Creation of public use files: lessons learned from the comparative effectiveness research public use files data pilot project

In this paper we describe lessons learned from the creation of Basic Stand Alone (BSA) Public Use Files (PUFs) for the Comparative Effectiveness Research Public Use Files Data Pilot Project (CER-PUF). CER-PUF is aimed at increasing access to the Centers for Medicare and Medicaid Services (CMS) Medicare claims datasets through PUFs that: do not require user fees and data use agreements, have been de-identified to assure the confidentiality of the beneficiaries and providers, and still provide substantial analytic utility to researchers. For this paper we define PUFs as datasets characterized by free and unrestricted access to any user. We derive lessons learned from five major project activities: (i) a review of the statistical and computer science literature on best practices in PUF creation, (ii) interviews with comparative effectiveness researchers to assess their data needs, (iii) case studies of PUF initiatives in the United States, (iv) interviews with stakeholders to identify the most salient issues regarding making microdata publicly available, and (v) the actual process of creating the Medicare claims data BSA PUFs

Antimicrobial therapy for otitis media with effusion ( secretory otitis media)

Objective. —To determine the effectiveness of antimicrobial treatment for otitis media with effusion ( secretory otitis media) in children. Data Source. —We report the reexamination of a previously published study by Mandel et al that evaluated the efficacy of a 2-week course of antimicrobials (amoxicillin trihydrate) with and without a 4-week course of an oral decongestant-antihistamine combination in a double-blind, placebo-controlled, randomized trial involving 518 infants and children with otitis media with effusion. Data Synthesis. —At 4 weeks, amoxicillin efficacy as determined by a tympanometric criterion (P=.121) or by a measure of improvement in hearing (P=.311) was insignificant. Only by otoscopic judgment, which is shown to contain a systematic bias as used in this clinical trial, could an argument be made for a marginal efficacy of amoxicillin at the 4-week end point. Logistic regression analyses of the combined effects of treatment and prognostic factors showed no significant differences between placebo- and antibiotic-treated groups for unilateral effusions and for bilateral effusions. When subjects with unilateral and bilateral effusions were combined, the estimated efficacy of antibiotic treatment was 12.3% by otoscopy (P =.014) and 4.8% by tympanometry (P =.171). We also demonstrate the sensitivity of outcome to diagnostic measures used and provide statistical evidence questioning the validity of otoscopic observations in this study. Six weeks after the termination of amoxicillin therapy, the recurrence of effusion was two to six times higher in the amoxicillin-treated children than in those treated with placebo (P=.001), and resolution of effusion was not significantly different among antibiotic and placebo groups (13.6% and 11.3%, respectively; P=.477). Conclusions. —Amoxicillin with and without decongestant-antihistamine combination is not effective for the treatment of persistent asymptomatic middle-ear effusions in infants and children

Prenatal diagnosis and postnatal follow-up of congenitally corrected transposition of the great arteries and recurrent supraventricular tachycardia

The prenatal sonographic diagnosis of congenitally corrected transposition of the great arteries (ccTGA), a rare form of congenital heart disease is very difficult. A24-year-old woman was referred to our center at 28 weeks’ gestation because of suspected fetal cardiac anomalies. This article reports a case of ccTGA with supraventricular tachycardia, ventricular septal defect, pulmonary valve stenosis, tricuspid valvar displacement and moderate tricuspid regurgitation during her pregnancy. The combined presence of SVT and ccTGA are occasionally present in the literature.peer-reviewe

Hippocampus and retrosplenial cortex combine path integration signals for successful navigation

The current study used fMRI in humans to examine goal-directed navigation in an open field environment. We designed a task that required participants to encode survey-level spatial information and subsequently navigate to a goal location in either first person, third person, or survey perspectives. Critically, no distinguishing landmarks or goal location markers were present in the environment, thereby requiring participants to rely on path integration mechanisms for successful navigation. We focused our analysis on mechanisms related to navigation and mechanisms tracking linear distance to the goal location. Successful navigation required translation of encoded survey-level map information for orientation and implementation of a planned route to the goal. Our results demonstrate that successful first and third person navigation trials recruited the anterior hippocampus more than trials when the goal location was not successfully reached. When examining only successful trials, the retrosplenial and posterior parietal cortices were recruited for goal-directed navigation in both first person and third person perspectives. Unique to first person perspective navigation, the hippocampus was recruited to path integrate self-motion cues with location computations toward the goal location. Last, our results demonstrate that the hippocampus supports goal-directed navigation by actively tracking proximity to the goal throughout navigation. When using path integration mechanisms in first person and third person perspective navigation, the posterior hippocampus was more strongly recruited as participants approach the goal. These findings provide critical insight into the neural mechanisms by which we are able to use map-level representations of our environment to reach our navigational goals

Investigation of synthesis and some properties of the copper complexes containing imidazole ligand

The copper(II) complexes bearing tetrasubstituted imidazole derivatives containing oxygen donor as ligands (L1-6) were synthesized and characterized by spectroscopic methods, magnetic measurements, elemental and thermogravimetric analyses. The fluorescence efficiency of the ligands (L1-6) and their copper(II) complexes were investigated at r.t. in DMF solution. Theoretical calculations were performed for the copper(II) complex of L4 ligand, in this study. The molecular geometry, bond lengths, bond angles and vibrational wave numbers were calculated by using ab initio calculations based on the Hartree-Fock{HF/6-31G(d)} and the density functional theory {B3LYP/6-31G(d)} in the ground state

European Integration and Democratic Consolidation: Spain, Poland and Turkey in Comparative Perspective

The study explored when, under what conditions, and to what extent did European integration, particularly the European Union’s requirement for democratic conditionality, contribute to democratic consolidation in Spain, Poland, and Turkey? On the basis of a four-part definition, the dissertation examined the democratizing impact of European integration process on each of the following four components of consolidation: (i) holding of fair, free and competitive elections, (ii) protection of fundamental rights, including human and minority rights, (iii) high prospects of regime survival and civilian control of the military, and (iv) legitimacy, elite consensus, and stateness. To assess the relative significance of EU’s democratizing leverage, the thesis also examined domestic and non-EU international dynamics of democratic consolidation in the three countries. By employing two qualitative methods (case study and process-tracing), the study focused on three specific time frames: 1977-1986 for Spain, 1994-2004 for Poland, and 1999-present for Turkey. In addition to official documents, newspapers, and secondary sources, face-to-face interviews made with politicians, academics, experts, bureaucrats, and journalists in the three countries were utilized. The thesis generated several conclusions. First of all, the EU’s democratizing impact is not uniform across different components of democratic consolidation. Moreover, the EU’s democratizing leverage in Spain, Poland, and Turkey involved variations over time for three major reasons: (i) the changing nature of EU’s democratic conditionality over time (ii) varying levels of the EU’s credible commitment to the candidate country’s prospect for membership, and (iii) domestic dynamics in the candidate countries. Furthermore, the European integration process favors democratic consolidation but its magnitude is shaped by the candidate country’s prospect for EU membership and domestic factors in the candidate country. Finally, the study involves a major policy implication for the European Union: unless the EU provides a clear prospect for membership, its democratizing leverage will be limited in the candidate countries

Metatarsophalangeal joint pain in psoriatic arthritis: a cross-sectional study

Methods. Thirty-four consecutive patients with PsA (mean age 45.3 years, 65% female, mean disease duration 9.9 years) and 22 control participants (mean age 37.9 years, 64% female) underwent clinical and US examination to determine the presence of pain, swelling, synovitis, erosions, effusions and submetatarsal bursae at the MTP joints. Mean barefoot peak plantar pressures were determined at each MTP joint. Levels of pain, US-determined pathology and peak pressures were compared between groups. Binary logistic regression was used to identify demographic, clinical examination-derived, US-derived and plantar pressure predictors of pain at the MTP joints in the PsA group. Results. The presence of pain, deformity, synovitis, erosions (P < 0.001) and submetatarsal bursae and peak plantar pressure at MTP 3 (P < 0.05) were significantly higher in the PsA group. MTP joint pain in PsA was independently predicted by high BMI, female gender and the presence of joint subluxation, synovitis and erosion. Conclusion. These results suggest local inflammatory and structural factors, together with systemic factors (gender, BMI), are predominantly responsible for painful MTP joints in PsA, with no clear role for plantar pressure characteristics