Evidence-based rules from family practice to inform family practice; The learning healthcare system case study on urinary tract infections

Background: Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). Methods: Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. Results: The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis". The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. Conclusions: We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data

66/09/21 Motion to Dismiss Appeal Filed as of Right and Memorandum Opposing Jurisdiction

The trial court properly found that there is a distinction between a frisk and a search, and that in the circumstances of this case the frisk preceded the arrest, and further, that the arrest and search in connection therewith were legal. The opinion of the Court of Appeals and the authorities cited therein support that conclusion. The defendant has not shown any valid reason why these findings should be disturbed. The motion for leave to appeal should therefore be overruled. From the Conclusion, page 14

66/09/21 Motion to Dismiss Appeal Filed as of Right and Memorandum Opposing Jurisdiction

The trial court properly found that there is a distinction between a frisk and a search, and that in the circumstances of this case the frisk preceded the arrest, and further, that the arrest and search in connection therewith were legal. The opinion of the Court of Appeals and the authorities cited therein support that conclusion. The defendant has not shown any valid reason why these findings should be disturbed. The motion for leave to appeal should therefore be overruled. From the Conclusion, page 14

Antarctic Meteorites: A Statistical Look at a Uniquely Valuable Resource

As of the end of the 2018-19 field season, the U.S. Antarctic meteorite program has surpassed 23,000 meteorites collected. The U.S. collection is valuable in that it is classified in its entirety. The systematic methods employed to collect the meteorites have provided meteorites of more than 40 types, many of which are the first of their type ever recognized. One of the early drivers for consistent and methodical characterization of the entire U.S. Antarctic collection was to allow statistical comparisons. Early statistical assessments of the U.S. Antarctic collection examined mass distributions and the relative frequency of meteorite types as well as comparisons to a defined set of modern falls. Using these statistics argued that the flux of H chondrites changed over time used model size distributions to deconstruct the contribution of wind movement, meteorite supply and search losses to the Antarctic collection. Mass-based statistics and size distribution comparisons were examined by investigated various aspects of the statistics, including comparison with modern falls/Saharan finds. Also discuss geospatial statistics provides a comprehensive overview of the statistics of the Antarctic collections for the first 35 seasons of U.S. collection by ANSMET. Here we build upon that assessment and that from

64/09/22 Defendant\u27s Bill of Exceptions - part 2

Part two of Defendant\u27s Bill of Exceptions for State of Ohio v. John W. Terry and State of Ohio v. Richard D. Chilton. Appearances: John T. Corrigan and Reuben Payne for the State of Ohio and Louis Stokes for the Defendants

64/09/22 Defendant\u27s Bill of Exceptions - part 1

Defendant\u27s Bill of Exceptions for State of Ohio v. John W. Terry and State of Ohio v. Richard D. Chilton. Appearances: John T. Corrigan and Reuben Payne for the State of Ohio and Louis Stokes for the Defendants