Modification of claims-based measures improves identification of comorbidities in non-elderly women undergoing mastectomy for breast cancer: A retrospective cohort study

BACKGROUND: Accurate identification of underlying health conditions is important to fully adjust for confounders in studies using insurer claims data. Our objective was to evaluate the ability of four modifications to a standard claims-based measure to estimate the prevalence of select comorbid conditions compared with national prevalence estimates. METHODS: In a cohort of 11,973 privately insured women aged 18–64 years with mastectomy from 1/04–12/11 in the HealthCore Integrated Research Database, we identified diabetes, hypertension, deficiency anemia, smoking, and obesity from inpatient and outpatient claims for the year prior to surgery using four different algorithms. The standard comorbidity measure was compared to revised algorithms which included outpatient medications for diabetes, hypertension and smoking; an expanded timeframe encompassing the mastectomy admission; and an adjusted time interval and number of required outpatient claims. A χ2 test of proportions was used to compare prevalence estimates for 5 conditions in the mastectomy population to national health survey datasets (Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey). Medical record review was conducted for a sample of women to validate the identification of smoking and obesity. RESULTS: Compared to the standard claims algorithm, use of the modified algorithms increased prevalence from 4.79 to 6.79 % for diabetes, 14.75 to 24.87 % for hypertension, 4.23 to 6.65 % for deficiency anemia, 1.78 to 12.87 % for smoking, and 1.14 to 6.31 % for obesity. The revised estimates were more similar, but not statistically equivalent, to nationally reported prevalence estimates. Medical record review revealed low sensitivity (17.86 %) to capture obesity in the claims, moderate negative predictive value (NPV, 71.78 %) and high specificity (99.15 %) and positive predictive value (PPV, 90.91 %); the claims algorithm for current smoking had relatively low sensitivity (62.50 %) and PPV (50.00 %), but high specificity (92.19 %) and NPV (95.16 %). CONCLUSIONS: Modifications to a standard comorbidity measure resulted in prevalence estimates that were closer to expected estimates for non-elderly women than the standard measure. Adjustment of the standard claims algorithm to identify underlying comorbid conditions should be considered depending on the specific conditions and the patient population studied. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1636-7) contains supplementary material, which is available to authorized users

Development of a model for marburgvirus based on severe-combined immunodeficiency mice

The filoviruses, Ebola (EBOV) and Marburg (MARV), cause a lethal hemorrhagic fever. Human isolates of MARV are not lethal to immmunocompetent adult mice and, to date, there are no reports of a mouse-adapted MARV model. Previously, a uniformly lethal EBOV-Zaire mouse-adapted virus was developed by performing 9 sequential passages in progressively older mice (suckling to adult). Evaluation of this model identified many similarities between infection in mice and nonhuman primates, including viral tropism for antigen-presenting cells, high viral titers in the spleen and liver, and an equivalent mean time to death. Existence of the EBOV mouse model has increased our understanding of host responses to filovirus infections and likely has accelerated the development of countermeasures, as it is one of the only hemorrhagic fever viruses that has multiple candidate vaccines and therapeutics. Here, we demonstrate that serially passaging liver homogenates from MARV-infected severe combined immunodeficient (scid) mice was highly successful in reducing the time to death in scid mice from 50–70 days to 7–10 days after MARV-Ci67, -Musoke, or -Ravn challenge. We performed serial sampling studies to characterize the pathology of these scid mouse-adapted MARV strains. These scid mouse-adapted MARV models appear to have many similar properties as the MARV models previously developed in guinea pigs and nonhuman primates. Also, as shown here, the scid-adapted MARV mouse models can be used to evaluate the efficacy of candidate antiviral therapeutic molecules, such as phosphorodiamidate morpholino oligomers or antibodies

Spatially modelling the association between access to recreational facilities and exercise: the ‘Multi-ethnic study of atherosclerosis’

Numerous studies have investigated the relationship between the built environment and physical activity. However these studies assume that these relationships are invariant over space. In this study, we introduce a novel method to analyze the association between access to recreational facilities and exercise allowing for spatial heterogeneity. In addition, this association is studied before and after controlling for crime, a variable that could explain spatial heterogeneity of associations. We use data from the Chicago site of the Multi-Ethnic Study of Atherosclerosis of 781 adults aged 46 years and over. A spatially varying coefficient Tobit regression model is implemented in the Bayesian setting to allow for the association of interest to vary over space. The relationship is shown to vary over Chicago, being positive in the south but negative or null in the north. Controlling for crime weakens the association in the south with little change observed in northern Chicago. The results of this study indicate that spatial heterogeneity in associations of environmental factors with health may vary over space and deserve further exploration

Measurement of the Induced Proton Polarization P_n in the 12C(e,e'\vec{p}) Reaction

The first measurements of the induced proton polarization, P_n, for the 12C (e,e'\vec{p}) reaction are reported. The experiment was performed at quasifree kinematics for energy and momentum transfer (\omega,q) \approx (294 MeV, 756 MeV/c) and sampled a recoil momentum range of 0-250 MeV/c. The induced polarization arises from final-state interactions and for these kinematics is dominated by the real part of the spin-orbit optical potential. The distorted-wave impulse approximation provides good agreement with data for the 1p_{3/2} shell. The data for the continuum suggest that both the 1s_{1/2} shell and underlying l > 1 configurations contribute.Comment: 5 pages LaTeX, 2 postscript figures, accepted by Physical Reveiw Letter

Using global analysis, partial specifications, and an extensible assertion language for program validation and debugging

We discuss a framework for the application of abstract interpretation as an aid during program development, rather than in the more traditional application of program optimization. Program validation and detection of errors is first performed statically by comparing (partial) specifications written in terms of assertions against information obtained from (global) static analysis of the program. The results of this process are expressed in the user assertion language. Assertions (or parts of assertions) which cannot be checked statically are translated into run-time tests. The framework allows the use of assertions to be optional. It also allows using very general properties in assertions, beyond the predefined set understandable by the static analyzer and including properties defined by user programs. We also report briefly on an implementation of the framework. The resulting tool generates and checks assertions for Prolog, CLP(R), and CHIP/CLP(fd) programs, and integrates compile-time and run-time checking in a uniform way. The tool allows using properties such as types, modes, non-failure, determinacy, and computational cost, and can treat modules separately, performing incremental analysis

A Comparison of Polarization Observables in Electron Scattering from the Proton and Deuteron

Recoil proton polarization observables were measured for both the p($\vec {\rm e}$,e$^\prime\vec{\rm p}\,$) and d($\vec {\rm e}$,e$^\prime\vec{\rm p}\,)$n reactions at two values of Q$^2$ using a newly commissioned proton Focal Plane Polarimeter at the M.I.T.-Bates Linear Accelerator Center. The hydrogen and deuterium spin-dependent observables $D_{\ell\ell}$ and $D_{{\ell}t}$, the induced polarization $P_n$ and the form factor ratio $G^p_E/G^p_M$ were measured under identical kinematics. The deuterium and hydrogen results are in good agreement with each other and with the plane-wave impulse approximation (PWIA).Comment: 9 pages, 1 figure; accepted by Phys. Rev. Let

Development of a modular and scalable data acquisition system for calorimeters at a linear collider

A data acquisition (DAQ) system has been developed which will read out and control calorimeters serving as prototype systems for a future detector at an electron-positron linear collider. This is a modular, flexible and scalable DAQ system in which the hardware and signals are standards-based, using FPGAs and serial links. The idea of a backplaneless system was also pursued with a commercial development board housed in a PC and a chain of concentrator cards between it and the detector forming the basis of the system. As well as describing the concept and performance of the system, its merits and disadvantages are discussed.Comment: 12 pages, 6 figures, accepted by JINST. Version updated accounting for comments from journal referee