St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketch of Roof], untitled. Blue ink sketch on tracing paper, 18 x 31 3/4 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketches], untitled. Ink sketches on tracing paper, 12x19 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketch], untitled. Green ink sketch on tracing paper, 12x19 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketches], untitled. Blue ink sketches on tracing paper, 18x17 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Schematic Design Drawing of Steeple Section], untitled. Green marker coloring on black-line print, 8 1/2 x 11 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketches of Roof], untitled. Ink sketches on tracing paper, initialed, 12 x 21 1/4 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketches of Steeple], untitled. Blue ink sketches with purple marker coloring on tracing paper, 18x27 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Early Conceptual Sketch], untitled. Blue ink sketch on steno pad paper, 6x9 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketches of Eternal Flame], untitled. Blue and brown ink sketches on tracing paper, 12x29 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketch of Entrance Door Elevation], untitled. Brown ink sketch on tracing paper, 12 x 24 1/4 inches [from photographic copy by Lance Burgharrdt]

St. Peter's Lutheran Church, Columbus, Indiana, 1980-1988

[Conceptual Sketch of Pew], untitled. Blue ink sketch on tracing paper, 12x12 inches [from photographic copy by Lance Burgharrdt]

St. Matthew and St. Mark and the General epistles; ed. with an introduction and notes,

St. Matthew.--St. Mark.--An Epistle to Hebrews.--The general Epistles of St. Peter.--The general Epistle of St. Jude.

59 plates for notes upon the Castle of Budrun (Halicarnassus) and its association with the Knights of St. John of Jerusalem,

"The plates are from drawings made by Corporal R. Spackman, R.E. (British Museum Add. Ms. 30, 988) ..."

Patterns in blood pressure medication use in US incident dialysis patients over the first 6 months.

BACKGROUND: Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on outcomes is unclear. METHODS: We described patterns of BP medication prescription over 6 months after dialysis initiation in hemodialysis and peritoneal dialysis patients, stratified by cardiovascular comorbidity, diabetes, and other patient characteristics. The cohort included 13,072 adult patients (12,159 hemodialysis, 913 peritoneal dialysis) who initiated dialysis in Dialysis Clinic, Inc., facilities January 1, 2003-June 30, 2008, and remained on the original modality for at least 6 months. We evaluated monthly patterns in BP medication prescription over 6 months and at 12 and 24 months after initiation. RESULTS: Prescription patterns varied by dialysis modality over the first 6 months; substantial proportions of patients with prescriptions for beta-blockers, renin angiotensin system agents, and dihydropyridine calcium channel blockers in month 6 no longer had prescriptions for these medications by month 24. Prescription of specific medication classes varied by comorbidity, race/ethnicity, and age, but little by sex. The mean number of medications was 2.5 at month 6 in hemodialysis and peritoneal dialysis cohorts. CONCLUSIONS: This study evaluates BP medication patterns in both hemodialysis and peritoneal dialysis patients over the first 6 months of dialysis. Our findings highlight the challenges of assessing comparative effectiveness of a single BP medication class in dialysis patients. Longitudinal designs should be used to account for changes in BP medication management over time, and designs that incorporate common combinations should be considered.

Comparative effectiveness studies to improve clinical outcomes in end stage renal disease: the DEcIDE patient outcomes in end stage renal disease study.

BACKGROUND: Evidence is lacking to inform providers' and patients' decisions about many common treatment strategies for patients with end stage renal disease (ESRD). METHODS/DESIGN: The DEcIDE Patient Outcomes in ESRD Study is funded by the United States (US) Agency for Health Care Research and Quality to study the comparative effectiveness of: 1) antihypertensive therapies, 2) early versus later initiation of dialysis, and 3) intravenous iron therapies on clinical outcomes in patients with ESRD. Ongoing studies utilize four existing, nationally representative cohorts of patients with ESRD, including (1) the Choices for Healthy Outcomes in Caring for ESRD study (1041 incident dialysis patients recruited from October 1995 to June 1999 with complete outcome ascertainment through 2009), (2) the Dialysis Clinic Inc (45,124 incident dialysis patients initiating and receiving their care from 2003-2010 with complete outcome ascertainment through 2010), (3) the United States Renal Data System (333,308 incident dialysis patients from 2006-2009 with complete outcome ascertainment through 2010), and (4) the Cleveland Clinic Foundation Chronic Kidney Disease Registry (53,399 patients with chronic kidney disease with outcome ascertainment from 2005 through 2009). We ascertain patient reported outcomes (i.e., health-related quality of life), morbidity, and mortality using clinical and administrative data, and data obtained from national death indices. We use advanced statistical methods (e.g., propensity scoring and marginal structural modeling) to account for potential biases of our study designs. All data are de-identified for analyses. The conduct of studies and dissemination of findings are guided by input from Stakeholders in the ESRD community. DISCUSSION: The DEcIDE Patient Outcomes in ESRD Study will provide needed evidence regarding the effectiveness of common treatments employed for dialysis patients. Carefully planned dissemination strategies to the ESRD community will enhance studies' impact on clinical care and patients' outcomes.