Investigating the Reasons of Undeliverable Mail Sent to Communicable Disease Patients

poster abstractPreventing spread of communicable diseases is a primary objective of public health (PH). Marion County Public Health Department (MCPHD) notifies carriers of contagious diseases via United States Postal Service (USPS) to remind patients their social responsibility not to spread the disease. We examined MCPHD’s completed case files for hepatitis C, acute hepatitis B and salmonellosis. We investigated the rate and cause of delivery failure of documented returned letters for these periods: acute hepatitis B and salmonellosis (8/2010-7/2012 & 9/2013-5/2014), hepatitis C (2/2012-7/2012 & 9/2013-5/2014). These patient addresses used on the letters were obtained from provider and lab reports and from databases that have records of previous addresses. We examined the address source and the process information went through. The overall initial delivery failure rate of the letters sent to these patients was 6.6% (80 out of 1211). We grouped the reasons into patient-originated (44%) and process-originated (56%). Patientoriginated reasons included patient giving false information to avoid the bill, being homeless (shelters, churches given as address). Process-originated reasons included typo, incomplete address, and postal errors. Since there are several steps to the process, there is no single solution to undeliverable mail problem. Using Coding Accuracy Support System (CASS) system may help initial entry errors, sending an initial confirmatory mail by the provider or using phone or email may be alternatives. Our analysis establishes a baseline for error rates for the management of address information, thus gives insights to improve the process. The framework also allows cost-effectiveness analysis for possible solutions like implementing CASS or using electronic records

Systematic Exploration of Associations Between Select Neural and Dermal Diseases in a Large Healthcare Database

Indiana University-Purdue University Indianapolis (IUPUI)In the age of big data, better use of large, real-world datasets is needed, especially ultra-large databases that leverage health information exchange (HIE) systems to gather data from multiple sources. Promising as this process is, there have been challenges analyzing big data in healthcare due to big data attributes, mainly regarding volume, variety, and velocity. Thus, these health data require not only computational approaches but also context-based controls.In this research, we systematically examined associations among select neural and dermal conditions in an ultra-large healthcare database derived from an HIE, in which computational approaches with epidemiological measures were used. After a systematic cleaning, a binary logistic model-based methodology was used to search for associations, controlling for race and gender. Age groups were chosen using an algorithm to find the highest incidence rates for each condition pair. A binomial test was conducted to check for significant temporal direction among conditions to infer cause and effect. Gene-disease association data were used to evaluate the association among the conditions and assess the shared genetic background. The results were adjusted for multiple testing, and network graphs of significant associations were created. Findings among methodologies were compared to each other and with prior studies in the literature. In the results, seemingly distant neural and dermal conditions had an extensive number of associations. Controlling for race and gender tightened these associations, especially for racial factors affecting dermal conditions, like melanoma, and gender differences on conditions like migraine. Temporal and gene associations helped explain some of the results, but not all. Network visualizations summarized results, highlighting central conditions and stronger associations. Healthcare data are confounded by many factors that hide associations of interest. Triangulating associations with separate analyses helped with the interpretation of results. There are still numerous confounders in these data that bias associations. Aside from what is known, our approach with limited variables may inform hypothesis generation. Using additional variables with controlled-computational methods that require minimal external input may provide results that can guide healthcare, health policy, and further research

Automating Provider Reporting of Communicable Disease Cases using Health Information Technology

poster abstractIntroduction Disease surveillance is a core public health (PH) function, which enables PH authorities to monitor disease outbreak and develop programs and policies to reduce disease burden. To manage and adjudicate cases of suspected communicable disease, PH workers gather data elements about persons, clinical care, and providers from various clinical sources, including providers, laboratories, among others. Current processes are paper-based and often yield incomplete and untimely reporting across different diseases requiring time-consuming follow-up by PH authorities to get needed information. Health information technology (HIT) refers to a wide range of technologies used in health care settings, including electronic health records and laboratory information systems. Health information exchange (HIE) involves electronic sharing of data and information between HIT systems, including those used in PH. Previous research has shown that using HIE to electronically report laboratory results to PH can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting [1]. Methods Our study uses an intervention to electronically pre-populate provider-based communicable disease case reporting forms with existing clinical, laboratory and patient data available through one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation of the intervention will be conducted utilizing mixed methods in a concurrent design framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention. Results The intervention has been implemented in seven primary care clinics in the metropolitan Indianapolis area plus one rural clinic in Edinburgh. Analysis of baseline data shows that provider-based reports vary in their completeness, yet they contain critical information not available from laboratory information systems [2]. Furthermore, PH workers access a range of sources to gather the data they need to investigate disease cases [3]. Discussion and Conclusion By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community. Early results are promising, and continued evaluation will be completed over the next 24 months

Model Atmospheres for Irradiated Stars in pre-Cataclysmic Variables

Model atmospheres have been computed for M dwarfs that are strongly irradiated by nearby hot companions. A variety of primary and secondary spectral types are explored in addition to models specific to four known systems: GD 245, NN Ser, AA Dor, and UU Sge. This work demonstrates that a dramatic temperature inversion is possible on at least one hemisphere of an irradiated M dwarf and the emergent spectrum will be significantly different from an isolated M dwarf or a black body flux distribution. For the first time, synthetic spectra suitable for direct comparison to high-resolution observations of irradiated M dwarfs in non-mass transferring post-common envelope binaries are presented. The effects of departures from local thermodynamic equilibrium on the Balmer line profiles are also discussed.Comment: Accepted for publication in ApJ; 12 pages, 10 figure

Relationship between musculoskeletal pain and Vitamin D levels in elderly women

Introduction: Pain is a common symptom of aging. Vitamin D is an effective pre-prohormone with ubiquitous receptors in many tissues, including the musculoskeletal system. Vitamin D deficiency is known to cause pain, proximal muscle weakness in lower extremities, skeletal mineralization defects, balance disorders, increased risk of fall and fracture, and reduced functional capacity. This study aimed to evaluate the relationship between vitamin D levels and the musculoskeletal pain in female patients aged 65 years or over. Methods: This descriptive cross-sectional study included 120 female patients aged 65 years and over who were admitted to physical therapy and rehabilitation outpatient clinic. The participants were administered a questionnaire consisting of demographic data (age, education, occupation, sun exposure, physical activity levels, intake of calcium-rich foods), musculoskeletal pain, and location of the pain. The levels of 25(OH) vitamin D (vitamin D), calcium, phosphorus, alkaline phosphatase, and parathormon in the serum were recorded from the hospital database. Results: Of the participants, 101 (84%) had vitamin D deficiency or insufficiency, 83 (69%) had musculoskeletal pain, and 37 (31%) had no pain at all. Serum vitamin D levels were significantly lower in those who had pain (p=0.008). Sixty-two (75%) of the patients with musculoskeletal pain (n=83) had vitamin D deficiency or insufficiency. Among those with musculoskeletal system pain and vitamin D deficiency or insufficiency (n=62), the pain was most frequently localized to the lower back (41%) and upper back (32%). Conclusion: It is important to evaluate serum 25(OH) vitamin D levels particularly in elderly female patients admitted with musculoskeletal pain. Vitamin D deficiency should be kept in mind for female patients suffering from the lower and upper back pain. Considering the role of vitamin D on the musculoskeletal system, assessment of vitamin D levels and, in case of deficiency, supplementation therapy is recommended for elderly women

An asteroseismic study of the Delta Scuti star 44 Tau

In this paper we investigate theoretical pulsation models for the delta Scuti star 44 Tau. The star was monitored during several multisite campaigns which confirmed the presence of radial and nonradial oscillations. Moreover, its exceptionally low rotational velocity makes 44 Tau particulary interesting for an asteroseismic study. Due to the measured log g value of 3.6 +/- 0.1, main sequence and post-main sequence models have to be considered. We perform mode identification based on photometric and spectroscopic data. A nonadiabatic pulsation code is used to compute models that fit the identified modes. The influence of different opacity tables and element mixtures on the results is tested. The observed frequencies of 44 Tau can be fitted in both the main sequence and the post-main sequence evolutionary stage. Post-main sequence models are preferable as they fulfill almost all observational constraints (fit of observed frequencies, position in the HRD and instability range). These models can be obtained with normal chemical composition which is in agreement with recent spectroscopic measurements. The efficiency of envelope convection (in the framework of the mixing-length theory) is predicted to be very low in 44 Tau. We show that the results are sensitive to the choice between the OPAL and OP opacities. While the pulsation models of 44 Tau computed with OP opacities are considerably too cool and too faint, the use of OPAL opacities results in models within the expected temperature and luminosity range.Comment: 9 pages, 15 figures, 2 tables, accepted for publication in A&

HAŞMET DÎVÂNI’NDA HİKEMÎ TARZIN İZLERİ / TRACES OF PHİLOSOPHİC STYLE IN HASHMET’S DİVAN

Asıl adı Mehmed olan Haşmet (öl. 1182/1768), XVIII. yüzyıl şairlerindendir. Mahallileşme Akımı ve Sebk-i Hindî’nin temsilcisi konumundadır. Hikemî tarzın en önemli ismi Nâbî’nin takipçisi kabul edilmektedir.Bu çalışmada, Haşmet’in şiirlerindeki düşünceye dayalı unsurlar, veciz ifadeler, ahlakî muhtevalı sözler, dünya görüşü ve diğer hikemî hususlar üzerinde durulacaktır.</p

BAZI XVI. YÜZYIL DİVANLARINDA KIYMETLİ TAŞLAR

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Utjecaj odnosa koncentracija bakra u hrani i plazmi na razvojnu ortopedsku bolest u ždrjebadi.

The study group consisted of ten foals, 3-6 months old, 6 male and 4 female, KWPN breed, with developmental orthopedic disease (DOD). The control group consisted of eight healthy foals. On clinical examination, lameness, swelling of joints, and pain were observed in all foals. Clinical, radiographic, and pathological findings in ten foals indicated DOD. Serum Cu concentrations in foals with DOD were significantly lower than in the control group (0.094 ± 0.011 mg/kg vs, 0.932 ± 0.068 mg/kg, respectively; P0.05), serum Ca levels (187.836 ± 7.921 μg/dL vs. 150.912 ± 5.271 μg/dL, respectively, P >0.05), and serum P levels (247.339 ± 10.729 μg/dL vs. 190.470 ± 5.775 μg/dL, respectively, P >0.05) were observed both in foals with DOD and in healthy foals. There were no statistically significant differences between the DOD group and the control group with respect to serum levels of Ca, P and Zn. We concluded that DOD is associated with reduced serum levels of Cu in foals. Copper is an important trace element for growing foals.Pokusna skupina sastojala se od 10 ždrjebadi s razvojnom ortopedskom bolešću, šest muške i četiri ženske, u dobi od tri do šest mjeseci, pasmine kraljevski nizozemski toplokrvnjak. Kontrolna skupina sastojala se od šest zdrave ždrjebadi. Sva je ždrjebad bila klinički pregledana na hromost, otekline zglobova i bol. Klinički, radiografski i patološki nalazi upućivali su na razvojnu ortopedsku bolest. Koncentracija bakra u ždrjebadi s razvojnom bolešću bila je značajno manja nego u ždrjebadi kontrolne skupine (0,094 ± 0,011 mg/kg u odnosu na 0,932 ± 0,068 mg/kg; P0,05, dok su serumske razine kalcija iznosile 187,836 ± 7,921 μg/dL u odnosu na 150,912 ± 5,271 μg/dL u kontrolne skupine, P>0,05, te razine fosfora 247,339 ± 10,729 μg/dL u pokusne u odnosu na 190,470 ± 5,775 μg/dL u kontrolne skupine, P>0,05. Nisu ustanovljene statistički značajne razlike između istraživane i kontrolne skupine s obzirom na razine Ca, P i Zn. Zaključuje se da je razvojna ortopedska bolest u ždrjebadi povezana s razinom Cu u serumu. Bakar je važan element za rast ždrjebadi