Validation of de-identified record linkage to ascertain hospital admissions in a cohort study

Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables. Methods A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review. Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%. Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.

Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial

The lymphedema diagnostic method used in descriptive or intervention studies may influence results found. The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial, between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic criteria used. No between-group differences were noted in the proportion of women who had a change in interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively (cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting was shown to be safe for women following breast cancer, even for those at risk or with lymphedema, irrespective of the diagnostic criteria used.

A mixed-method study to investigate the relationship between the number of social support people present during labour, women’s perceptions and birth outcomes

The birth of a baby is a significant event for women and their families, with the event being influenced by the prevailing social and cultural context. Historically, women throughout the world have given birth at home assisted by other women who helped them cope with the stress of labour and birth. In the middle of the twentieth century, the togetherness, caring and support that were provided within the social and cultural context of childbirth began to change; women in most developed countries, and to some extent in developing countries, laboured and gave birth in institutions that isolated them from the support of family and friends. This practice is referred to as the medical model of childbirth and, over time, birthing within this model has come to be viewed by women as a dehumanising experience. In an attempt to secure a more supportive experience, women began to demand the presence of a supportive companion; namely their partner. This event became the catalyst for a number of studies focusing on different types of support providers and their contribution to the phenomenon of social support during labour. More recently, it has become a common practice for some women to be supported during labour by a number of people from their social network. However, research on the influence of such supportive people on women’s experience of labour and birth and on birth outcomes is scarce. The aim of this study is to examine the influence of various support arrangements from a woman’s family and social network on her experience of labour and birth and on birth outcomes. The mixed-method study was conducted to answer three research questions: 1. Do women with more than one support person present during labour and birth have similar perceptions and experiences of support compared to women with one support person? 2. Do women with more than one support person present during labour and birth have similar birth outcomes compared to women with one support person? 3. Do women with different types of support providers during labour and birth have similar birth outcomes? Methods Phase one of this study developed, pilot tested and administered a newly developed instrument designed to measure women’s perceptions of supportive behaviours provided during labour. Specific birth outcome data were extracted from the medical records. Phase two consisted of in-depth interviews with a sample of women who had completed the survey. Results: The results identified a statistically significant relationship between women’s perceptions of social support and the number of support providers: women supported by one person only rated the supportive behaviours of that person more highly compared to women who were supported by a number of people. The results also identified that women supported by one person used less analgesia. An additional qualitative finding was that some women sacrificed the support of female relatives at the request of their partners. Conclusion: By using a mixed-method approach, this study found that women were selective in their choice of support providers, as they chose individuals with whom they had an enduring affectionate attachment. Women place more emphasis on a support person’s ability to fulfil their attachment needs of close proximity and a sense of security and safety, rather than their ability to provide the expected functional supportive behaviours.

Sustainable Road Management in Texas : network-level flexible pavement structural condition analysis using data mining techniques

The research team recognized the value of network-level Falling Weight Deflectometer (FWD) testing to evaluate the structural condition trends of flexible pavements. However, practical limitations due to the cost of testing, traffic control and safety concerns and the ability to test a large network may discourage some agencies from conducting the network-level FWD testing. For this reason, the surrogate measure of the Structural Condition Index (SCI) is suggested for use. The main purpose of the research presented in this paper is to investigate data mining strategies and to develop a prediction method of the structural condition trends for network-level applications which does not require FWD testing. The research team first evaluated the existing and historical pavement condition, distress, ride, traffic and other data attributes in the Texas Department of Transportation (TxDOT) Pavement Maintenance Information System (PMIS), applied data mining strategies to the data, discovered useful patterns and knowledge for SCI value prediction, and finally provided a reasonable measure of pavement structural condition which is correlated to the SCI. To evaluate the performance of the developed prediction approach, a case study was conducted using the SCI data calculated from the FWD data collected on flexible pavements over a 5-year period (2005 – 09) from 354 PMIS sections representing 37 pavement sections on the Texas highway system. The preliminary study results showed that the proposed approach can be used as a supportive pavement structural index in the event when FWD deflection data is not available and help pavement managers identify the timing and appropriate treatment level of preventive maintenance activities.

Evaluation of the iPhone with an acrylic sleeve versus the Scoliometer for rib hump measurement in scoliosis

Background. Vertebral rotation found in structural scoliosis contributes to trunkal asymmetry which is commonly measured with a simple Scoliometer device on a patient's thorax in the forward flexed position. The new generation of mobile 'smartphones' have an integrated accelerometer, making accurate angle measurement possible, which provides a potentially useful clinical tool for assessing rib hump deformity. This study aimed to compare rib hump angle measurements performed using a Smartphone and traditional Scoliometer on a set of plaster torsos representing the range of torsional deformities seen in clinical practice. Methods. Nine observers measured the rib hump found on eight plaster torsos moulded from scoliosis patients with both a Scoliometer and an Apple iPhone on separate occasions. Each observer repeated the measurements at least a week after the original measurements, and were blinded to previous results. Intra-observer reliability and inter-observer reliability were analysed using the method of Bland and Altman and 95% confidence intervals were calculated. The Intra-Class Correlation Coefficients (ICC) were calculated for repeated measurements of each of the eight plaster torso moulds by the nine observers. Results. Mean absolute difference between pairs of iPhone/Scoliometer measurements was 2.1 degrees, with a small (1 degrees) bias toward higher rib hump angles with the iPhone. 95% confidence intervals for intra-observer variability were +/- 1.8 degrees (Scoliometer) and +/- 3.2 degrees (iPhone). 95% confidence intervals for inter-observer variability were +/- 4.9 degrees (iPhone) and +/- 3.8 degrees (Scoliometer). The measurement errors and confidence intervals found were similar to or better than the range of previously published thoracic rib hump measurement studies. Conclusions. The iPhone is a clinically equivalent rib hump measurement tool to the Scoliometer in spinal deformity patients. The novel use of plaster torsos as rib hump models avoids the variables of patient fatigue and discomfort, inconsistent positioning and deformity progression using human subjects in a single or multiple measurement sessions.

Mixed-dimensional consistent coupling by multi-point constraint equations for efficient multi-scale modeling

Finding an appropriate linking method to connect different dimensional element types in a single finite element model is a key issue in the multi-scale modeling. This paper presents a mixed dimensional coupling method using multi-point constraint equations derived by equating the work done on either side of interface connecting beam elements and shell elements for constructing a finite element multiscale model. A typical steel truss frame structure is selected as case example and the reduced scale specimen of this truss section is then studied in the laboratory to measure its dynamic and static behavior in global truss and local welded details while the different analytical models are developed for numerical simulation. Comparison of dynamic and static response of the calculated results among different numerical models as well as the good agreement with those from experimental results indicates that the proposed multi-scale model is efficient and accurate.

An improved method to detect damage using modal strain energy based damage index

This paper presents two novel concepts to enhance the accuracy of damage detection using the Modal Strain Energy based Damage Index (MSEDI) with the presence of noise in the mode shape data. Firstly, the paper presents a sequential curve fitting technique that reduces the effect of noise on the calculation process of the MSEDI, more effectively than the two commonly used curve fitting techniques; namely, polynomial and Fourier’s series. Secondly, a probability based Generalized Damage Localization Index (GDLI) is proposed as a viable improvement to the damage detection process. The study uses a validated ABAQUS finite-element model of a reinforced concrete beam to obtain mode shape data in the undamaged and damaged states. Noise is simulated by adding three levels of random noise (1%, 3%, and 5%) to the mode shape data. Results show that damage detection is enhanced with increased number of modes and samples used with the GDLI.

A general method to determine sampling windows for nonlinear mixed effects models with an application to population pharmacokinetic studies

Optimal design methods have been proposed to determine the best sampling times when sparse blood sampling is required in clinical pharmacokinetic studies. However, the optimal blood sampling time points may not be feasible in clinical practice. Sampling windows, a time interval for blood sample collection, have been proposed to provide flexibility in blood sampling times while preserving efficient parameter estimation. Because of the complexity of the population pharmacokinetic models, which are generally nonlinear mixed effects models, there is no analytical solution available to determine sampling windows. We propose a method for determination of sampling windows based on MCMC sampling techniques. The proposed method attains a stationary distribution rapidly and provides time-sensitive windows around the optimal design points. The proposed method is applicable to determine sampling windows for any nonlinear mixed effects model although our work focuses on an application to population pharmacokinetic models.

A common neighbour based two-way collaborative recommendation method

Traditional recommendation methods offer items, that are inanimate and one way recommendation, to users. Emerging new applications such as online dating or job recruitments require reciprocal people-to-people recommendations that are animate and two-way recommendations. In this paper, we propose a reciprocal collaborative method based on the concepts of users' similarities and common neighbors. The dataset employed for the experiment is gathered from a real life online dating network. The proposed method is compared with baseline methods that use traditional collaborative algorithms. Results show the proposed method can achieve noticeably better performance than the baseline methods.

Assessment of “change in flexibility method” in structural health monitoring systems

The modern structural diagnosis process is rely on vibration characteristics to assess safer serviceability level of the structure. This paper examines the potential of change in flexibility method to use in damage detection process and two main practical constraints associated with it. The first constraint addressed in this paper is reduction in number of data acquisition points due to limited number of sensors. Results conclude that accuracy of the change in flexibility method is influenced by the number of data acquisition points/sensor locations in real structures. Secondly, the effect of higher modes on damage detection process has been studied. This addresses the difficulty of extracting higher order modal data with available sensors. Four damage indices have been presented to identify their potential of damage detection with respect to different locations and severity of damage. A simply supported beam with two degrees of freedom at each node is considered only for a single damage cases throughout the paper.

Spelling instruction through Etymology : a method of developing spelling lists for older students

The purpose of this study was to investigate whether an approach to developing word lists centred on etymological roots would improve the spelling performance of older primary school students. Participants were 46 students in the last year of primary school in south-east Queensland (31 girls and 15 boys) across three classes, with two classes being assigned to control conditions. Students were evaluated pre- and post-intervention on three dependent measures: British Spelling Test Series spelling, spelling in writing and writing. The results of this intervention revealed improvements in spelling for girls but not for boys. The implications for improved teaching methods are discussed.