Nonadherence to Oral Antihyperglycemic Agents: Subsequent Hospitalization and Mortality among Patients with Type 2 Diabetes in Clinical Practice

Using real-world clinical data from the Indiana Network for Patient Care, we analyzed the associations between non-adherence to oral antihyperglycemic agents (OHA) and subsequent diabetes-related hospitalization and all-cause mortality for patients with type 2 diabetes. OHA adherence was measured by the annual proportion of days covered (PDC) for 2008 and 2009. Among 24,067 eligible patients, 35,507 annual PDCs were formed. Over 90% (n=21,798) of the patients had a PDC less than 80%. In generalized linear mixed model analyses, OHA non-adherence is significantly associated with diabetes related hospitalizations (OR: 1.2; 95% CI [1.1,1.3]; p<0.0001). Older patients, white patients, or patients who had ischemic heart disease, stroke, or renal disease had higher odds of hospitalization. Similarly, OHA non-adherence increased subsequent mortality (OR: 1.3; 95% CI [1.02, 1.61]; p<0.0001). Patient age, male gender, income and presence of ischemic heart diseases, stroke, and renal disease were also significantly associated with subsequent all-cause death

A Vision for the Systematic Monitoring and Improvement of the Quality of Electronic Health Data

In parallel with the implementation of information and communications systems, health care organizations are beginning to amass large-scale repositories of clinical and administrative data. Many nations seek to leverage so-called Big Data repositories to support improvements in health outcomes, drug safety, health surveillance, and care delivery processes. An unsupported assumption is that electronic health care data are of sufficient quality to enable the varied use cases envisioned by health ministries. The reality is that many electronic health data sources are of suboptimal quality and unfit for particular uses. To more systematically define, characterize and improve electronic health data quality, we propose a novel framework for health data stewardship. The framework is adapted from prior data quality research outside of health, but it has been reshaped to apply a systems approach to data quality with an emphasis on health outcomes. The proposed framework is a beginning, not an end. We invite the biomedical informatics community to use and adapt the framework to improve health data quality and outcomes for populations in nations around the world

High Spectral Resolution Measurement of the Sunyaev–Zel'dovich Effect Null with Z-Spec

The Sunyaev-Zel'dovich (SZ) effect spectrum crosses through a null where ΔT_CMB = 0 near ν_0 = 217 GHz. In a cluster of galaxies, ν0 can be shifted from the canonical thermal SZ effect value by corrections to the SZ effect scattering due to the properties of the inter-cluster medium. We have measured the SZ effect in the hot galaxy cluster RX J 1347.5 – 1145 with Z-Spec, an R ~ 300 grating spectrometer sensitive between 185 and 305 GHz. These data comprise a high spectral resolution measurement around the null of the SZ effect and clearly exhibit the transition from negative to positive ΔT_CMB over the Z-Spec band. The SZ null position is measured to be ν_0 = 225.8 ± 2.5(stat.) ± 1.2(sys.) GHz, which differs from the canonical null frequency by 3.0σ and is evidence for modifications to the canonical thermal SZ effect shape. Assuming the measured shift in ν0 is due only to relativistic corrections to the SZ spectrum, we place the limit kT_e = 17.1 ± 5.3 keV from the zero-point measurement alone. By simulating the response of the instrument to the sky, we are able to generate likelihood functions in {y_0, T_e, v_pec} space. For v_pec = 0 km s^(–1), we measure the best-fitting SZ model to be y_0 = 4.6^(+0.6)_(–0.9) × 10^(–4), T_e, 0 = 15.2^(+12)_(–7.4) keV. When v pec is allowed to vary, a most probable value of v_pec = + 450 ± 810 km s^(–1) is found

Area-level incarceration and STI risk among a cohort of justice-involved adolescents and adults

Background: Living in areas of high incarceration is associated with increased risk of STI; however, STI risk with respect to both this area-level exposure and an individual’s involvement with the justice system is not known. Objective: Among individuals before and after arrest or incarceration, assess the association between area-level incarceration rates and risk of chlamydia, gonorrhea, or syphilis. Methods: Retrospective cohort study of individuals living in Marion County (Indianapolis), Indiana who were arrested or in jail, prison, juvenile detention, or juvenile prison between 2005-2008 (N=97,765). Area-level incarceration exposure was defined by the proportion of person-days incarcerated among the total population*365 within a census block group. A 1-year period was assessed before and after a randomly-selected arrest/incarceration per person. Multivariable logistic regression, controlling for age, race, STI history, and year, was performed to assess chlamydia, gonorrhea, or syphilis risk by quartile area-level incarceration exposure, adjusting for individual clustering and stratifying by gender. Results: Area-level incarceration was associated with increased odds of each STI, with a dose response relationship particularly among those with an arrest or jail stay. Women with a history of arrest or jail/prison stay and living in high incarceration areas had higher odds of STI, compared to men with comparable incarceration history and living in similar areas

Gallbladder Ejection Fraction is Unrelated to Gallbladder Pathology in Children and Adolescents

Objectives: Biliary dyskinesia is a common diagnosis that frequently results in cholecystectomy. In adults, most clinicians use a cut off value for the gallbladder ejection fraction (GBEF) of <35% to define the disease. This disorder is not well characterized in children. Our aim was to determine the relation between GBEF and gallbladder pathology using a large statewide medical record repository. Methods: We obtained records from all patients of 21 years and younger who underwent hepatic iminodiacetic acid (HIDA) testing within the Indiana Network for Patient Care from 2004 to 2013. GBEF results were obtained from radiology reports using data mining techniques. Age, sex, race, and insurance status were obtained for each patient. Any gallbladder pathology obtained subsequent to an HIDA scan was also obtained and parsed for mention of cholecystitis, cholelithiasis, or cholesterolosis. We performed mixed effects logistic regression analysis to determine the influence of age, sex, race, insurance status, pathologist, and GBEF on the presence of these histologic findings. Results: Two thousand eight hundred forty-one HIDA scans on 2558 patients were found. Of these, 310 patients had a full-text gallbladder pathology report paired with the HIDA scan. GBEF did not correlate with the presence of gallbladder pathology (cholecystitis, cholelithiasis, or cholesterolosis) when controlling for age, sex, race, insurance status, and pathologist using a mixed effects model. Conclusions: Hypokinetic gallbladders are no more likely to have gallbladder pathology than normal or hyperkinetic gallbladders in the setting of a patient with both a HIDA scan and a cholecystectomy. Care should be used when interpreting the results of HIDA scans in children and adolescents

Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana

BACKGROUND: Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. METHODS: We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics. RESULTS: We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. CONCLUSIONS: This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population

Nanoscale piezoelectric response across a single antiparallel ferroelectric domain wall

Surprising asymmetry in the local electromechanical response across a single antiparallel ferroelectric domain wall is reported. Piezoelectric force microscopy is used to investigate both the in-plane and out-of- plane electromechanical signals around domain walls in congruent and near-stoichiometric lithium niobate. The observed asymmetry is shown to have a strong correlation to crystal stoichiometry, suggesting defect-domain wall interactions. A defect-dipole model is proposed. Finite element method is used to simulate the electromechanical processes at the wall and reconstruct the images. For the near-stoichiometric composition, good agreement is found in both form and magnitude. Some discrepancy remains between the experimental and modeling widths of the imaged effects across a wall. This is analyzed from the perspective of possible electrostatic contributions to the imaging process, as well as local changes in the material properties in the vicinity of the wall