The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

BACKGROUND: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance. METHODS: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used. Variability was captured through 2 performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables, using a multilevel 2-equation system. RESULTS: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and longer withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and so had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and longer withdrawal times. CONCLUSIONS: Our results suggest that gatekeeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight the fact that longer withdrawal times do not necessarily indicate higher quality in teaching centers.

Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.

BACKGROUND AND OBJECTIVES: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. SAMPLE SIZE CALCULATION: It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.

Open licensing's impact on higher education resources colombian and catalan approaches

A new initiative has sprung on the path created by the Open Access (OA) movement: Open Education (OE). The initiative's aim is to open up all educational resources at all learning levels. In order to achieve this goal, several international institutions, like UNESCO and the OECD, have published reports, surveys and documents to help educational institutions in this endeavor. This global initiative needs a legal framework; as a result, efforts thus far have usually resorted to Open Licensing (OL), especially Creative Commons (CC) licensing. In fact, as a response to this new movement, Creative Commons launched a new program, ccLearn , which recognizes open licensing's impact on education and directly supports the idea of open educational resources (OER). However, there still remain a good amount of open questions: What is happening locally with OL in higher education? How are educational institutions receiving the initiative? How is it that the OL initiative relates to educational resources? Are there local examples of open educational resources (OER)? How do these local instances incorporate CC into their educational frameworks?. To this effect, this analysis aims to focus on the legal approach and specifically on the way the educational sector is using open licenses outside the English speaking world. It will do so by looking at the current situation in two specific scenarios, the Colombian and the Catalan experiences with open educational projects at the higher education level.

Explaining Open Courseware Europe

Since two years ago, five European universities are working together with Creative Commons and the Open Courseware Consortium in an EU funded project aimed at supporting student virtual mobility on the basis of OCW. During those two years, there have been several workshops dedicated to different topics and some documents have been produced, among them about the use of CC licenses. The final goal of the project is to establish an European branch of the OCW Consortium as the existing ones in other regions. More information about the project: http://opencourseware.eu/

The structure of Mediterranean rocky reef ecosystems across environmental and human gradients, and conservation implications

Historical exploitation of the Mediterranean Sea and the absence of rigorous baselines makes it difficult to evaluate the current health of the marine ecosystems and the efficacy of conservation actions at the ecosystem level. Here we establish the first current baseline and gradient of ecosystem structure of nearshore rocky reefs at the Mediterranean scale. We conducted underwater surveys in 14 marine protected areas and 18 open access sites across the Mediterranean, and across a 31-fold range of fish biomass (from 3.8 to 118 g m22). Our data showed remarkable variation in the structure of rocky reef ecosystems. Multivariate analysis showed three alternative community states: (1) large fish biomass and reefs dominated by non-canopy algae, (2) lower fish biomass but abundant native algal canopies and suspension feeders, and (3) low fish biomass and extensive barrens, with areas covered by turf algae. Our results suggest that the healthiest shallow rocky reef ecosystems in the Mediterranean have both large fish and algal biomass. Protection level and primary production were the only variables significantly correlated to community biomass structure. Fish biomass was significantly larger in well-enforced no-take marine reserves, but there were no significant differences between multi-use marine protected areas (which allow some fishing) and open access areas at the regional scale. The gradients reported here represent a trajectory of degradation that can be used to assess the health of any similar habitat in the Mediterranean, and to evaluate the efficacy of marine protected areas.

ABS: a database of Annotated regulatory Binding Sites from orthologous promoters

Information about the genomic coordinates and the sequence of experimentally identified transcription factor binding sites is found scattered under a variety of diverse formats. The availability of standard collections of such high-quality data is important to design, evaluate and improve novel computational approaches to identify binding motifs on promoter sequences from related genes. ABS (http://genome.imim.es/datasets/abs2005/index.html) is a public database of known binding sites identified in promoters of orthologous vertebrate genes that have been manually curated from bibliography. We have annotated 650 experimental binding sites from 68 transcription factors and 100 orthologous target genes in human, mouse, rat or chicken genome sequences. Computational predictions and promoter alignment information are also provided for each entry. A simple and easy-to-use web interface facilitates data retrieval allowing different views of the information. In addition, the release 1.0 of ABS includes a customizable generator of artificial datasets based on the known sites contained in the collection and an evaluation tool to aid during the training and the assessment of motif-finding programs.

Automatic filtering and substantiation of drug safety signals

Drug safety issues pose serious health threats to the population and constitute a major cause of mortality worldwide. Due to the prominent implications to both public health and the pharmaceutical industry, it is of great importance to unravel the molecular mechanisms by which an adverse drug reaction can be potentially elicited. These mechanisms can be investigated by placing the pharmaco-epidemiologically detected adverse drug reaction in an information-rich context and by exploiting all currently available biomedical knowledge to substantiate it. We present a computational framework for the biological annotation of potential adverse drug reactions. First, the proposed framework investigates previous evidences on the drug-event association in the context of biomedical literature (signal filtering). Then, it seeks to provide a biological explanation (signal substantiation) by exploring mechanistic connections that might explain why a drug produces a specific adverse reaction. The mechanistic connections include the activity of the drug, related compounds and drug metabolites on protein targets, the association of protein targets to clinical events, and the annotation of proteins (both protein targets and proteins associated with clinical events) to biological pathways. Hence, the workflows for signal filtering and substantiation integrate modules for literature and database mining, in silico drug-target profiling, and analyses based on gene-disease networks and biological pathways. Application examples of these workflows carried out on selected cases of drug safety signals are discussed. The methodology and workflows presented offer a novel approach to explore the molecular mechanisms underlying adverse drug reactions

Motivic analysis and its relevance to raga identification in carnatic music

A raga is a collective melodic expression consisting of motifs. A raga can be identified using motifs which areunique to it. Motifs can be thought of as signature prosodic phrases. Different ragas may be composed of the same setof notes, or even phrases, but the prosody may be completely different. In this paper, an attempt is made to determinethe characteristic motifs that enable identification of a raga and distinguish between them. To determine this, motifs are first manually marked for a set of five popular raga by a professional musician. The motifs are then normalisedwith respect to the tonic. HMMs are trained for each motif using 80% of the data and about 20% are used for testing. The results do indicate that about 80% of the motifs are identified as belonging to a specific raga accurately.

Metrical strength and contradiction in turkish Makam music

In this paper we investigate how note onsets in Turkish Makam music compositions are distributed, and in how far this distribution supports or contradicts the metrical structure of the pieces, the usul. We use MIDI data to derive the distributions in the form of onset histograms, and comparethem with metrical weights that are applied to describe the usul in theory. We compute correlation and syncopation values to estimate the degrees of support and contradiction, respectively. While the concept of syncopation is rarelymentioned in the context of this music, we can gain interesting insight into the structure of a piece using such a measure.We show that metrical contradiction is systematically applied in some metrical structures. We will compare thedifferences between Western music and Turkish Makam music regarding metrical support and contradiction. Such a study can help avoiding pitfalls in later attempts to perform audio processing tasks such as beat tracking or rhythmic similarity measurements.

Accessing Legal Information in Catalonia. Open Acces to Legislation and Case Law

The article outlines free online legal resources to conduct research on Catalan and Spanish legislation and case-law. Most of these resources are primary sources made public by government bodies. The list shows how the Spanish and Catalan governments, in their attempt to promote equal access to legislation and case-law, cover the different jurisdictions. The text also mentions some resources to conduct historical legal research about legislation and case law, and some free legal private websites.

L'estadística i els nous mitjans de càlcul

Aquesta exposició vol presentar breument el ventall d'eines disponibles, la terminologia utilitzada i, en general, el marc metodològic de l'estadística exploratoria i de l'analisi de dades, el paradigma de la disciplina.En el decurs dels darrers anys, la disciplina no ha estat pas capgirada, però de tota manera sí que cal una actualització permanent.S'han forjat i provat algunes eines gairebé només esbossades, han aparegut nous dominis d'aplicació. Cal precisar la relació amb els competidors i dinamics veïns (intel·ligencia artificial, xarxes neurals, Data Mining). La perspectiva que presento dels mètodes d'anàlisi de dades emana evidentment d'un punt de vista particular; altres punts de vista poden ser igualment vàlids

Provision of supplementary materials in Library and Information Science scholarly journals

Purpose This study seeks to analyse the policies of library and information science (LIS) journals regarding the publication of supplementary materials, the number of journals and articles that include this feature, the kind of supplementary materials published with regard to their function in the article, the formats employed and the access provided to readers. Design/methodology/approach The study analysed the instructions for authors of LIS journals indexed in the ISI Journal Citation Reports, as well as the supplementary materials attached to the articles published in their 2011 online volumes. Findings Large publishers are more likely to have a policy regarding the publication of supplementary materials, and policies are usually homogeneous across all the journals of a given publisher. Most policies state the acceptance of supplementary materials, and even journals without a policy also publish supplementary materials. The majority of supplementary materials provided in LIS articles are extended methodological explanations and additional results in the form of textual information in PDF or Word files. Some toll-access journals provide open access to any reader to these files. Originality/value This study provides new insights into the characteristics of supplementary materials in LIS journals. The results may be used by journal publishers to establish a policy on the publication of supplementary materials and, more broadly, to develop data sharing initiatives in academic settings.

Promoting the Creation, Share and Use of OERs through Open Repositories and Social Networks

In this paper we discuss and analyze the process of using a learning object repository and building a social network on the top of it, including aspects related to open source technologies, promoting the use of the repository by means of social networks and helping learners to develop their own learning paths.

Open Educational Resources: an opportunity for virtual learning institutions

The Universitat Oberta de Catalunya (UOC, Open University of Catalonia) is involved inseveral research projects and educational activities related to the use of Open Educational Resources (OER). Some of the discussed issues in the concept of OER are research issues which are being tackled in two EC projects (OLCOS and SELF). Besides the research part, the UOC aims at developing a virtual centre for analysing and promoting the concept of OERin Europe in the sector of Higher and Further Education. The objectives are to makeinformation and learning services available to provide university management staff,eLearning support centres, faculty and learners with practical information required to create, share and re-use such interoperable digital content, tools and licensing schemes. In the realisation of these objectives, the main activities are the following: to provide organisationaland individual e-learning end-users with orientation; to develop perspectives and useful recommendations in the form of a medium-term Roadmap 2010 for OER in Higher and Further Education in Europe; to offer practical information and support services about how to create, share and re-use open educational content by means of tutorials, guidelines, best practices, and specimen of exemplary open e-learning content; to establish a larger group ofcommitted experts throughout Europe and other continents who not only share theirexpertise but also steer networking, workshops, and clustering efforts; and to foster and support a community of practice in open e-learning content know-how and experiences.

Open Apps: Opening Teaching Experiences and Applications

The Universitat Oberta de Catalunya (Open University of Catalonia, UOC) is an online university that makes extensive use of information and communication technologies to provide education. Ever since its establishment in 1995, the UOC has developed and tested methodologies and technological support services to meet the educational challenges posed by its student community and its teaching and management staff. The know-how it has acquired in doing so is the basis on which it has created the Open Apps platform, which is designed to provide access to open source technical applications, information on successful learning and teaching experiences, resources and other solutions, all in a single environment. Open Apps is an open, online catalogue, the content of which is available to all students for learning purposes, all IT professionals for downloading and all teachers for reusing.To contribute to the transfer of knowledge, experience and technology, each of the platform¿s apps comes with full documentation, plus information on cases in which it has been used and related tools. It is hoped that such transfer will lead to the growth of an external partner network, and that this, in turn, will result in improvements to the applications and teaching/learning practices, and in greater scope for collaboration.Open Apps is a strategic project that has arisen from the UOC's commitment to the open access movement and to giving knowledge and technology back to society, as well as its firm belief that sustainability depends on communities of interest.