Secondary analysis of effectivness of tinidazole-containing-quadruple eradication therapy in asymptomatic H. pylori infected children in El Paso

Helicobacter pylori infection is frequently acquired during childhood. This microorganism is known to cause gastritis, and duodenal ulcer in pediatric patients, however most children remain completely asymptomatic to the infection. Currently there is no consensus in favor of treatment of H. pylori infection in asymptomatic children. The firstline of treatment for this population is triple medication therapy including two antibacterial agents and one proton pump inhibitor for a 2 week duration course. Decreased eradication rate of less than 75% has been documented with the use of this first-line therapy but novel tinidazole-containing quadruple sequential therapies seem worth investigating. None of the previous studies on such therapy has been done in the United States of America. As part of an iron deficiency anemia study in asymptomatic H. pylori infected children of El Paso, Texas, we conducted a secondary data analysis of study data collected in this trial to assess the effectiveness of this tinidazole-containing sequential quadruple therapy compared to placebo on clearing the infection. Subjects were selected from a group of asymptomatic children identified through household visits to 11,365 randomly selected dwelling units. After obtaining parental consent and child assent a total of 1,821 children 3-10 years of age were screened and 235 were positive to a novel urine immunoglobulin class G antibodies test for H. pylori infection and confirmed as infected using a 13C urea breath test, using a hydrolysis urea rate >10 μg/min as cut-off value. Out of those, 119 study subjects had a complete physical exam and baseline blood work and were randomly allocated to four groups, two of which received active H. pylori eradication medication alone or in combination with iron, while the other two received iron only or placebo only. Follow up visits to their houses were done to assess compliance and occurrence of adverse events and at 45+ days post-treatment, a second urea breath test was performed to assess their infection status. The effectiveness was primarily assessed on intent to treat basis (i.e., according to their treatment allocation), and the proportion of those who cleared their infection using a cut-off value >10 μg/min of for urea hydrolysis rate, was the primary outcome. Also we conducted analysis on a per-protocol basis and according to the cytotoxin associated gene A product of the H. pylori infection status. Also we compared the rate of adverse events across the two arms. On intent-to-treat and per-protocol analyses, 44.3% and 52.9%, respectively, of the children receiving the novel quadruple sequential eradication cleared their infection compared to 12.2% and 15.4% in the arms receiving iron or placebo only, respectively. Such differences were statistically significant (p<0.001). The study medications were well accepted and safe. In conclusion, we found in this study population, of mostly asymptomatically H. pylori infected children, living in the US along the border with Mexico, that the quadruple sequential eradication therapy cleared the infection in only half of the children receiving this treatment. Research is needed to assess the antimicrobial susceptibility of the strains of H. pylori infecting this population to formulate more effective therapies. ^

Demographic analysis of Certified Industrial Hygienists (CIH) with the use of survival analysis techniques

Objective. The goal of this study is to characterize the current workforce of CIHs, the lengths of professional practice careers of the past and current CIHs.^ Methods. This is a secondary data analysis of data compiled from all of the nearly 50 annual roster listings of the American Board of Industrial Hygiene (ABIH) for Certified Industrial Hygienists active in each year since 1960. Survival analysis was performed as a technique to measure the primary outcome of interest. The technique which was involved in this study was the Kaplan-Meier method for estimating the survival function.^ Study subjects: The population to be studied is all Certified Industrial Hygienists (CIHs). A CIH is defined by the ABIH as an individual who has achieved the minimum requirements for education, working experience and through examination, has demonstrated a minimum level of knowledge and competency in the prevention of occupational illnesses. ^ Results. A Cox-proportional hazards model analysis was performed by different start-time cohorts of CIHs. In this model we chose cohort 1 as the reference cohort. The estimated relative risk of the event (defined as retirement, or absent from 5 consecutive years of listing) occurred for CIHs for cohorts 2,3,4,5 relative to cohort 1 is 0.385, 0.214, 0.234, 0.299 relatively. The result show that cohort 2 (CIHs issued from 1970-1980) has the lowest hazard ratio which indicates the lowest retirement rate.^ Conclusion. The manpower of CIHs (still actively practicing up to the end of 2009) increased tremendously starting in 1980 and grew into a plateau in recent decades. This indicates that the supply and demand of the profession may have reached equilibrium. More demographic information and variables are needed to actually predict the future number of CIHs needed. ^

BEST SUBSET SELECTION FOR CATEGORICAL DATA

When choosing among models to describe categorical data, the necessity to consider interactions makes selection more difficult. With just four variables, considering all interactions, there are 166 different hierarchical models and many more non-hierarchical models. Two procedures have been developed for categorical data which will produce the "best" subset or subsets of each model size where size refers to the number of effects in the model. Both procedures are patterned after the Leaps and Bounds approach used by Furnival and Wilson for continuous data and do not generally require fitting all models. For hierarchical models, likelihood ratio statistics (G('2)) are computed using iterative proportional fitting and "best" is determined by comparing, among models with the same number of effects, the Pr((chi)(,k)('2) (GREATERTHEQ) G(,ij)('2)) where k is the degrees of freedom for ith model of size j. To fit non-hierarchical as well as hierarchical models, a weighted least squares procedure has been developed.^ The procedures are applied to published occupational data relating to the occurrence of byssinosis. These results are compared to previously published analyses of the same data. Also, the procedures are applied to published data on symptoms in psychiatric patients and again compared to previously published analyses.^ These procedures will make categorical data analysis more accessible to researchers who are not statisticians. The procedures should also encourage more complex exploratory analyses of epidemiologic data and contribute to the development of new hypotheses for study. ^

Descriptive analysis of Ben Taub Pediatric Weight Management Program

The purpose of this study is to descriptively analyze the current program at Ben Taub Pediatric Weight Management Program in Houston, Texas, a program designed to help overweight children ages three to eighteen to lose weight. In Texas, approximately one in every three children is overweight or obese. Obesity is seen at an even greater level within Ben Taub due to the hospital's high rate of service for underserved minority populations (Dehghan et al, 2005; Tyler and Horner, 2008; Hunt, 2009). The weight management program consists of nutritional, behavioral, physical activity, and medical counseling. Analysis will focus on changes in weight, BMI, cholesterol levels, and blood pressure from 2007–2010 for all participants who attended at least two weight management sessions. Recommendations will be given in response to the results of the data analysis.^

Motivational interviewing and feedback for college drinkers: Handling missing values with complete case analysis and multiple imputation

Objective: In this secondary data analysis, three statistical methodologies were implemented to handle cases with missing data in a motivational interviewing and feedback study. The aim was to evaluate the impact that these methodologies have on the data analysis. ^ Methods: We first evaluated whether the assumption of missing completely at random held for this study. We then proceeded to conduct a secondary data analysis using a mixed linear model to handle missing data with three methodologies (a) complete case analysis, (b) multiple imputation with explicit model containing outcome variables, time, and the interaction of time and treatment, and (c) multiple imputation with explicit model containing outcome variables, time, the interaction of time and treatment, and additional covariates (e.g., age, gender, smoke, years in school, marital status, housing, race/ethnicity, and if participants play on athletic team). Several comparisons were conducted including the following ones: 1) the motivation interviewing with feedback group (MIF) vs. the assessment only group (AO), the motivation interviewing group (MIO) vs. AO, and the intervention of the feedback only group (FBO) vs. AO, 2) MIF vs. FBO, and 3) MIF vs. MIO.^ Results: We first evaluated the patterns of missingness in this study, which indicated that about 13% of participants showed monotone missing patterns, and about 3.5% showed non-monotone missing patterns. Then we evaluated the assumption of missing completely at random by Little's missing completely at random (MCAR) test, in which the Chi-Square test statistic was 167.8 with 125 degrees of freedom, and its associated p-value was p=0.006, which indicated that the data could not be assumed to be missing completely at random. After that, we compared if the three different strategies reached the same results. For the comparison between MIF and AO as well as the comparison between MIF and FBO, only the multiple imputation with additional covariates by uncongenial and congenial models reached different results. For the comparison between MIF and MIO, all the methodologies for handling missing values obtained different results. ^ Discussions: The study indicated that, first, missingness was crucial in this study. Second, to understand the assumptions of the model was important since we could not identify if the data were missing at random or missing not at random. Therefore, future researches should focus on exploring more sensitivity analyses under missing not at random assumption.^

UNDERSTANDING NURSE CREATED COGNITIVE ARTIFACTS: PERSONALLY-CREATED-COGNITIVE-ARTIFACTS AS EXTERNAL REPRESENTATIONS OF DISTRIBUTED COGNITION

Manuscript 1: “Conceptual Analysis: Externalizing Nursing Knowledge” We use concept analysis to establish that the report tool nurses prepare, carry, reference, amend, and use as a temporary data repository are examples of cognitive artifacts. This tool, integrally woven throughout the work and practice of nurses, is important to cognition and clinical decision-making. Establishing the tool as a cognitive artifact will support new dimensions of study. Such studies can characterize how this report tool supports cognition, internal representation of knowledge and skills, and external representation of knowledge of the nurse. Manuscript 2: “Research Methods: Exploring Cognitive Work” The purpose of this paper is to describe a complex, cross-sectional, multi-method approach to study of personal cognitive artifacts in the clinical environment. The complex data arrays present in these cognitive artifacts warrant the use of multiple methods of data collection. Use of a less robust research design may result in an incomplete understanding of the meaning, value, content, and relationships between personal cognitive artifacts in the clinical environment and the cognitive work of the user. Manuscript 3: “Making the Cognitive Work of Registered Nurses Visible” Purpose: Knowledge representations and structures are created and used by registered nurses to guide patient care. Understanding is limited regarding how these knowledge representations, or cognitive artifacts, contribute to working memory, prioritization, organization, cognition, and decision-making. The purpose of this study was to identify and characterize the role a specific cognitive artifact knowledge representation and structure as it contributed to the cognitive work of the registered nurse. Methods: Data collection was completed, using qualitative research methods, by shadowing and interviewing 25 registered nurses. Data analysis employed triangulation and iterative analytic processes. Results: Nurse cognitive artifacts support recall, data evaluation, decision-making, organization, and prioritization. These cognitive artifacts demonstrated spatial, longitudinal, chronologic, visual, and personal cues to support the cognitive work of nurses. Conclusions: Nurse cognitive artifacts are an important adjunct to the cognitive work of nurses, and directly support patient care. Nurses need to be able to configure their cognitive artifact in ways that are meaningful and support their internal knowledge representations.

Reference list of 120 datasets from time series station Payerne used for exploratory search

The analysis of time-dependent data is an important problem in many application domains, and interactive visualization of time-series data can help in understanding patterns in large time series data. Many effective approaches already exist for visual analysis of univariate time series supporting tasks such as assessment of data quality, detection of outliers, or identification of periodically or frequently occurring patterns. However, much fewer approaches exist which support multivariate time series. The existence of multiple values per time stamp makes the analysis task per se harder, and existing visualization techniques often do not scale well. We introduce an approach for visual analysis of large multivariate time-dependent data, based on the idea of projecting multivariate measurements to a 2D display, visualizing the time dimension by trajectories. We use visual data aggregation metaphors based on grouping of similar data elements to scale with multivariate time series. Aggregation procedures can either be based on statistical properties of the data or on data clustering routines. Appropriately defined user controls allow to navigate and explore the data and interactively steer the parameters of the data aggregation to enhance data analysis. We present an implementation of our approach and apply it on a comprehensive data set from the field of earth bservation, demonstrating the applicability and usefulness of our approach.

Generating Automated News to Explain the Meaning of Sensor Data

An important competence of human data analysts is to interpret and explain the meaning of the results of data analysis to end-users. However, existing automatic solutions for intelligent data analysis provide limited help to interpret and communicate information to non-expert users. In this paper we present a general approach to generating explanatory descriptions about the meaning of quantitative sensor data. We propose a type of web application: a virtual newspaper with automatically generated news stories that describe the meaning of sensor data. This solution integrates a variety of techniques from intelligent data analysis into a web-based multimedia presentation system. We validated our approach in a real world problem and demonstrate its generality using data sets from several domains. Our experience shows that this solution can facilitate the use of sensor data by general users and, therefore, can increase the utility of sensor network infrastructures.

Metodología para la optimización de la base de datos de líneas límite del Instituto Geográfico Nacional

Esta metodología se ha desarrollado en el marco de un proyecto que es el objeto del Convenio Específico de Colaboración entre el Instituto Geográfico Nacional y la Escuela de Topografía de la Universidad Politécnica de Madrid relativo a la investigación, desarrollo, formación y difusión de conocimientos en el campo de las tecnologías de la información geográfica (TIG) para la investigación y desarrollo de la tecnología y metodología adecuada para la optimización de la información de la Base de Datos de Líneas Límite de la Dirección General del Instituto Geográfico Nacional. El fin fundamental del mismo es desarrollar una metodología para mejorar la precisión de la Base de Datos de Líneas Límite que tiene el Instituto Geográfico Nacional. La exigencia actual de calidad y seguridad en la descripción geométrica de las líneas límite obliga a optimizar dicha descripción mediante la aplicación de nuevas tecnologías no existentes en el momento del levantamiento, y al diseño de metodologías adecuadas que, minimizando los tiempos y costes de ejecución, consideren asimismo los distintos agentes que participan en España en la definición de las líneas límite. Para desarrollar dicha metodología será necesario en primer lugar digitalizar la información de los cuadernos de campo y las actas de deslinde existentes en el Instituto Geográfico Nacional, para que sea un trabajo abordable desde las tecnologías actuales; posteriormente, volcar la información referente a las líneas límite sobre ortofotografías a escala 1:5.000, a partir de los datos de los cuadernos de campo digitalizados. Se propondrá un nuevo sistema de gestión, tratamiento y almacenamiento de las líneas límite, con información sobre su linaje (origen de datos, precisión), así como el formato de salida de las propias líneas límite. Para controlar la calidad de la metodología propuesta, se deberá validar la misma mediante un estudio teórico de lamedida de rendimientos y precisiones y su verificación mediante toma de datos en campo. Particularmente, se llevará a cabo dicha validación en un conjunto de 140 líneas límite de 36 municipios de la provincia de Ávila y Segovia (los comprendidos en las hojas 556 y 457 del Mapa Topográfico Nacional 1:50.000). Una vez contrastada la metodología y efectuados los oportunos procesos de refinamiento, se redactarán las conclusiones de todo el proyecto, que englobarán las recomendaciones de trabajo y las precisiones resultantes, los rendimientos de los diferentes procesos y los costes que se generen mediante el empleo de la nueva metodología. ABSTARCT: This paper introduces the development of a methodology for the optimisation of the municipal boundaries database of the Instituto Geográfico Nacional. This project has arisen as part of a collaboration agreement between the Instituto Geográfico Nacional and the Escuela de Topografía of the Universidad Politécnica de Madrid which seeks to promote research, development and training in Geographic Information Technologies. Current quality requirements demand the use of new technologies to improve the accuracy of the geometrical description of municipal boundaries. These technologies didn’t exist when the municipal boundaries were first drawn up. Besides, it is convenient to design an appropriate methodology that minimises both costs and time employed. The two main steps in the process are: first, the conversion of all the available data (fixing boundary minutes and field survey notebooks) into digital format in order to make possible their integration in a CAD system; and second, the display and visual overlay of these digital data over an 1:5000 orthophotography of the study area, to identify the boundary monuments. A new system will be proposed to manage, process and storage municipal boundaries information, including its lineage; an output format for these data will be designed as well. In addition, a quality control will be designed to audit this scheme using Data Analysis and Statistical Inference techniques. Moreover, GPS technology will be used to get some boundary monuments co-ordinates to check the results of the proposed methodology. The complete scheme will be tested in a study area corresponding to Ávila and Segovia provinces comprising 140 boundary segments from 36 municipalities.