Beyond the ecological fallacy: potential problems when studying healthcare organisations.

Ecological studies, which consider patient groups rather than individuals, are common in health policy research. The ‘ecological fallacy’ is a well-recognised methodological concern, but in this perspectives paper, we focus on less often appreciated but equally important limitations of such studies. In particular, we consider reliability and power as they apply to ecological studies, and make recommendations to inform the appropriate design and interpretation of these increasingly popular studies.This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. GL is supported by a Cancer Research UK Clinician Scientist Fellowship (A18180). The views expressed in this publication are those of the authors and not necessarily those of any funder or any other organisation or institution.This is the author accepted manuscript. The final version is available from SAGE via http://dx.doi.org/10.1177/014107681561057

Response rates to patient surveys

BACKGROUND: Patient surveys typically have variable response rates between organizations, leading to concerns that such differences may affect the validity of performance comparisons. OBJECTIVE: To explore the size and likely sources of associations between hospital-level survey response rates and patient experience. RESEARCH DESIGN, SUBJECTS, AND MEASURES: Cross-sectional mail survey including 60 patient experience items sent to 101,771 cancer survivors recently treated by 158 English NHS hospitals. Age, sex, race/ethnicity, socioeconomic status, clinical diagnosis, hospital type, and region were available for respondents and nonrespondents. RESULTS: The overall response rate was 67% (range, 39% to 77% between hospitals). Hospitals with higher response rates had higher scores for all items (Spearman correlation range, 0.03-0.44), particularly questions regarding hospital-level administrative processes, for example, procedure cancellations or medical note availability.From multivariable analysis, associations between individual patient experience and hospital-level response rates were statistically significant (P<0.05) for 53/59 analyzed questions, decreasing to 37/59 after adjusting for case-mix, and 25/59 after further adjusting for hospital-level characteristics.Predicting responses of nonrespondents, and re-estimating hypothetical hospital scores assuming a 100% response rate, we found that currently low performing hospitals would have attained even lower scores. Overall nationwide attainment would have decreased slightly to that currently observed. CONCLUSIONS: Higher response rate hospitals have more positive experience scores, and this is only partly explained by patient case-mix. High response rates may be a marker of efficient hospital administration, and higher quality that should not, therefore, be adjusted away in public reporting. Although nonresponse may result in slightly overestimating overall national levels of performance, it does not appear to meaningfully bias comparisons of case-mix-adjusted hospital results.GL is supported by a Cancer Research UK Clinician Scientist Fellowship (A18180).This is the final version of the article. It first appeared from Wolters Kluwer via http://dx.doi.org/10.1097/MLR.000000000000045

Ortho-semantic learning of novel words: An event-related potential study of grade 3 children

Introduction: As children become independent readers, they regularly encounter new words whose meanings they must infer from context, and whose spellings must be learned for future recognition. The self-teaching hypothesis proposes orthographic learning skills are critical in the transition to fluent reading, while the lexical quality hypothesis further emphasizes the importance of semantics. Event-related potential (ERP) studies of reading development have focused on effects related to the N170 component—print tuning (letters vs. symbols) and lexical tuning (real words vs. consonant strings)—as well as the N400 reflecting semantic processing, but have not investigated the relationship of these components to word learning during independent reading. Methods: In this study, children in grade 3 independently read short stories that introduced novel words, then completed a lexical decision task from which ERPs were derived. Results: Like real words, newly-learned novel words evoked a lexical tuning effect, indicating rapid establishment of orthographic representations. Both real and novel words elicited significantly smaller N400s than pseudowords, suggesting that semantic representations of the novel words were established. Further, N170 print tuning predicted accuracy on identifying the spellings of the novel words, while the N400 effect for novel words was associated with reading comprehension. Discussion: Exposure to novel words during self-directed reading rapidly establishes neural markers of orthographic and semantic processing. Furthermore, the ability to rapidly filter letter strings from symbols is predictive of orthographic learning, while rapid establishment of semantic representations of novel words is associated with stronger reading comprehension

The POKEMON Speckle Survey of Nearby M dwarfs. I. New Discoveries

M dwarfs are favorable targets for exoplanet detection with current instrumentation, but stellar companions can induce false positives and inhibit planet characterization. Knowledge of stellar companions is also critical to our understanding of how binary stars form and evolve. We have therefore conducted a survey of stellar companions around nearby M dwarfs, and here we present our new discoveries. Using the DSSI speckle imager at the 4.3-meter Lowell Discovery Telescope, and the similar NESSI instrument at the 3.5-meter WIYN telescope, we carried out a volume-limited survey of M-dwarf multiplicity to 15 parsecs, with a special emphasis on including the later M dwarfs that were overlooked in previous surveys. Additional brighter targets at larger distances were included for a total sample size of 1070 M dwarfs. Observations of these 1070 targets revealed 26 new companions; 22 of these systems were previously thought to be single. If all new discoveries are confirmed, then the number of known multiples in the sample will increase by 7.6%. Using our observed properties, as well as the parallaxes and 2MASS K magnitudes for these objects, we calculate the projected separation, and estimate the mass ratio and component spectral types, for these systems. We report the discovery of a new M-dwarf companion to the white dwarf Wolf 672 A, which hosts a known M-dwarf companion as well, making the system trinary. We also examine the possibility that the new companion to 2MASS J13092185-2330350 is a brown dwarf. Finally, we discuss initial insights from the POKEMON survey.Comment: 23 pages, 6 figures, 5 table

DNA hypomethylation during MSC chondrogenesis occurs predominantly at enhancer regions

Regulation of transcription occurs in a cell type specific manner orchestrated by epigenetic mechanisms including DNA methylation. Methylation changes may also play a key role in lineage specification during stem cell differentiation. To further our understanding of epigenetic regulation in chondrocytes we characterised the DNA methylation changes during chondrogenesis of mesenchymal stem cells (MSCs) by Infinium 450 K methylation array. Significant DNA hypomethylation was identified during chondrogenic differentiation including changes at many key cartilage gene loci. Integration with chondrogenesis gene expression data revealed an enrichment of significant CpGs in upregulated genes, while characterisation of significant CpG loci indicated their predominant localisation to enhancer regions. Comparison with methylation profiles of other tissues, including healthy and diseased adult cartilage, identified chondrocyte-specific regions of hypomethylation and the overlap with differentially methylated CpGs in osteoarthritis. Taken together we have associated DNA methylation levels with the chondrocyte phenotype. The consequences of which has potential to improve cartilage generation for tissue engineering purposes and also to provide context for observed methylation changes in cartilage diseases such as osteoarthritis

Evaluation of an alternative spectroscopic approach for aflatoxin analysis: Comparative analysis of food and feed samples with UPLC-MS/MS

Increasing research has highlighted the effects of changing climates on the occurrence and prevalence of toxigenic Aspergillus species producing aflatoxins. There is concern of the toxicological effects to human health and animal productivity following acute and chronic exposure that may affect the future ability to provide safe and sufficient food globally. Considerable research has focused on the detection of these toxins, based on the physicochemical and biochemical properties of the aflatoxin compounds, in agricultural products for human and animal consumption. As improvements in food security continue more regulations for acceptable levels of aflatoxins have arisen globally; the most stringent in Europe. These regulations are important for developing countries as aflatoxin occurrence is high significantly effecting international trade and the economy. In developed countries analytical approaches have become highly sophisticated, capable of attaining results with high precision and accuracy, suitable for regulatory laboratories. Regrettably, many countries that are affected by aflatoxin contamination do not have resources for high tech HPLC and MS instrumentation and require more affordable, yet robust equally accurate alternatives that may be used by producers, processors and traders in emerging economies. It is especially important that those companies wishing to exploit the opportunities offered by lucrative but highly regulated markets in the developed world, have access to analytical methods that will ensure that their exports meet their customers quality and safety requirements. This work evaluates the ToxiMet system as an alternative approach to UPLC–MS/MS for the detection and determination of aflatoxins relative to current European regulatory standards. Four commodities: rice grain, maize cracked and flour, peanut paste and dried distillers grains were analysed for natural aflatoxin contamination. For B1 and total aflatoxins determination the qualitative correlation, above or below the regulatory limit, was good for all commodities with the exception of the dried distillers grain samples for B1 for which no calibration existed. For B1 the quantitative R2 correlations were 0.92, 0.92, 0.88 (<250 μg/kg) and 0.7 for rice, maize, peanuts and dried distillers grain samples respectively whereas for total aflatoxins the quantitative correlation was 0.92, 0.94, 0.88 and 0.91. The ToxiMet system could be used as an alternative for aflatoxin analysis for current legislation but some consideration should be given to aflatoxin M1 regulatory levels for these commodities considering the high levels detected in this study especially for maize and peanuts. (Résumé d'auteur

Search Engine Advertising: Channel Substitution when Pricing Ads to Context

We explore substitution patterns across advertising platforms. Using data on the advertising prices paid by lawyers for 139 Google search terms in 195 locations, we exploit a natural experiment in “ambulance-chaser” regulations across states. When lawyers cannot contact clients by mail, advertising prices per click for search engine advertisements are 5%–7% higher. Therefore, online advertising substitutes for offline advertising. This substitution toward online advertising is strongest in markets with fewer customers, suggesting that the relationship between the online and offline media is mediated by the marketers' need to target their communications.NET Institut

Geographic Variation in Pneumonia and Influenza in Long-Term Care Facilities:A National Study

There is large county-level geographic variation in pneumonia and influenza hospitalizations among short-stay and long-stay long-term care facility residents in the United States. Long-term care facilities in counties in the Southern and Midwestern regions had the highest rates of pneumonia and influenza from 2013 to 2015. Future research should identify reasons for these geographic differences