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PubMed1999

Generalized likelihood ratio detection for fMRI using complex data.

The majority of functional magnetic resonance imaging (fMRI) studies obtain functional information using statistical tests based on the magnitude image reconstructions. Recently, a complex correlation (CC) test was proposed based on the complex image data in order to take advantage of phase information in the signal. However, the CC test ignores additional phase information in the baseline component of the data. In this paper, a new detector for fMRI based on a generalized likelihood ratio test (GLRT) is proposed. The GLRT exploits the fact that the fMRI response signal as well as the baseline component of the data share a common phase. Theoretical analysis and Monte Carlo simulation are used to explore the performance of the new detector. At relatively low signal intensities, the GLRT outperforms both the standard magnitude data test and the CC test. At high signal intensities, the GLRT performs as well as the standard magnitude data test and significantly better than the CC test.

Likelihood Functions↗

PubMed1996

A Web-based repository manager for brain mapping data.

The Web provides a rapid prototyping environment for building platform-independent graphical user interfaces. A Web-based console can be implemented as a suite of CGI scripts that generate HTML code, manipulate files, execute system commands, and invoke external tools. Often these tools share data by reading and writing flat files, which must be explicitly maintained by the CGI programmer. In a repository system, meta-data about each file object are maintained in a database, and access to all data is regulated by a layer of control services. This paper describes the design and implementation of a Web-based Repository Manager (WRM), which provides an application programmer's interface for controlling applications, generating HTML documents, handling Web forms, and managing multi-media data. The WRM is being used to develop a console for the Brain Mapping Framework, a system for visualizing cortical stimulation data obtained during neurosurgery.

Brain Mapping↗

PubMed1980

National health data for policy and planning.

The role of the National Center for Health Statistics (NCHS) in providing data for health policy and planning at the national and local level is discussed. Four specific examples are considered. First, data from the Hospital Discharge Survey are used to identify surgical procedures with large increases between 1965 and 1976: 30 percent rise in the incidence of hysterectomy, 169 percent increase in cesarean section, 100 percent increase in lens extraction, and 35 percent increase in orthopedic surgery. The extent to which such increases represent unnecessary utilization and their impact on costs are discussed. Second, the combination of data from two sources (Health Interview Survey and Health and Nutrition Examination Survey) is illustrated by considering selected policy issues related to hypertension. Next, the problem of designating medically underserved areas is discussed in relation to the difficulties in implementing federal policies at the local level without local data. The potential for national data systems to provide guidance for these policies is also considered. The final example discusses the use of vital statistics to provide small area data for local health planning. In conclusion several areas are considered which need development in order to maximize the use of data for policy and planning: research on measurement of health status, with particular emphasis on how health policy can affect health status; research on appropriate levels of health resources and services; development of shared data systems to reduce cost and respondent burden; and training, especially at the undergraduate level and in interdisciplinary graduate programs.

Data Collection↗

PubMed2006

The community barometer: a breast health needs assessment tool for community-based organizations.

This article presents findings from the ACCESS Project focusing on the impact of an outreach initiative that used "data sharing" as a mechanism to establish a wide variety of academic-community partnerships for cancer awareness. The Community Barometer, a brief needs assessment tool developed for this purpose, was used to collect data from clients, and sometimes staff members, of a variety of community-based organizations in New York City. Over a 5-year period, Barometer data were collected from 1,001 women who were affiliated with 20 community-based organizations. Analysis of these data supported our hypothesis that community-based organizations are more likely than chance to serve women with similar needs and preferences for breast health education and screening and that customized or tailored programs were warranted. Four case studies are presented. Limitations of the instrument and its administration in community settings as well as future research objectives are discussed.

Adult↗

PubMed1998

Use of the Physician Insurers Association of America database as a surveillance tool for diabetes-related malpractice claims in the U.S.

OBJECTIVE: To examine the available national surveillance data on malpractice claims associated with diabetes and to determine the medical specialties having the highest number of claims and the classes and costs of filed claims relating to diabetes. RESEARCH DESIGN AND METHODS: Data was abstracted from the Data Sharing Reports (DSRs) of the Physicians Insurers Association of America (PIAA), as well as a search of the PIAA's computerized database for the period spanning 1 January 1985 to 31 December 1996. Data on numbers of claims, medical causes of loss, indemnity paid, demographics of claimants and physicians, severity, and medical specialties with diabetes-related claims were available. RESULTS: A total of 906 diabetes claims were reported to PIAA, and the total indemnity paid was $26,892,848. A significant downward trend (P = 0.004) was noted for the period between 1993 and 1996. Diabetes claimants were older and predominantly male, relative to all claimants. Ophthalmology, internal medicine, and general and family practice had the highest rates of reported claims at 16.5, 13.6, and 13.4 diabetes claims per 1,000 claims, respectively. Of the diabetes-related injuries, 44% occurred in the practitioners office, as compared with 27% for all claims. A greater proportion of diabetes claims were associated with the highest level of severity of injury with respect to all claims compiled by the PIAA. CONCLUSIONS: The database of the PIAA can be a useful resource to monitor trends in diabetes-related malpractice. Further study into whether claims result from lack of adherence to practice guidelines is needed. Prevention programs designed to reduce the liability among high-risk specialties may also lead to improved care for the patient with diabetes.

Databases, Factual↗

PubMed2005

Developing a Cyberinfrastructure for integrated assessments of environmental contaminants.

The objective of this study was to design and implement prototype software for capturing field data and automating the process for reporting and analyzing the distribution of mercury. The four phase process used to design, develop, deploy and evaluate the prototype software is described. Two different development strategies were used: (1) design of a mobile data collection application intended to capture field data in a meaningful format and automate transfer into user databases, followed by (2) a re-engineering of the original software to develop an integrated database environment with improved methods for aggregating and sharing data. Results demonstrated that innovative use of commercially available hardware and software components can lead to the development of an end-to-end digital cyberinfrastructure that captures, records, stores, transmits, compiles and integrates multi-source data as it relates to mercury.

Automation↗

PubMedDate not supplied

Research in pediatric dental postgraduate programs and residencies: results of a survey.

PURPOSE: The purpose of this study was to determine various aspects of the research experiences in postgraduate and residency training programs in pediatric dentistry. METHODS: A survey was developed and sent to all directors of postgraduate and residency training programs in pediatric dentistry. The survey consisted of 21 items on various topics related to research experiences of the postgraduate students and residents. The items varied in structure, but most contained response sets deemed appropriate for the intent of the question. The directors were asked to complete the survey and return the questionnaire in a self-addressed stamped envelope within a 3-week period. If a program did not respond within 6 weeks, a follow-up survey was sent. The response sets were collated and analyzed with descriptive and nonparametric statistics. RESULTS: Forty of 55 programs responded with usable data sets. All reporting programs indicated that research experiences occur for residents and all have access to statistical assistance. Eighty-seven percent devote clinical hours to student research and 50% of the students share data or protocols. Only a minority (7%) of programs has not published student research in the last 5 years. Interference with revenue-generating clinic times (45%), lack of faculty understanding/interest in research (40%), and lack of financial resources (32%) were the 3 major obstacles for postgraduate research. CONCLUSIONS: Despite research being accomplished in postgraduate programs in pediatric dentistry, variability in key factors (eg, devoted research time) is common among programs. The impact of this variability on the profession and its advancement of scientific endeavors are unknown.

Attitude of Health Personnel↗

PubMedDate not supplied

How outbreaks of infectious disease are detected: a review of surveillance systems and outbreaks.

To learn how outbreaks of infectious disease are detected and to describe the entities and information systems that together function to identify outbreaks in the U.S., the authors drew on multiple sources of information to create a description of existing surveillance systems and how they interact to detect outbreaks. The results of this analysis were summarized in a system diagram. The authors reviewed a sample of recent outbreaks to determine how they were detected, with reference to the system diagram. The de facto U.S. system for detection of outbreaks consists of five components: the clinical health care system, local/state health agencies, federal agencies, academic/professional organizations, and collaborating governmental organizations. Primary data collection occurs at the level of clinical health care systems and local health agencies. The review of a convenience sample of outbreaks showed that all five components of the system participated in aggregating, analyzing, and sharing data. The authors conclude that the current U.S. approach to detection of disease outbreaks is complex and involves many organizations interacting in a loosely coupled manner. State and local health departments and the health care system are major components in the detection of outbreaks.

Communicable Disease Control↗

PubMed2026

Exploring the emerging concept of precision rehabilitation: a qualitative study.

PURPOSE: This descriptive qualitative study explored knowledge users' perspectives on precision rehabilitation concepts, barriers, facilitators, and future directions as part of a convergent mixed methods scoping review. MATERIALS AND METHODS: Sixteen clinicians, administrators, and researchers from three North American tertiary care rehabilitation centers were recruited using convenience and snowball sampling to participate in individual semi-structured interviews. Conventional qualitative content analysis followed a deductive thematic approach based on predetermined categories. RESULTS: Analyses revealed three main themes: (1) Although precision rehabilitation shares foundational concepts with precision medicine, there are certain elements, such as personalization, that are uniquely expressed; (2) Rehabilitation-specific facilitators to precision approaches include the use of unobtrusive technology to collect large amounts of data in real-world contexts, while barriers include rehabilitation's typically small, heterogeneous sample sizes; and (3) The future of precision rehabilitation will require collaborative data-sharing to focus on determining care trajectories that enhance functional outcomes. CONCLUSION: Findings provide the first qualitative synthesis of knowledge users perspectives to complement quantitative evidence and inform the emerging field of precision rehabilitation.

Humans↗

PubMed2006

Stationary sources of airborne lead: a comparison of emissions data for southern California.

Estimates for the air releases of lead from stationary point sources are considered for the South Coast Air Basin of California. We have examined four databases published by U.S. Environmental Protection Agency, the California Air Resources Board, and the South Coast Air Quality Management District. Our analysis indicates that none of the databases includes every emitting facility in the South Coast Air Basin of California and that other discrepancies among the databases exist. Additionally, the data have been analyzed for temporal variation, and some of the California Air Resources Board data are not current. The South Coast Air Quality Management District inventory covers 12 times more facilities in 2001 than in 1996. From this analysis, we conclude that all four of the databases would benefit by sharing data, increasing transparency, analyzing uncertainty, and standardizing emission estimation methods.

Air Pollutants, Occupational↗

PubMed2005

Discovery and integrative neuroscience.

Hypothesis driven research has been shown to be an excellent model for pursuing investigations in neuroscience. The Human Genome Project demonstrated the added value of discovery research, especially in areas where large amounts of data are produced. Neuroscience has become a data rich field, and one that would be enhanced by incorporating the discovery approach. Databases, as well as analytical, modeling and simulation tools, will have to be developed, and they will need to be interoperable and federated. This paper presents an overview of the development of the field of neuroscience databases and associate tools: Neuroinformatics. The primary focus is on the impact of NIH funding of this process. The important issues of data sharing, as viewed from the perspective of the scientist and private and public funding organizations, are discussed. Neuroinformatics will provide more than just a sophisticated array of information technologies to help scientists understand and integrate nervous system data. It will make available powerful models of neural functions and facilitate discovery, hypothesis formulation and electronic collaboration.

Animals↗

PubMed1995

International Poison Information Center data collection capabilities.

Hundreds of poison information centers are in operation throughout the world. Their common objective is to reduce the morbidity and mortality associated with accidental and intentional poisoning exposures. However, there is little information available which describes the impact of the centers on the outcome of poisonings or on poisoning trends. The objective of this project was to determine the data collection capabilities of poison information centers outside of the US with a goal of ascertaining whether a common database existed and if an international database of poisoning exposures could be developed. A survey was developed which requested information on the specific instrument used to document poisoning exposures, how that information was compiled, whether it was available in a computer database, the type of database, and whether it was available to external agencies and at what cost. The survey was sent to 75 poison information centers outside of the US. The data were compiled and analyzed using Paradox 3.5. Twenty-four of the 75 poison information centers completed and returned the surveys. Four of the 24 had no computer capabilities and only 9 centers indicated a willingness to share data. The majority of the databases were in a DOS format, but no consistent type of database software was used. If the sample that responded to the survey is representative of the international poison information center community, there is neither a common data collection instrument nor a common toxic exposure surveillance system which can be used to identify poisoning trends or to track the outcome of poisonings. A concerted effort to create a universal database on poisoning exposures should be considered.

Data Collection↗

PubMed1999

Mental health benefit limits and cost sharing under managed care: a national survey of employers.

Mental health services experts suggest that managed care diminishes the need for arbitrary benefit limits and consumer cost-sharing. Data from 577 health plans were used to test the hypotheses that health maintenance organizations (HMOs) and carve-out plans are less likely to use benefit limits or service exclusions, have more generous limits, and have lower cost-sharing requirements than non-HMOs and non-carve-out plans. The results show that HMOs were more likely to use service exclusions and did not make less use of benefit limits. Carve-outs were less likely to use some coverage exclusions. Comparisons of the stringency of limits and cost-sharing provisions did not show consistent differences.

Cost Sharing↗

PubMedDate not supplied

Are gatekeepers necessary?

Primary care physicians, acting as gatekeepers, are being used in an attempt to better control rising healthcare costs. However, the success of gatekeepers is difficult to measure because of the lack of data. The purpose of this article is to outline the function of gatekeepers, address the complications in measuring the benefits, and propose methods for further studies. In addition, we hope to foster a sense of responsibility and emphasize the importance of sharing data among organizations involved in the delivery of healthcare.

Cost-Benefit Analysis↗

PubMed2005

Efficient application of Internet databases for new signal processing methods.

This paper highlights the ways in which Internet databases may be efficiently used to foster the application of progress in biomedical sciences via data sharing and new algorithms. Employing the Internet to accelerate the pace of interdisciplinary research has significant potential, yet as with all new technologies, the first applications often cause more disappointment than positive outcomes. We discuss examples of solutions to the basic issues: (1) finding the relevant datasets (in portals connected via the Inter-neuro infrastructure), (2) reading the particular format in which the data was stored (using the SignalML language for metadescription of time series), (3) choosing the right method for the data analysis (we provide a brief review of the methods used for the analysis of EEGs, and discuss two of them in detail: Directed Transfer Function and Matching Pursuit), and (4) sharing the software for chosen methods of analysis (via repositories such as the eeg.pl thematic portal).

Algorithms↗

PubMedDate not supplied

A framework for an institutional high level security policy for the processing of medical data and their transmission through the Internet.

BACKGROUND: The Internet provides many advantages when used for interaction and data sharing among health care providers, patients, and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality, integrity, and availability of information. It is therefore essential that Health Care Establishments processing and exchanging medical data use an appropriate security policy. OBJECTIVE: To develop a High Level Security Policy for the processing of medical data and their transmission through the Internet, which is a set of high-level statements intended to guide Health Care Establishment personnel who process and manage sensitive health care information. METHODS: We developed the policy based on a detailed study of the existing framework in the EU countries, USA, and Canada, and on consultations with users in the context of the Intranet Health Clinic project. More specifically, this paper has taken into account the major directives, technical reports, law, and recommendations that are related to the protection of individuals with regard to the processing of personal data, and the protection of privacy and medical data on the Internet. RESULTS: We present a High Level Security Policy for Health Care Establishments, which includes a set of 7 principles and 45 guidelines detailed in this paper. The proposed principles and guidelines have been made as generic and open to specific implementations as possible, to provide for maximum flexibility and adaptability to local environments. The High Level Security Policy establishes the basic security requirements that must be addressed to use the Internet to safely transmit patient and other sensitive health care information. CONCLUSIONS: The High Level Security Policy is primarily intended for large Health Care Establishments in Europe, USA, and Canada. It is clear however that the general framework presented here can only serve as reference material for developing an appropriate High Level Security Policy in a specific implementation environment. When implemented in specific environments, these principles and guidelines must also be complemented by measures, which are more specific. Even when a High Level Security Policy already exists in an institution, it is advisable that the management of the Health Care Establishment periodically revisits it to see whether it should be modified or augmented.

Access to Information↗

PubMed2006

Anterior cervical fixation: analysis of load-sharing and stability with use of static and dynamic plates.

BACKGROUND: Anterior plates provide stability following decompression and fusion of the cervical spine. Various plate designs have emerged, and they include static plates with fixed-angle screws, rotationally dynamic plates that allow the screws to toggle in the plate, and translationally dynamic plates that allow the screws to both toggle and translate vertically. The goal of this study was to document the effects of plate design following a single-level corpectomy and placement of a full-length strut graft and the effects following 10% subsidence of the graft. METHODS: A total of twenty-one cadaveric cervical spines (C2-T1) were randomized into three treatment groups and were tested for initial range of motion. A C5 corpectomy was performed, reconstruction was done with a full-length interbody spacer containing a load-cell, and an anterior cervical plate was applied. Load-sharing data were recorded with incremental axial loads. The range of motion was measured with +/- 2.5 Nm of torque in flexion-extension, lateral bending, and axial rotation. Then, the total length of the interbody spacer was reduced by 10% to simulate subsidence, and load-sharing and the range of motion were retested. RESULTS: With the full-length interbody spacer, there were no significant differences in the abilities of the constructs to share load or limit motion. Following shortening of the interbody spacer, the static plate construct lost nearly 70% of its load-sharing capability, while neither of the dynamic plate constructs lost load-sharing capabilities. Also, the static plate construct allowed significantly more motion in flexion-extension following simulated subsidence than did either of the dynamic plate constructs (p < 0.05). CONCLUSIONS: Although all of the tested anterior cervical plating systems provide similar load-sharing and stiffness following initial placement of the interbody spacer, the static plate system lost its ability to share load and limit motion following simulated subsidence of the interbody spacer. Both dynamic plate systems maintained load-sharing and stiffness despite simulated subsidence. CLINICAL RELEVANCE: This study provides an improved understanding of the immediate performance of anterior cervical fusion surgery with plate fixation.

Aged↗

PubMed1989

A reassessment of the time-sharing paradigm with ANCOVA.

The purpose of this note is to follow up on the suggestion by Willis and Goodwin (1987) (Neuropsychologia, 25, 719-724) that analysis of covariance is the proper statistical control to eliminate the confound provided by the "initial values problem" inherent in the time-sharing paradigm. The discrepancy between baseline tapping speed of the dominant versus nondominant hand can affect concurrent tapping disruption rates independently of laterality factors. A re-analysis of previous time-sharing data showed that significant laterality main effects and interactions as shown by ANOVA are eliminated with ANCOVA procedures. Thus, when the initial-values problem is statistically controlled, the laterality effect of asymmetrical hand disruption disappears. This result seriously questions the continued use of the time-sharing paradigm as a behavioral index of language lateralization.

Adult↗