Quantifying data quality for clinical trials using electronic data capture.

BACKGROUND: Historically, only partial assessments of data quality have been performed in clinical trials, for which the most common method of measuring database error rates has been to compare the case report form (CRF) to database entries and count discrepancies. Importantly, errors arising from medical record abstraction and transcription are rarely evaluated as part of such quality assessments. Electronic Data Capture (EDC) technology has had a further impact, as paper CRFs typically leveraged for quality measurement are not used in EDC processes. METHODS AND PRINCIPAL FINDINGS: The National Institute on Drug Abuse Treatment Clinical Trials Network has developed, implemented, and evaluated methodology for holistically assessing data quality on EDC trials. We characterize the average source-to-database error rate (14.3 errors per 10,000 fields) for the first year of use of the new evaluation method. This error rate was significantly lower than the average of published error rates for source-to-database audits, and was similar to CRF-to-database error rates reported in the published literature. We attribute this largely to an absence of medical record abstraction on the trials we examined, and to an outpatient setting characterized by less acute patient conditions. CONCLUSIONS: Historically, medical record abstraction is the most significant source of error by an order of magnitude, and should be measured and managed during the course of clinical trials. Source-to-database error rates are highly dependent on the amount of structured data collection in the clinical setting and on the complexity of the medical record, dependencies that should be considered when developing data quality benchmarks.

Hierarchical random walks in trace fossils and the origin of optimal search behavior

Efficient searching is crucial for timely location of food and other resources. Recent studies show diverse living animals employ a theoretically optimal scale-free random search for sparse resources known as a Lévy walk, but little is known of the origins and evolution of foraging behaviour and the search strategies of extinct organisms. Here we show using simulations of self-avoiding trace fossil trails that randomly introduced strophotaxis (U-turns) – initiated by obstructions such as ¬¬¬self-trail avoidance or innate cueing – leads to random looping patterns with clustering across increasing scales that is consistent with the presence of Lévy walks. This predicts optimal Lévy searches can emerge from simple behaviours observed in fossil trails. We then analysed fossilized trails of benthic marine organisms using a novel path analysis technique and find the first evidence of Lévy-like search strategies in extinct animals. Our results show that simple search behaviours of extinct animals in heterogeneous environments give rise to hierarchically nested Brownian walk clusters that converge to optimal Lévy patterns. Primary productivity collapse and large-scale food scarcity characterising mass extinctions evident in the fossil record may have triggered adaptation of optimal Lévy-like searches. The findings suggest Lévy-like behaviour has been employed by foragers since at least the Eocene but may have a more ancient origin, which could explain recent widespread observations of such patterns among modern taxa.

Translating policy into practice: A case study in the secondary prevention of coronary heart disease

Background: This paper focuses on the relationships between health ‘policy’ as it is embodied in official documentation, and health ‘practice’ as reported and reflected on in the talk of policy makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland – involving as they do a predominantly state funded (National Health Service) system in the north and a mixed healthcare economy in the south. The key question is to determine how the rhetoric of health policy as contained in policy documents connects to, and gets translated into practice and action.

Methods: The data sources for the study include relevant healthcare policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents’ contents and how they saw the impact of ‘policy’ on primary care practice.

Results: The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.

Conclusion: To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.

Flux and turnover of fixed carbon in soil microbial biomass of limed and unlimed plots of an upland grassland ecosystem

The influence of liming on rhizosphere microbial biomass C and incorporation of root exudates was studied in the field by in situ pulse labelling of temperate grassland vegetation with (13)CO(2) for a 3-day period. In plots that had been limed (CaCO(3) amended) annually for 3 years, incorporation into shoots and roots was, respectively, greater and lower than in unlimed plots. Analysis of chloroform-labile C demonstrated lower levels of (13)C incorporation into microbial biomass in limed soils compared to unlimed soils. The turnover of the recently assimilated (13)C compounds was faster in microbial biomass from limed than that from unlimed soils, suggesting that liming increases incorporation by microbial communities of root exudates. An exponential decay model of (13)C in total microbial biomass in limed soils indicated that the half-life of the tracer within this carbon pool was 4.7 days. Results are presented and discussed in relation to the absolute values of (13)C fixed and allocated within the plant-soil system.

A prospective cohort study of obesity and risk of oesophageal and gastric adenocarcinoma in the NIH-AARP Diet and Health Study

Objective: The incidence of oesophageal adenocarcinoma (EAC) has increased rapidly over the past 40 years and accumulating evidence suggests that obesity, as measured by body mass index (BMI), is a major risk factor. It remains unclear whether abdominal obesity is associated with EAC and gastric adenocarcinoma.

Design: Cox proportional hazards regression was used to examine associations between overall and abdominal obesity with EAC and gastric adenocarcinoma among 218 854 participants in the prospective NIHeAARP cohort.

Results: 253 incident EAC, 191 gastric cardia adenocarcinomas and 125 gastric non-cardia adenocarcinomas accrued to the cohort. Overall obesity (BMI) was positively associated with EAC and gastric
cardia adenocarcinoma risk (highest ($35 kg/m2) vs referent (18.5e<25 kg/m2); HR 2.11, 95% CI 1.09 to 4.09 and HR 3.67, 95% CI 2.00 to 6.71, respectively). Waist circumference was also positively associated with EAC and gastric cardia adenocarcinoma risk (highest vs referent; HR 2.01, 95% CI 1.35 to 3.00 and HR 2.22, 95% CI 1.43 to 3.47, respectively), whereas waist-to-hip ratio (WHR) was positively associated with EAC risk only (highest vs referent; HR 1.81, 95% CI 1.24 to 2.64) and persisted in patients with normal BMI (18.5e<25 kg/m2). Mutual adjustment of WHR and BMI attenuated
both, but did not eliminate the positive associations for either with risk of EAC. In contrast, the majority of the anthropometric variables were not associated with adenocarcinomas of the gastric non-cardia.

Conclusion Overall obesity was associated with a higher risk of EAC and gastric cardia adenocarcinoma, whereas abdominal obesity was found to be associated with increased EAC risk; even in people with normal BMI

The views of general practitioners on advance care planning for patients living with dementia

Background Advance care planning (ACP) facilitates communication
and understanding of preferences, nevertheless the use of
ACPs in primary care for patients with dementia is low. The disease’s
uncertain course and the inability to communicate with
the patient living with dementia are significant challenges for
GPs.
Aim The purpose of this study was to describe the attitudes and
practice preferences of GPs working within the UK’s National
Health System (NHS) regarding communication, and decisionmaking
for patients with dementia and their families
Methods A cross-sectional survey, using a purposive, cluster sample
of GPs across Northern Ireland with registered dementia
patients was used.
Results One hundred and thirty-three GPs (40.6%) participated
in the survey, representing 60.9% of surveyed practices. While
most respondents regarded dementia as a terminal disease
(96.2%) only 37.6% felt that palliative care applied equally from
the time of diagnosis to severe dementia. While most respondents
thought that early discussions would facilitate decision-making
during advanced dementia (61%), respondents were divided
on whether ACP should be initiated at the time of diagnoses
(39.8% in favour vs 45.8% disagreed). Interestingly, GPs who
were longer in practice placed greater importance on the presence
of an advance directive (F (2, 124) = 3.38, p = 0.037).
Discussion The timing of initiating ACP varies across individuals
requiring GPs to carefully consider strategies and receptiveness
of the patient and family carer.
Conclusion The findings promote both ongoing training in communication
and dementia management for GPs to meet the
needs of their patients living with dementia.

Acompanhamento da reabilitação estrutural da ETA de Morgavel

Relatório de Estágio para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Edificações

Visions d’État : deux systèmes d'informations géographiques dans la « gouvernance »

L'administration fédérale canadienne et la Commission européenne ont construit, dans le courant des années 2000, deux réseaux de Systèmes d'informations géographiques (SIG) : le Système national d'information forestière au Canada, et l'Infrastructure d'information géographique dans la Communauté européenne. Ces SIG permettent le traitement géographique de données sociales et environnementales ainsi que leur représentation sur des cartes. Nous appréhendons ces deux réseaux de SIG sous l'angle de leur valeur heuristique : leur analyse nous permet d'étudier les configurations institutionnelles dans lesquelles ils ont été développés, c'est-à-dire, dans ces cas précis, ce qu'il est convenu d'appeler la « gouvernance ». Les SIG sont des instruments de mesure et de représentation de certains phénomènes : ils appartiennent à la classe des instruments d'objectivation. En tant qu'instruments d'objectivation, ils nous permettent de discuter deux éléments théoriques de la « gouvernance » : le rapport entre les administrations centrales et les administrations locales ; le rapport entre les administrations étatiques et les organisations non-étatiques. A travers cette discussion, nous montrons d'une part que la réarticulation de paliers de gouvernement différents ne signifie pas, comme cela a pu être écrit, un retrait de l'administration centrale au profit des administrations locales, mais au contraire une manière de contrôler plus étroitement celles-ci. Nous montrons d'autre part que cette renégociation des rapports entre les administrations centrales et locales ne s'accompagne pas, en pratique, d’une renégociation des rapports entre administrations étatiques et organisations non-étatiques. En révélant que les données non-étatiques ne sont pas intégrées dans les réseaux de SIG étatiques, nous relativisons les théories qui voient dans la « gouvernance » un mode de gouvernement ouvert aux organisations non-étatiques. Cela nous conduit à approfondir la piste qui envisage les instruments étatiques d'objectivation comme des moyens d'écarter de l'objectivation des phénomènes sociaux ou naturels les éléments qui contredisent l'action gouvernementale. Cette exégèse politique de deux ensembles de programmes informatiques particuliers – les SIG – nous amène, en conclusion, à proposer de considérer certains programmes informatiques comme des institutions politiques.

Immigration et identité face aux enjeux de la Guerre Froide : une étude du débat sur la politique d'immigration dans la sphère publique américaine (1952-1965)

Résumé: Au lendemain de la Seconde Guerre Mondiale, la nécessité de moderniser la politique d’immigration américaine fait l’unanimité, la principale loi régissant l’immigration datant de 1924. Cependant, la question des paramètres de la réforme fait naître un débat fortement polarisé. Les défenseurs du statu quo, qui souhaitent maintenir le système des quotas nationaux faisant de l’origine nationale le premier critère d’admission, auront initialement le dessus, comme en fait foi le passage du McCarran-Walter Act en 1952. D’autre part, les partisans d’une libéralisation affirment que cette loi restrictive et discriminatoire va à l’encontre des objectifs de la politique étrangère américaine, particulièrement dans un conflit aussi idéologiquement chargé que la Guerre Froide. Au courant des années cinquante et au début des années soixante, les réformateurs libéraux auront progressivement le dessus dans le débat, si bien qu’une nouvelle loi sera adoptée en 1965. Ce mémoire propose d’aborder cette période de réforme sous l’angle de l’opinion publique. À partir, des sources permettant de prendre le pouls de la société américaine au sujet de la politique d’immigration, il a été possible d’observer une libéralisation progressive de l’opinion publique durant la période. Dans le cadre de ce mémoire, l’interprétation de cette évolution est centrée sur l’influence grandissante des enjeux de la Guerre Froide dans le débat entourant la réforme.

Hyperspectral field measurements to determine dry matter yield and nutritive value of legume-grass swards

Summary: Productivity, botanical composition and forage quality of legume-grass swards are important factors for successful arable farming in both organic and conventional farming systems. As these attributes can vary considerably within a field, a non-destructive method of detection while doing other tasks would facilitate a more targeted management of crops, forage and nutrients in the soil-plant-animal system. This study was undertaken to explore the potential of field spectral measurements for a non destructive prediction of dry matter (DM) yield, legume proportion in the sward, metabolizable energy (ME), ash content, crude protein (CP) and acid detergent fiber (ADF) of legume-grass mixtures. Two experiments were conducted in a greenhouse under controlled conditions which allowed collecting spectral measurements which were free from interferences such as wind, passing clouds and changing angles of solar irradiation. In a second step this initial investigation was evaluated in the field by a two year experiment with the same legume-grass swards. Several techniques for analysis of the hyperspectral data set were examined in this study: four vegetation indices (VIs): simple ratio (SR), normalized difference vegetation index (NDVI), enhanced vegetation index (EVI) and red edge position (REP), two-waveband reflectance ratios, modified partial least squares (MPLS) regression and stepwise multiple linear regression (SMLR). The results showed the potential of field spectroscopy and proved its usefulness for the prediction of DM yield, ash content and CP across a wide range of legume proportion and growth stage. In all investigations prediction accuracy of DM yield, ash content and CP could be improved by legume-specific calibrations which included mixtures and pure swards of perennial ryegrass and of the respective legume species. The comparison between the greenhouse and the field experiments showed that the interaction between spectral reflectance and weather conditions as well as incidence angle of light interfered with an accurate determination of DM yield. Further research is hence needed to improve the validity of spectral measurements in the field. Furthermore, the developed models should be tested on varying sites and vegetation periods to enhance the robustness and portability of the models to other environmental conditions.

Nitrogen and carbon dynamics in grassland soils and plants after application of digestate

A better understanding of effects after digestate application on plant community, soil microbial community as well as nutrient and carbon dynamics is crucial for a sustainable grassland management and the prevention of species and functional diversity loss. The specific research objectives of the thesis were: (i) to investigate effects after digestate application on grass species and soil microbial community, especially focussing on nitrogen dynamic in the plant-soil system and to examine the suitability of the digestate from the “integrated generation of solid fuel and biogas from biomass” (IFBB) system as fertilizer (Chapter 3). (ii) to investigate the relationship between plant community and functionality of soil microbial community of extensively managed meadows, taking into account temporal variations during the vegetation period and abiotic soil conditions (Chapter 4). (iii) to investigate the suitability of IFBB-concept implementation as grassland conservation measure for meadows and possible associated effects of IFBB digestate application on plant and soil microbial community as well as soil microbial substrate utilization and catabolic evenness (Chapter 5). Taken together the results indicate that the digestate generated during the IFBB process stands out from digestates of conventional whole crop digestion on the basis of higher nitrogen use efficiency and that it is useful for increasing harvestable biomass and the nitrogen content of the biomass, especially of L. perenne, which is a common species of intensively used grasslands. Further, a medium application rate of IFBB digestate (50% of nitrogen removed with harvested biomass, corresponding to 30 50 kg N ha-1 a-1) may be a possibility for conservation management of different meadows without changing the functional above- and belowground characteristic of the grasslands, thereby offering an ecologically worthwhile alternative to mulching. Overall, the soil microbial biomass and catabolic performance under planted soil was marginally affected by digestate application but rather by soil properties and partly by grassland species and legume occurrence. The investigated extensively managed meadows revealed a high soil catabolic evenness, which was resilient to medium IFBB application rate after a three-year period of application.

Los intereses políticos detrás de la mediación de Burkina Faso en el conflicto de Costa de Marfil en el año 2007

Este estudio de caso tiene como finalidad evidenciar los intereses políticos detrás de la mediación de Burkina Faso en el Conflicto de Costa de Marfil en el año 2007. En ese orden de ideas, este trabajo de grado analiza cómo la situación interna y externa de Burkina Faso, incidió en su decisión de mediar en el conflicto marfileño. Para lograr esto, en esta investigación se recurre a los conceptos de Interés Nacional y Poder Político propios de la Teoría del Realismo Político de Relaciones Internacionales, desarrollada por Hans Morgenthau, y al concepto de Seguridad del Régimen expuesto por John Clark. Además de las fuentes teóricas mencionadas anteriormente, se emplearon artículos y publicaciones de diversa índole sobre el fenómeno a estudiar.