What does validation of cases in electronic record databases mean? The potential contribution of free text

Electronic health records are increasingly used for research. The definition of cases or endpoints often relies on the use of coded diagnostic data, using a pre-selected group of codes. Validation of these cases, as ‘true’ cases of the disease, is crucial. There are, however, ambiguities in what is meant by validation in the context of electronic records. Validation usually implies comparison of a definition against a gold standard of diagnosis and the ability to identify false negatives (‘true’ cases which were not detected) as well as false positives (detected cases which did not have the condition). We argue that two separate concepts of validation are often conflated in existing studies. Firstly, whether the GP thought the patient was suffering from a particular condition (which we term confirmation or internal validation) and secondly, whether the patient really had the condition (external validation). Few studies have the ability to detect false negatives who have not received a diagnostic code. Natural language processing is likely to open up the use of free text within the electronic record which will facilitate both the validation of the coded diagnosis and searching for false negatives

IMPACTS OF THE NORTHEAST INTERSTATE DAIRY COMPACT ON THE WIC PROGRAM: EVIDENCE FROM BOSTON AND HARTFORD

This paper examines the impacts of the Northeast Interstate Dairy Compact (Compact) on the Women, Infants and Children (WIC) program using an autoregressive-moving average (ARMA) model and data from Boston and Hartford. While the results for Boston indicate that the difference between the net fluid milk price paid by WIC program and the forecasted fluid milk price with no Compact in effect was not significant over the period of July 1997 to June 1998, the results for Hartford suggest that the net price paid by WIC was significantly greater than the forecasted price with no Compact in effect over the same period. A similar analysis of the changes in markups suggests that the increase in the net fluid milk price paid by the WIC program in Hartford was largely due to increased markups.Food Security and Poverty,

Mental Health Shared Care in Australia 2001: Report for the Commonwealth Department of Health and Aged Care

This literature review was completed to inform the development of the Access to Psychiatry component of the Better Outcomes in Mental Health Care InitiativeThis study provides a summary of the current policy and research literature on shared care and comments on the current debates around workforce, training and better coordination and integration of care between general practice and mental health services. It contributes to the knowledge base on the current state of mental health care reform in Australia. The review focuses specifically on better ways of integrating mental health care across the general practice and specialty mental health sectors and provides commentary on the points of influence, key players and social, political and economic events, which together have reshaped the culture of mental health care in Australia. Particular attention is paid to key national policy events in Australian general practice and the specialist mental health sector in the last decade, and how policy makers in both contexts have been influential in shaping a shift in emphasis from an isolationist service delivery model to one of partnership and community-based mental health care.Primary Mental Health Care Australian Resource Centre (PARC

Baseline study of employability related activities in Scottish colleges

In October 2004, the Scottish Funding Council (SFC)'s predecessor bodies, theSFEFC and the SHEFC, publishedLearning to Work(SFC 2004), a discussion paperabout how Scotland's colleges and universities can help to enhance learners'employability. In subsequent dialogue with stakeholders, there was agreement thatemployability should be a specific focus for quality enhancement in the college sectorfrom 2006-07. As a basis for further development, the SFC commissioned this studyto provide information on the range of current activities and practices in Scotland'scolleges which contribute to enhancing employability

Like mother like nest: similarity in microbial communities of adult female Pied Flycatchers and their nests

Microbial relationships between birds and nesting environments are complex and remain poorly understood. Past studies have focused on between-nest variation in egg/chick bacterial profiles with little attention given to the microbial relationships between adult birds and their nests. Moreover, very little microbial research has included mycology despite fungi being prevalent in nesting environments and important correlates of fitness in chicks. In this study, we identified microbes associated with feathers, skin and nests of Pied Flycatchers Ficedula hypoleuca, an internationally-declining migrant songbird. From 75 samples, we isolated 50 bacterial OTUs (Operational Taxonomic Units; dominated by Enterococcus, Sanguibacter, Pseduomonas) and 63 fungal OTUs (dominated by Penicillium, Aspergillus), many of which had not previously been isolated from birds. Although females had significantly higher non-haemolytic bacterial OTU richness and males significantly higher fungal OTU richness, there was considerable diversity in actual OTUs isolated and thus there was no “typical” female, male, or nest microbial profile. Interestingly though, we show for the first time that the microflora of individual females is significantly more similar the microflora of her own nest than the site-level average of all nests. This suggests microbes are shared within female-nest pairs such that microbial communities start to converge. This is probably a two-way interaction as gut/skin microbes were isolated from nests and plant/soil microbes were isolated from females. Convergence was not seen for males, which probably reflects the role of the female as sole nest builder and egg incubator in this species. We discuss these findings in relation to microbial transfer pathways and avian nesting behaviour

Intra-seasonal variability of Southern Ocean primary production: the role of storms and mesoscale turbulence

The Southern Ocean is one of the stormiest places on earth; here strong mid-latitude storms frequently traverse large distances of this ocean. Underlying these passing storms, the Southern Ocean is characterized by having some of the highest eddy kinetic energy ever measured (eddies occupying the meso to sub-mesoscale). The presence of the passage of intense storms and meso to sub-mesoscale eddy variability has the potential to strongly impact the intraseasonal variability of the upper ocean environment where phytoplankton live. Yet, exactly how phytoplankton growth rates and its variability are impacted by the dominance of such features is not clear. Herein, lies the problem addressed by the core of this thesis, which seeks to advance the understanding of intra-seasonal variability of Southern Ocean primary production. The drivers of this intra-seasonal variability have been explored from two points of view: the local-scale and the remote-scale perspectives, with a suite of physicalbiogeochemical (NEMO-PISCES) numerical models of varying complexity. At the local-scale, these model experiments have suggested that intra-seasonal stormlinked physical supplies of dissolved iron (DFe) during the summer played a considerably more active and influential role in explaining the sustained summer productivity in the surface waters of the Southern Ocean than what was thought previously. This was through two important insights: 1. Storm-eddy interactions may strongly enhance the magnitude and extent of upperocean vertical mixing in both the surface mixed layer as traditionally understood as well as in the subsurface ocean. These two mixing regimes have different dynamics but act in concert to amplify the DFe fluxes to the surface ocean. 2. Storm initiated inertial motions may, through interaction with eddies, greatly reinforce w and thus, enhance the vertical advection of DFe to the surface ocean, an effect that may last several days after the storm. At the local-scale, such storm-eddy dynamics may greatly increase the intra-seasonal variability of primary production, a step towards helping to explain why this variability is so strong in large regions of the Southern Ocean. At the remote-scale, the cumulative impact of these short-term storm-eddy interactions have unexpected implications in respect of the larger-scale mean flow and its influence on the effectiveness of intra-seasonal forcing of DFe fluxes. This counter intuitive feedback is a reduced strength of the intra-seasonal variability in primary production despite what was shown at the local-scale. Moreover, the addition of storms intensified the main clockwise cell of the meridional overturning circulation particularly the downward branch thus, reducing DFe inventory from the upper-ocean. Such an impact could potentially be enhanced with increasing storm intensities as suggested by climate projections. Understanding these remote-scale and local-scale responses of primary productivity to storms and their interaction with the underlying ocean mesoscale turbulence may be key to better understanding the sensitivities of the carbon cycle to short-term variability and long-term trends in atmospheric forcing