for large scale and coupled applications. The MPI layer uses a combination of standard MPI and the Global Array Toolkit from PNL to provide a lightweight mechanism for coupling codes together concurrently. The single processor code is highly efficient and can run magnetospheric simulations at the default CCMC resolution faster than real time on a MacBook pro. We have run the new code through the Athena suite of tests, and the results compare favorably with the codes available to the astrophysics community. LFM/GAMERA has been applied to many different situations ranging from the inner and outer heliosphere and magnetospheres of Venus, the Earth, Jupiter and Saturn. We present example results the Earth's magnetosphere including a coupled ring current (RCM), the magnetospheres of Jupiter and Saturn, and the inner heliosphere.