What factors are associated with success with insulin pumps?

What factors are associated with success with insulin pumps?Diabetes UK conference gran

In the absence of cancer registry data, is it sensible to assess incidence using hospital separation records?

BACKGROUND: Within the health literature, a major goal is to understand distribution of service utilisation by social location. Given equivalent access, differential incidence leads to an expectation of differential service utilisation. Cancer incidence is differentially distributed with respect to socioeconomic status. However, not all jurisdictions have incidence registries, and not all registries allow linkage with utilisation records. The British Columbia Linked Health Data resource allows such linkage. Consequently, we examine whether, in the absence of registry data, first hospitalisation can act as a proxy measure for incidence, and therefore as a measure of need for service. METHODS: Data are drawn from the British Columbia Linked Health Data resource, and represent 100% of Vancouver Island Health Authority cancer registry and hospital records, 1990–1999. Hospital separations (discharges) with principal diagnosis ICD-9 codes 140–208 are included, as are registry records with ICDO-2 codes C00-C97. Non-melanoma skin cancer (173/C44) is excluded. Lung, colorectal, female breast, and prostate cancers are examined separately. We compare registry and hospital annual counts and age-sex distributions, and whether the same individuals are represented in both datasets. Sensitivity, specificity and predictive values are calculated, as is the kappa statistic for agreement. The registry is designated the gold standard. RESULTS: For all cancers combined, first hospitalisation counts consistently overestimate registry incidence counts. From 1995–1999, there is no significant difference between registry and hospital counts for lung and colorectal cancer (p = 0.42 and p = 0.56, respectively). Age-sex distribution does not differ for colorectal cancer. Ten-year period sensitivity ranges from 73.0% for prostate cancer to 84.2% for colorectal cancer; ten-year positive predictive values range from 89.5% for female breast cancer to 79.35% for prostate cancer. Kappa values are consistently high. CONCLUSION: Claims and registry databases overlap with an appreciable proportion of the same individuals. First hospital separation may be considered a proxy for incidence with reference to colorectal cancer since 1995. However, to examine equity across cancer health services utilisation, it is optimal to have access to both hospital and registry files

Is hospital discharge administrative data an appropriate source of information for cancer registries purposes? Some insights from four Spanish registries

<p>Abstract</p> <p>Background</p> <p>The use of hospital discharge administrative data (HDAD) has been recommended for automating, improving, even substituting, population-based cancer registries. The frequency of false positive and false negative cases recommends local validation.</p> <p>Methods</p> <p>The aim of this study was to detect newly diagnosed, false positive and false negative cases of cancer from hospital discharge claims, using four Spanish population-based cancer registries as the gold standard. Prostate cancer was used as a case study.</p> <p>Results</p> <p>A total of 2286 incident cases of prostate cancer registered in 2000 were used for validation. In the most sensitive algorithm (that using five diagnostic codes), estimates for Sensitivity ranged from 14.5% (CI95% 10.3-19.6) to 45.7% (CI95% 41.4-50.1). In the most predictive algorithm (that using five diagnostic and five surgical codes) Positive Predictive Value estimates ranged from 55.9% (CI95% 42.4-68.8) to 74.3% (CI95% 67.0-80.6). The most frequent reason for false positive cases was the number of prevalent cases inadequately considered as newly diagnosed cancers, ranging from 61.1% to 82.3% of false positive cases. The most frequent reason for false negative cases was related to the number of cases not attended in hospital settings. In this case, figures ranged from 34.4% to 69.7% of false negative cases, in the most predictive algorithm.</p> <p>Conclusions</p> <p>HDAD might be a helpful tool for cancer registries to reach their goals. The findings suggest that, for automating cancer registries, algorithms combining diagnoses and procedures are the best option. However, for cancer surveillance purposes, in those cancers like prostate cancer in which care is not only hospital-based, combining inpatient and outpatient information will be required.</p

Protein/DNA interactions in complex DNA topologies: expect the unexpected

DNA supercoiling results in compacted DNA structures that can bring distal sites into close proximity. It also changes the local structure of the DNA, which can in turn influence the way it is recognised by drugs, other nucleic acids and proteins. Here, we discuss how DNA supercoiling and the formation of complex DNA topologies can affect the thermodynamics of DNA recognition. We then speculate on the implications for transcriptional control and the three-dimensional organisation of the genetic material, using examples from our own simulations and from the literature. We introduce and discuss the concept of coupling between the multiple length-scales associated with hierarchical nuclear structural organisation through DNA supercoiling and topology

Seasonal movement and groundwater flow mechanism in an unsaturated saprolitic hillslope

Numerous field monitoring programs have been conducted to investigate the performance of an unsaturated soil slope subjected to rainfalls in wet seasons. Most case histories focus on the response of matric suction, which is one of the two stress-state variables governing unsaturated soil behaviour. However, effects due to another variable, net normal stress, are often ignored. Also, slope performance under alternative wet and dry seasons is rarely reported and analysed. In this study, a saprolitic hillslope situated in Hong Kong was instrumented heavily to investigate its seasonal movement due to changes of the two variables and also groundwater flow mechanism. Two-year seasonal variations of matric suction and net normal stress were monitored by tensiometers together with heat dissipation matric water potential sensors and earth pressure cells, respectively. During heavy rainstorms in wet season, there was a substantial recharge of the main groundwater table, causing a significant increase of positive pore-water pressure in deeper depths. Rupture surface likely developed at depths between 5.5 and 6 m, hence resulting in a "deep-seated" mode of downslope movement. The downslope movement resulted in a peak increase of horizontal stress. In dry seasons, matric suction of up to 190 kPa was recorded, and the associated soil shrinkage led to substantial upslope rebounds. The stress built up in wet seasons hence reduced. After monitoring period of 2 years, downslope ratcheting is identified. Up to 40 % of the downslope displacements were recovered by the upslope rebounds