How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety

OBJECTIVE: As part of the WHO ICD-11 development initiative, the Topic Advisory Group on Quality and Safety explores meta-features of morbidity data sets, such as the optimal number of secondary diagnosis fields. DESIGN: The Health Care Quality Indicators Project of the Organization for Economic Co-Operation and Development collected Patient Safety Indicator (PSI) information from administrative hospital data of 19-20 countries in 2009 and 2011. We investigated whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared with six countries that did not. Furthermore, administrative hospital data from six of these countries and two American states, California (2011) and Florida (2010), were analysed for distributions of coded patient safety events across diagnosis fields. RESULTS: Among the participating countries, increasing the number of diagnosis fields was not associated with any overall increase in PSI rates. However, high proportions of PSI-related diagnoses appeared beyond the sixth secondary diagnosis field. The distribution of three PSI-related ICD codes was similar in California and Florida: 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. CONCLUSIONS: Six to nine secondary diagnosis fields are inadequate for comparing complication rates using hospital administrative data; at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes. Increasing the number of fields should improve the international and intra-national comparability of data for epidemiologic and health services research, utilization analyses and quality of care assessment.

Mortality associated with diabetes mellitus in comparison with history of cardiovascular disease in older women.

BACKGROUND: Women with diabetes mellitus have an increased risk of cardiovascular disease (CVD) mortality and current treatment guidelines consider diabetes to be equivalent to existing CVD, but few data exist about the relative importance of these risk factors for total and cause-specific mortality in older women. METHODS: We studied 9704 women aged ≥65 years enrolled in a prospective cohort study (Study of Osteoporotic Fractures) during a mean follow-up of 13 years and compared all-cause, CVD and coronary heart disease (CHD) mortality among non-diabetic women without and with a prior history of CVD at baseline and diabetic women without and with a prior history of CVD. Diabetes mellitus and prior CVD (history of angina, myocardial infarction or stroke) were defined as self-report of physician diagnoses. Cause of death was adjudicated from death certificates and medical records when available (>95% deaths confirmed). Ascertainment of vital status was 99% complete. Log-rank tests for the rates of death and multivariate Cox hazard models adjusted for age, smoking, physical activity, systolic blood pressure, waist girth and education were used to compare mortality among the four groups with non-diabetic women without CVD as the referent group. Results are reported as adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: At baseline mean age was 71.7±5.3 years, 7.0% reported diabetes mellitus and 14.5% reported prior CVD. 4257 women died during follow-up, 36.6% were attributed to CVD. The incidence of CVD death per 1000 person-years was 9.9 and 21.6 among non-diabetic women without and with CVD, respectively, and 23.8 and 33.3 among diabetic women without and with CVD, respectively. Compared to nondiabetic women without prior CVD, the risk of CVD mortality was elevated among both non-diabetic women with CVD (HR=1.82, CI: 1.60-2.07, P<0.001) and diabetic women without prior CVD (HR=2.24, CI: 1.87-2.69, P<0.001). CVD mortality was highest among diabetic women with CVD (HR=3.41, CI: 2.61-4.45, P<0.001). Compared to non-diabetic women with CVD, diabetic women without prior CVD had a significantly higher adjusted HR for total and CVD mortality (P<0.001 and P<0.05 respectively). CHD mortality did not differ significantly between non-diabetic women with CVD and diabetic women without prior CVD. CONCLUSION: Older diabetic women without prior CVD have a higher risk of all-cause and CVD mortality and a similar risk of CHD mortality compared to non-diabetic women with pre-existing CVD. For older women, these data support the equivalence of prior CVD and diabetes mellitus in current guidelines for the prevention of CVD.

Woody Gall symptoms in different citrus species and varieties artificially colonized by the citrus brown aphid Toxoptera citricidus

Seedlings of 41 different citrus species and varieties were massively colonized with the citrus brown aphid Toxoptera citricidus, obtained from Pêra sweet orange (Citrus sinensis) trees, presenting symptoms of the "Capão Bonito" complex of the Citrus tristeza virus (CTV). The objective was to evaluate resistance or tolerance of the varieties to that virus complex, but even after eight months of inoculation no stem pitting was observed in the plants. Otherwise, the presence of galls similar to those induced by the vein enation-woody gall disease was observed in 73% of the plants of Volkamer Palermo (Citrus volkameriana), 60% of the Volkamer Catania 2, 2% of the Rangpur Lime D.22.30 (Citrus limonia), 13% of the Volkamer Australian Red, the Rangpur Lime hybrid, the Orlando tangelo (Citrus reticulata x Citrus paradisi) and the Florida Rough lemon (C. jambhiri), and 7% of the Carrizo citrange (Poncirus trifoliata x Citrus sinensis). The highest incidence and the largest gall size were observed in the Palermo Volkamer showing that this clone would be the most suitable to be used as an indicator plant in biological indexing tests for the disease. There are no previous reports in the literature about the occurrence of woody galls in Orlando tangelo and Carrizo citrange.

Floristic and structural variation of weeds in eucalyptus plantations as influenced by relief and time of year

The objective of this work was to analyze the floristic variation and phytosociological structure of weeds as influenced by relief and time of year in eucalyptus plantations in Santana do Paraíso and Guanhães - MG. The total area sampled for each locality was approximately 10 ± 3 hectares, comprising three types of relief: lowland, slope, and upper area. In each type of relief, 10 plots of 1 m² were sampled, corresponding to 30 plots per locality, where they were randomly allocated in a zigzag. The taxonomic identification was performed in four assessments, corresponding to the months of November and March, comprising two ratings each season, always at the same points, and geo-referenced using the Global Positioning System (GPS). A total of 3,893 individuals, 18 families and 61 species, were identified in Santana do Paraiso and a total of 1,166 individuals, 13 families and 58 species, in Guanhães. In both localities, the most representative families in terms of wealth were: Poaceae, Asteraceae, and Fabaceae. Galinsoga parviflora was the most abundant species. The Vernonia polyantes was identified only in the lowlands, while Arrabida florida was identified in the slope and upper area. On the other hand, Emilia coccinea, Sida rhombifolia, S. paniculatum and Spermacoce latifolia were common to all three environments. Commelina benghalensis was present only in the month of March, while G. parviflora was present only in the month of November. It was concluded that the floristic and phytosociological variation of weeds in eucalyptus plantations is influenced by the type of relief and time of year, which should guide the management practices used in the culture.

Americae pars borealis, Florida, Baccalaos, Canada, Corterealis

Julkaisussa: Speculum orbis terrae. Vol I

Charles C. Chapman's birthday celebration, Fullerton, California,1932

Family portrait taken at Charles C. Chapman's birthday celebration, Fullerton, California,July 2, 1932. The group poses outside his residence on the lawn. Top row [left to right]: Arthur Irvin, Charles Wickett, Irvin Chapman, Sam Collins, Paul Williams, Grant Chapman,, Sidney Chapman, Clay McCarn, Earl Chapman's son David McDougal, Earl Chapman's son William McDougal, Earl Chapman, Harry Chapman, William Wickett Sr. Second row [left to right]: Mr. VanMeter, Mrs. Sinclair, C. C. Sinclair, John Franklin, Way Bagley, Marjorie Collins, Emma Williams, Ruth Chapman, Vesta Chapman, Inez Bagley, Grace Chapman, Bertha Chapman, Clough Chapman, Frank and Bertha Chapman's daughter Agnes McDougal [Streech], Georgiana Chapman, Thela Clough, Mrs. Earl [Ann] Chapman, Bessie Reynolds, Fred Chapman, E. B. [Bert] Reynolds. Seated [left to right]: Mrs. VanMeter, Hattie Clark, Louie Messlar, Charlie Thamer, Louella Thamer, Dolla Harris, Stanley Chapman Sr. holding Mary Anne, Ethel Wickett, Charles C. Chapman, Clara Chapman, Colum C. Chapman, Aunt Annie Colum, Deryth Chapman, Anna Marie Chapman, Floy Chapman, Edith Chapman. Front row [left to right]: Sam E. Collins, Bill Wickett Jr., Joyce Chapman, Marilyn Chapman, Elizabeth Chapman, Mary McCarn, Nina Chapman Lescher, Jodeane Collins, Bob Gibb, Jean Chapman. In front is a floral arrangement with drawing of a Western Union telegram "To Chas. C. Chapman, July 2, 1932, N. Fullerton, Cal., 'Wishing you a happy birthday, Nina."

Speech of Com. Jesse Duncan Elliott, U.S.N. delivered in Hagerstown, Md. on 14th November, 1843.-

Published by the Committee of Arrangement of Washington County, Maryland.

Metal music as critical dystopia : humans, technology and the future in 1990s science fiction metal

Metal Music as Critical Dystopia: Humans, Technology and the Future in 1990s Science Fiction Metal seeks to demonstrate that the dystopian elements in metal music are not merely or necessarily a sonic celebration of disaster. Rather, metal music's fascination with dystopian imagery is often critical in intent, borrowing themes and imagery from other literary and cinematic traditions in an effort to express a form of social commentary. The artists and musical works examined in this thesis maintain strong ties with the science fiction genre, in particular, and tum to science fiction conventions in order to examine the long-term implications of humanity's complex relationship with advanced technology. Situating metal's engagements with science fiction in relation to a broader practice of blending science fiction and popular music and to the technophobic tradition in writing and film, this thesis analyzes the works of two science fiction metal bands, VOlvod and Fear Factory, and provides close readings of four futuristic albums from the mid to late 1990s that address humanity's relationship with advanced technology in musical and visual imagery as well as lyrics. These recorded texts, described here as cyber metal for their preoccupation with technology in subject matter and in sound, represent prime examples of the critical dystopia in metal music. While these albums identify contemporary problems as the root bf devastation yet to come, their musical narratives leave room for the possibility of hope , allowing for the chance that dystopia is not our inevitable future.

Speech of Com. Jesse Duncan Elliott, U.S.N. delivered in Hagerstown, Md. on 14th November, 1843

Published by the Committee of Arrangement of Washington County, Maryland Printed by G.B. Zeiber and Co.

Official Programme of the Niagara Falls Park Opening Celebration, 1885

Niagara Falls State Park is the oldest state park in the United States. It is also referred to as the State Reservation (this title appears on page 2 of the program). Frederick Olmstead was the landscape architect of the park and he also designed Central Park in New York City. In July 1885, the state of New York passed laws to issue bonds for the establishment of the Niagara Reservation. This park is a National Historic Landmark and covers over 400 acres. Close to 140 acres of that land is under water. In attendance at the opening were: the Governor of the State of New York, the officers of the State, members of the Niagara Falls Association of New York City and civil and military personnel. The commissioners at the time of the opening were: William Dorsheimer, Andrew H. Green, Martin B. Anderson, T. Hampden Robb and Sherman S. Rogers.

Two School Administrators’ Perspectives on How Intercultural Education is Promoted in Their Elementary Schools

This study examined the perspectives of 2 elementary school administrators (1 principal of a faith based school, and 1 vice-principal of a public school) towards intercultural education and how it was implemented in their schools. A generic qualitative research methodology guided this study. Face-to-face interviews that used a guide with open-ended questions were used to collect data. Participants were administrators in their respective schools, had been involved in intercultural activities at their school, and were professional acquaintances of the researcher. The interviews were digitally recorded and the interview transcripts were reviewed by participants to ensure accuracy. The administrators’ understanding of intercultural education tended to be limited to learning and celebration of various cultures. The intercultural education strategies used in the respective schools focussed on developing a knowledge base and provided limited intercultural interaction. The public school had greater resources available than the private faith-based school. However, the resources were not always used to facilitate intercultural education. Teachers and administrators were provided with very few professional development opportunities focussed on intercultural education.