Properties of healthcare teaming networks as a function of network construction algorithms

This is the final version. Available on open access from Public Library of Science via the DOI in this recordData Availability: The Center for Medicare Services Outpatient Claims DE-SynPUF (DE-SynPUF)\cite{RN120} test set is publicly available from the CMS web site. The full 2013 Medicare Part B Limited Data Set for Medicare claims can be obtained from the Center for Medicare Services. This data is bound by a privacy and limited distribution agreement, as well as HIPAA regulations, and thus cannot be made public with this manuscript. However, the files can be requested from the Center for Medicare Services by individual investigators and used to reproduce our findings. Release of the derived networks is also limited by Medicare requirements to remove nodes and edges where the total number of shared patients 11 shared patients, and these are available on figshare.com as referenced in the Supplemental Data section of the manuscript.Network models of healthcare systems can be used to examine how providers collaborate, communicate, refer patients to each other, and to map how patients traverse the network of providers. Most healthcare service network models have been constructed from patient claims data, using billing claims to link a patient with a specific provider in time. The data sets can be quite large (106±108 individual claims per year), making standard methods for network construction computationally challenging and thus requiring the use of alternate construction algorithms. While these alternate methods have seen increasing use in generating healthcare networks, there is little to no literature comparing the differences in the structural properties of the generated networks, which as we demonstrate, can be dramatically different. To address this issue, we compared the properties of healthcare networks constructed using different algorithms from 2013 Medicare Part B outpatient claims data. Three different algorithms were compared: Binning, sliding frame, and trace-route. Unipartite networks linking either providers or healthcare organizations by shared patients were built using each method. We find that each algorithm produced networks with substantially different topological properties, as reflected by numbers of edges, network density, assortativity, clustering coefficients and other structural measures. Provider networks adhered to a power law, while organization networks were best fit by a power law with exponential cutoff. Censoring networks to exclude edges with less than 11 shared patients, a common de-identification practice for healthcare network data, markedly reduced edge numbers and network density, and greatly altered measures of vertex prominence such as the betweenness centrality. Data analysis identified patterns in the distance patients travel between network providers, and a striking set of teaming relationships between providers in the Northeast United States and Florida, likely due to seasonal residence patterns of Medicare beneficiaries. We conclude that the choice of network construction algorithm is critical for healthcare network analysis, and discuss the implications of our findings for selecting the algorithm best suited to the type of analysis to be performed.National Institute of HealthPhilip Templeton FoundationUniversity of Rochester Center for Health Informatic

Noncommutative cosmological models coupled to a perfect fluid and a cosmological constant

In this work we carry out a noncommutative analysis of several Friedmann-Robert-Walker models, coupled to different types of perfect fluids and in the presence of a cosmological constant. The classical field equations are modified, by the introduction of a shift operator, in order to introduce noncommutativity in these models. We notice that the noncommutative versions of these models show several relevant differences with respect to the correspondent commutative ones.Comment: 27 pages. 7 figures. JHEP style.arXiv admin note: substantial text overlap with arXiv:1104.481

Noncommutative Particles in Curved Spaces

We present a formulation in a curved background of noncommutative mechanics, where the object of noncommutativity $\theta^{\mu\nu}$ is considered as an independent quantity having a canonical conjugate momentum. We introduced a noncommutative first-order action in D=10 curved spacetime and the covariant equations of motions were computed. This model, invariant under diffeomorphism, generalizes recent relativistic results.Comment: 1+15 pages. Latex. New comments and results adde

Phylogenetic relationships within Chamaecrista sect. Xerocalyx (Leguminosae, Caesalpinioideae) inferred from the cpDNA trnE-trnT intergenic spacer and nrDNA ITS sequences

Chamaecrista belongs to subtribe Cassiinae (Caesalpinioideae), and it comprises over 330 species, divided into six sections. The section Xerocalyx has been subjected to a profound taxonomic shuffling over the years. Therefore, we conducted a phylogenetic analysis using a cpDNA trnE-trnT intergenic spacer and nrDNA ITS/5.8S sequences from Cassiinae taxa, in an attempt to elucidate the relationships within this section from Chamaecrista. The tree topology was congruent between the two data sets studied in which the monophyly of the genus Chamaecrista was strongly supported. Our analyses reinforce that new sectional boundaries must be defined in the Chamaecrista genus, especially the inclusion of sections Caliciopsis and Xerocalyx in sect. Chamaecrista, considered here paraphyletic. The section Xerocalyx was strongly supported as monophyletic; however, the current data did not show C. ramosa (microphyllous) and C. desvauxii (macrophyllous) and their respective varieties in distinct clades, suggesting that speciation events are still ongoing in these specimens

Oral health-related quality of life of paediatric patients with AIDS

<p>Abstract</p> <p>Background</p> <p>Children with Acquired Immune Deficiency Syndrome (AIDS) exhibit impaired dental status, which can affect their quality of life. This study assessed the oral health-related quality of life of these patients and associated factors.</p> <p>Methods</p> <p>The "Child Perceptions Questionnaire 11-14", rating overall and domain-specific (oral symptoms, functional limitations, emotional well being, and social well being) oral health-related quality of life (OHR-QoL) was completed by 88 children with AIDS assisted in the Child Institute, Sao Paulo, Brazil. Parents or guardians provided behavioural and socio-demographic information. The clinical status was provided by hospital records. OHR-QoL covariates were assessed by Poisson regression analysis.</p> <p>Results</p> <p>The most affected OHR-QoL subscale concerned oral symptoms, whose rate was 23.9%. The direct answer for oral health and well being made up a rate of 47.7%. Brushing the teeth less than two times a day and viral load exceeding 10,000 HIV-RNA copies per millilitre of plasma were directly associated (p < 0.05) with a poorer oral health-related quality of life.</p> <p>Conclusions</p> <p>Children with more severe AIDS manifestations complained of poorer status of oral symptoms, functional limitations, emotional and social well being related to their oral health. Recognizing the factors that are associated with poorer OHR-QoL in children with AIDS may contribute to the planning of dental services for this population.</p