A study to determine the association between medical decision-making and the performance of an institutional ethics committee

This study developed proxy measures to test the independent effects of medical specialty, institutional ethics committee (IEC) and the interaction between the two, upon a proxy for the dependent variable of the medical decision to withhold/withdraw care for the dying--the resuscitation index (R-index). Five clinical vignettes were constructed and validated to convey the realism and contextual factors implicit in the decision to withhold/withdraw care. A scale was developed to determine the range of contact by an IEC in terms of physician knowledge and use of IEC policy.^ This study was composed of a sample of 215 physicians in a teaching hospital in the Southwest where proxy measures were tested for two competing influences, medical specialty and IEC, which alternately oppose and support the decision to withhold/withdraw care for the dying. A sub-sample of surgeons supported the hypothesis that an IEC is influential in opposing the medical training imperative to prolong life.^ Those surgeons with a low IEC score were 326 percent more likely to continue care than were surgeons with a high IEC score when compared to all other specialties. IEC alone was also found to significantly predict the decision to withhold/withdraw care. Interaction of IEC with the specialty of surgery was found to be the best predictor for a decision to withhold/withdraw care for the dying. ^

PROJECTION OF HEALTH DEMAND IN TERMS OF HOSPITAL ADMISSIONS FOR SELECTED DIAGNOSES IN HEALTH SYSTEMS AGENCY SERVICE AREAS

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) requires that health systems agencies (HSAs) plan for their health service areas by the use of existing data to the maximum extent practicable. Health planning is based on the identificaton of health needs; however, HSAs are, at present, identifying health needs in their service areas in some approximate terms. This lack of specificity has greatly reduced the effectiveness of health planning. The intent of this study is, therefore, to explore the feasibility of predicting community levels of hospitalized morbidity by diagnosis by the use of existing data so as to allow health planners to plan for the services associated with specific diagnoses.^ The specific objectives of this study are (a) to obtain by means of multiple regression analysis a prediction equation for hospital admission by diagnosis, i.e., select the variables that are related to demand for hospital admissions; (b) to examine how pertinent the variables selected are; and (c) to see if each equation obtained predicts well for health service areas.^ The existing data on hospital admissions by diagnosis are those collected from the National Hospital Discharge Surveys, and are available in a form aggregated to the nine census divisions. When the equations established with such data are applied to local health service areas for prediction, the application is subject to the criticism of the theory of ecological fallacy. Since HSAs have to rely on the availability of existing data, it is imperative to examine whether or not the theory of ecological fallacy holds true in this case.^ The results of the study show that the equations established are highly significant and the independent variables in the equations explain the variation in the demand for hospital admission well. The predictability of these equations is good when they are applied to areas at the same ecological level but become poor, predominantly due to ecological fallacy, when they are applied to health service areas.^ It is concluded that HSAs can not predict hospital admissions by diagnosis without primary data collection as discouraged by Public Law 93-641. ^

Exposure to nonsteroidal anti-inflammatory drugs and weight loss and hospitalization in non-small cell lung cancer patients

Background. Cancer cachexia is a common syndrome complex in cancer, occurring in nearly 80% of patients with advanced cancer and responsible for at least 20% of all cancer deaths. Cachexia is due to increased resting energy expenditure, increased production of inflammatory mediators, and changes in lipid and protein metabolism. Non-steroidal anti-inflammatory drugs (NSAIDs), by virtue of their anti-inflammatory properties, are possibly protective against cancer-related cachexia. Since cachexia is also associated with increased hospitalizations, this outcome may also show improvement with NSAID exposure. ^ Design. In this retrospective study, computerized records from 700 non-small cell lung cancer patients (NSCLC) were reviewed, and 487 (69.57%) were included in the final analyses. Exclusion criteria were severe chronic obstructive pulmonary disease, significant peripheral edema, class III or IV congestive heart failure, liver failure, other reasons for weight loss, or use of research or anabolic medications. Information on medication history, body weight and hospitalizations was collected from one year pre-diagnosis until three years post-diagnosis. Exposure to NSAIDs was defined if a patient had a history of being treated with NSAIDs for at least 50% of any given year in the observation period. We used t-test and chi-square tests for statistical analyses. ^ Results. Neither the proportion of patients with cachexia (p=0.27) nor the number of hospitalizations (p=0.74) differed among those with a history of NSAID use (n=92) and those without (n=395). ^ Conclusions. In this study, NSAID exposure was not significantly associated with weight loss or hospital admissions in patients with NSCLC. Further studies may be needed to confirm these observations.^

Application of the general linear model to assess the effect of missing data on bone marrow mononuclear cell therapy with infusion timing and follow-up MRI

With most clinical trials, missing data presents a statistical problem in evaluating a treatment's efficacy. There are many methods commonly used to assess missing data; however, these methods leave room for bias to enter the study. This thesis was a secondary analysis on data taken from TIME, a phase 2 randomized clinical trial conducted to evaluate the safety and effect of the administration timing of bone marrow mononuclear cells (BMMNC) for subjects with acute myocardial infarction (AMI).^ We evaluated the effect of missing data by comparing the variance inflation factor (VIF) of the effect of therapy between all subjects and only subjects with complete data. Through the general linear model, an unbiased solution was made for the VIF of the treatment's efficacy using the weighted least squares method to incorporate missing data. Two groups were identified from the TIME data: 1) all subjects and 2) subjects with complete data (baseline and follow-up measurements). After the general solution was found for the VIF, it was migrated Excel 2010 to evaluate data from TIME. The resulting numerical value from the two groups was compared to assess the effect of missing data.^ The VIF values from the TIME study were considerably less in the group with missing data. By design, we varied the correlation factor in order to evaluate the VIFs of both groups. As the correlation factor increased, the VIF values increased at a faster rate in the group with only complete data. Furthermore, while varying the correlation factor, the number of subjects with missing data was also varied to see how missing data affects the VIF. When subjects with only baseline data was increased, we saw a significant rate increase in VIF values in the group with only complete data while the group with missing data saw a steady and consistent increase in the VIF. The same was seen when we varied the group with follow-up only data. This essentially showed that the VIFs steadily increased when missing data is not ignored. When missing data is ignored as with our comparison group, the VIF values sharply increase as correlation increases.^

Extensive management of field margins enhances their potential to mitigate soil erosion

Soil erosion is a widespread problem in agricultural landscapes, particularly in regions with strong rainfall events. Vegetated field margins can mitigate negative impacts of soil erosion by trapping eroded material. In this data set, we present data of sediment trapped by 12 field margins during the monsoon season of 2013 in an agricultural landscape in the Haean-myun catchment in South Korea. Prior to the beginning of monsoon season, we equipped a total of 12 sites representing three replicates for each of four different types of field margins ("managed flat", "managed steep", "natural flat" and "natural steep") with Astroturf mats with a size of 34 cm x 25 cm (850 cm**2). The mats (n = 15 / site) were installed at three levels: upslope, immediately before the field margin to quantify the sediments that reach it, in the middle of the field margin to quantify the locally trapped sediments, and after the field margin at the downslope edge to quantify the sediments that leave the field margin to the next field or to the stream. Sediment was collected after each rain event until the end of the monsoon season.

New Constructive Solutions to Improve Energy Efficiency in Existing Buildings and their Economic Viability

The improvement of energy efficiency in existing buildings is always a challenge due to their particular, and sometimes protected, constructive solutions. New constructive regulations in Spain leave a big undefined gap when a restoration is considered because they were developed for new buildings. However, rehabilitation is considered as an opportunity for many properties because it allows owners to obtain benefits from the use of the buildings. The current financial and housing crisis has turned society point of view to existing buildings and making them more efficient is one of the Spanish government’s aims. The economic viability of a rehabilitation action should take all factors into account: both construction costs and the future operative costs of the building must be considered. Nevertheless, the application of these regulations in Spain is left to the designer’s opinion and always under a subjective point of view. With the research work described in this paper and with the help of some case-studies, the cost of adapting an existing building to the new constructive regulations will be studied and Energetic Efficiency will be evaluated depending on how the investment is recovered. The interest of the research is based on showing how new constructive solutions can achieve higher levels of efficiency in terms of energy, construction and economy and it will demonstrate that Life Cycle Costing analysis can be a mechanism to find the advantages and disadvantages of using these new constructive solutions. Therefore, this paper has the following objectives: analysing constructive solutions in existing buildings - to establish a process for assessing total life cycle costs (LCC) during the planning stages with consideration of future operating costs - to select the most advantageous operating system – To determine the return on investment in terms of construction costs based on new techniques, the achieved energy savings and investment payback periods.

A collaborative filtering approach to mitigate the new user cold start problem.

The new user cold start issue represents a serious problem in recommender systems as it can lead to the loss of new users who decide to stop using the system due to the lack of accuracy in the recommenda- tions received in that first stage in which they have not yet cast a significant number of votes with which to feed the recommender system?s collaborative filtering core. For this reason it is particularly important to design new similarity metrics which provide greater precision in the results offered to users who have cast few votes. This paper presents a new similarity measure perfected using optimization based on neu- ral learning, which exceeds the best results obtained with current metrics. The metric has been tested on the Netflix and Movielens databases, obtaining important improvements in the measures of accuracy, precision and recall when applied to new user cold start situations. The paper includes the mathematical formalization describing how to obtain the main quality measures of a recommender system using leave- one-out cross validation.

Compaslab.org, competences to be an ace. Learning design for a successful sustainable employability

Companies are looking for workers trained in soft skills, and we want to help in the learning process. How? Through three courses (Building trust through values, soft skills and entrepreneurship) and historical aces, characters who joined strong values, intellectual and social capabilities and an entrepreneurial spirit, to leave a legacy. CompasLab.org = Values + Skills + Action.

Barriers to recombination between closely related bacteria: MutS and RecBCD inhibit recombination between Salmonella typhimurium and Salmonella typhi

Previous studies have shown that inactivation of the MutS or MutL mismatch repair enzymes increases the efficiency of homeologous recombination between Escherichia coli and Salmonella typhimurium and between S. typhimurium and Salmonella typhi. However, even in mutants defective for mismatch repair the recombination frequencies are 102- to 103-fold less than observed during homologous recombination between a donor and recipient of the same species. In addition, the length of DNA exchanged during transduction between S. typhimurium and S. typhi is less than in transductions between strains of S. typhimurium. In homeologous transductions, mutations in the recD gene increased the frequency of transduction and the length of DNA exchanged. Furthermore, in mutS recD double mutants the frequency of homeologous recombination was nearly as high as that seen during homologous recombination. The phenotypes of the mutants indicate that the gene products of mutS and recD act independently. Because S. typhimurium and S. typhi are ≈98–99% identical at the DNA sequence level, the inhibition of recombination is probably not due to a failure of RecA to initiate strand exchange. Instead, these results suggest that mismatches act at a subsequent step, possibly by slowing the rate of branch migration. Slowing the rate of branch migration may stimulate helicase proteins to unwind rather than extend the heteroduplex and leave uncomplexed donor DNA susceptible to further degradation by RecBCD exonuclease.

Deprivation and emergency admissions for cancers of colorectum, lung, and breast in south east England: ecological study

Objectives: To examine the relation between deprivation and acute emergency admissions for cancers of the colon, rectum, lung, and breast in south east England.

Population based case-control study of sick leave in postmenopausal women before diagnosis of hyperparathyroidism

Objective: To analyse sick leave in women at risk of primary hyperparathyroidism before its diagnosis.

Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results

Preliminary results for the 2014/15 season indicate low to null effect of vaccination against influenza A(H3N2)-related disease. As of week 5 2015, there have been 1,136 hospital admissions, 210 were due to influenza and 98% of subtype A strains were H3. Adjusted influenza vaccine effectiveness was 33% (range: 6–53%) overall and 40% (range: 13% to 59%) in those 65 years and older. Vaccination reduced by 44% (28–68%) the probability of admission with influenza.

Letters from William Tudor to his mother, Delia Jarvis Tudor,

Two letters written from Birmingham, England, in which Tudor describes the town and his lodgings: "My establishment consists of a woman cook well recommended, [and] a housemaid....I am looking out for a cat, and have already a Newfoundland dog of Herculean dimensions." He also writes of his plans to leave England for New York.

Copies of papers relating to the resignation of President Kirkland of Harvard University,

This folder contains a notebook that includes handwritten copies of Kirkland's letter of resignation addressed to the Corporation of Harvard University, March 28, 1828; an address of President Kirkland to the students, delivered in the College Chapel after morning prayers, April 1, 1828; a letter from Francis C. Gray accompanied by a vote of the Corporation, April 2, 1828; a letter from Mr. Gray and vote of the Corporation, April 4, 1828; President Kirkland's reply to Mr. Gray, April 5, 1828; the address of the senior class to the President, presented to him the morning after he took leave of the College, April 2, 1828; and an address of the immediate government to Kirkland, April 2, 1828.

Letter from Samuel Willard, Exeter, New Hampshire, to William Willard and Katherine Willard, Petersham, Massachusetts, November 25, 1805

Willard describes his usual daily routines relating to teaching at Philips Academy and his plans to leave Exeter.