243 research outputs found
Using a Service Oriented Architecture Approach to Clinical Decision Support: Performance Results from Two CDS Consortium Demonstrations
The Clinical Decision Support Consortium has completed two demonstration trials involving a web service for the execution of clinical decision support (CDS) rules in one or more electronic health record (EHR) systems. The initial trial ran in a local EHR at Partners HealthCare. A second EHR site, associated with Wishard Memorial Hospital, Indianapolis, IN, was added in the second trial. Data were gathered during each 6 month period and analyzed to assess performance, reliability, and response time in the form of means and standard deviations for all technical components of the service, including assembling and preparation of input data. The mean service call time for each period was just over 2 seconds. In this paper we report on the findings and analysis to date while describing the areas for further analysis and optimization as we continue to expand our use of a Services Oriented Architecture approach for CDS across multiple institutions
Surgical versus nonsurgical therapy for lumbar spinal stenosis.
BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.
METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and 1 and 2 years.
RESULTS: A total of 289 patients were enrolled in the randomized cohort, and 365 patients were enrolled in the observational cohort. At 2 years, 67% of patients who were randomly assigned to surgery had undergone surgery, whereas 43% of those who were randomly assigned to receive nonsurgical care had also undergone surgery. Despite the high level of nonadherence, the intention-to-treat analysis of the randomized cohort showed a significant treatment effect favoring surgery on the SF-36 scale for bodily pain, with a mean difference in change from baseline of 7.8 (95% confidence interval, 1.5 to 14.1); however, there was no significant difference in scores on physical function or on the Oswestry Disability Index. The as-treated analysis, which combined both cohorts and was adjusted for potential confounders, showed a significant advantage for surgery by 3 months for all primary outcomes; these changes remained significant at 2 years.
CONCLUSIONS: In the combined as-treated analysis, patients who underwent surgery showed significantly more improvement in all primary outcomes than did patients who were treated nonsurgically. (ClinicalTrials.gov number, NCT00000411 [ClinicalTrials.gov].)
Acute Low Back Pain and Primary Care: How to Define Recovery and Chronification?
Prospective cohort stud
The causativeâinstrumental syncretism
Causative and applicative morphemes have been central in work on the morphosyntax of argument structure. However, several genetically unrelated languages use a single, syncretic form for both functions, which complicates the traditional view that a causative adds a new subject and an applicative adds a new object. In this paper, I propose an analysis of a morphological syncretism found in the Bantu language Kinyarwanda where the morphological causative and instrumental applicative are both realized by the morpheme âish. I argue for Kinyarwanda that both causation and the introduction of an instrument are analyzable as two outgrowths of the same semantic notion of introducing a new link into the causal chain described by the verb. The different causative and instrumental readings derive from underspecification of the position of the new link in the causal chain, although its placement is restricted via general constraints on possible event types as well as constraints on verb meaning and argument realization. This analysis provides an explanation for the presence of the causativeâinstrumental syncretism as well as provides insight into the interface between verb meaning and valency-changing morphology
Adjustment for survey nonârepresentativeness using recordâlinkage: refined estimates of alcohol consumption by deprivation in Scotland
Background and aims
Analytical approaches to addressing survey nonâparticipation bias typically use only demographic information to improve estimates. We applied a novel methodology which uses health information from data linkage to adjust for nonârepresentativeness. We illustrate the method by presenting adjusted alcohol consumption estimates for Scotland.
Design
Data on consenting respondents to the Scottish Health Surveys (SHeSs) 1995â2010 were linked confidentially to routinely collected hospital admission and mortality records. Synthetic observations representing nonârespondents were created using general population data. Multiple imputation was performed to compute adjusted alcohol estimates given a range of assumptions about the missing data. Adjusted estimates of mean weekly consumption were additionally calibrated to perâcapita alcohol sales data.
Setting
Scotland.
Participants
13 936 male and 18 021 female respondents to the SHeSs 1995â2010, aged 20â64 years.
Measurements
Weekly alcohol consumption, nonâ, bingeâ and problemâdrinking.
Findings
Initial adjustment for nonâresponse resulted in estimates of mean weekly consumption that were elevated by up to 17.8% [26.5 units (18.6â34.4)] compared with corrections based solely on socioâdemographic data [22.5 (17.7â27.3)]; other drinking behaviour estimates were little changed. Under more extreme assumptions the overall difference was up to 53%, and calibrating to sales estimates resulted in up to 88% difference. Increases were especially pronounced among males in deprived areas.
Conclusions
The use of routinely collected health data to reduce bias arising from survey nonâresponse resulted in higher alcohol consumption estimates among workingâage males in Scotland, with less impact for females. This new method of bias reduction can be generalized to other surveys to improve estimates of alternative harmful behaviours
'It's Just More Acceptable to Be White or Mixed Race and Gay Than Black and Gay': The Perceptions and Experiences of Homophobia in St. Lucia
Lesbian, gay and bisexual (LGB) individuals come from diverse cultural groups with differing ethnic and racial identities. However, most research on LGB people uses white western samples and studies of Afro-Caribbean diaspora often use Jamaican samples. Thus, the complexity of Afro-Caribbean LGB peoplesâ experiences of homophobia is largely unknown. The authorsâ analyses explore experiences of homophobia among LGB people in St. Lucia. Findings indicate issues of skin-shade orientated tolerance, regionalized disparities in levels of tolerance towards LGB people and regionalized passing (regionalized sexual identity shifting). Finally, the authorsâ findings indicate that skin shade identities and regional location influence the psychological health outcomes of homophobia experienced by LGB people in St. Lucia
ATRX dysfunction Induces replication defects in primary mouse cells
The chromatin remodeling protein ATRX, which targets tandem repetitive DNA, has been shown to be required for expression of the alpha globin genes, for proliferation of a variety of cellular progenitors, for chromosome congression and for the maintenance of telomeres. Mutations in ATRX have recently been identified in tumours which maintain their telomeres by a telomerase independent pathway involving homologous recombination thought to be triggered by DNA damage. It is as yet unknown whether there is a central underlying mechanism associated with ATRX dysfunction which can explain the numerous cellular phenomena observed. There is, however, growing evidence for its role in the replication of various repetitive DNA templates which are thought to have a propensity to form secondary structures. Using a mouse knockout model we demonstrate that ATRX plays a direct role in facilitating DNA replication. Ablation of ATRX alone, although leading to a DNA damage response at telomeres, is not sufficient to trigger the alternative lengthening of telomere pathway in mouse embryonic stem cells
A systematic review of attachment and psychosis:measurement, construct validity and outcomes
Objective:
This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis.<p></p>
nMethod:
The following computerised databases searched were CINAHL <1980 to December 2012; EMBASE < 1980 to December 2012; Ovid MEDLINE (R) < 1980 to December 2012; PsychINFO < 1980 to December 2012; and Google Scholar < 1980 to December 2012.<p></p>
Results:
We identified 22 papers describing 21 studies comprising 1453 participants, with a mean age of 35.0 years (range of 12â71 years), of whom 68.4% (n = 994) were male. Of our sample, 1112 (76.5%) had a diagnosis of schizophrenia. We found small to moderate associations between greater attachment insecurity (as reflected in anxiety and avoidance) and poorer engagement with services, more interpersonal problems, more avoidant coping strategies, more negative appraisals of parenting experiences and more severe trauma. We also found small to modest associations between attachment insecurity and more positive and negative symptoms and greater affective symptom problems.<p></p>
Conclusion:
Attachment theory may be useful as a means of understanding the developmental and interpersonal basis of recovery and adaptation in the context of psychosis. However, further research comprising more representative samples in their first episode and using prospective designs is required.<p></p>
Enter Mercury, Sleeping: Delivering Prayers on the Early Modern Stage
This is the author accepted manuscript. The final version is available from CUP via the DOI in this recor
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