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PubMed2007

Elasticities of market shares and social health insurance choice in Germany: a dynamic panel data approach.

In 1996, free choice of health insurers was introduced to the German social health insurance system. One objective was to increase efficiency through competition. A crucial precondition for effective competition among health insurers is that consumers search for lower-priced health insurers. We test this hypothesis by estimating the price elasticities of insurers' market shares. We use unique panel data and specify a dynamic panel model to explain changes in market shares. Estimation results suggest that short-run price elasticities are smaller than previously found by other studies. In the long-run, however, estimation results suggest substantial price effects.

Costs and Cost Analysis↗
PubMed1989

The benefit and underutilization of sharing kidneys for better histocompatibility.

The data of the UCLA Kidney Transplant Registry were reviewed with regard to sharing. The percentage of first-cadaver cyclosporine-treated transplants since 1984 with long cold ischemia time increased with sharing distance: 25% of unshared grafts, 40% of locally shared, and 61% of distantly shared ones had cold ischemia times over 24 hr; for cold ischemia times over 36 hr the numbers were 6%, 12%, and 24%, respectively. The immediate function rate did not parallel sharing distance the way cold ischemia time did: 85.7% without sharing, 74.4% with local sharing, and 83.5% with distant sharing. The percentage of well-matched (0 HLA-B,DR mismatches) transplants was low (3-5%) regardless of sharing status. Well-matched shared grafts with cyclosporine immunosuppression had a 9% survival advantage at one year compared with poorly matched unshared ones (85% vs. 76%). Long-term, well-matched shared grafts had a half-life of 11.9 years compared with 7.5 years for poorly matched unshared ones (reflecting graft loss from 3 to 10 years posttransplant). We conclude that sharing for histocompatibility has an overall beneficial effect.

Graft Survival↗
PubMed2006

An interactive stereoscopic display for cooperative work--volume visualization and manipulation with multiple users.

A stereoscopic display table for cooperative work with a volume data is described. Adequate stereoscopic image generated from the volume data is displayed and shared by multiple users. All the users can observe and interact with the volume data displayed on the IllusionHole in a face-to-face environment. It displays each pair of stereoscopic images such that all users observe the 3D image at exactly the same position. An outline of the system is described in this paper.

Depth Perception↗
PubMed2006

Shared parameter models for the joint analysis of longitudinal data and event times.

Longitudinal studies often gather joint information on time to some event (survival analysis, time to dropout) and serial outcome measures (repeated measures, growth curves). Depending on the purpose of the study, one may wish to estimate and compare serial trends over time while accounting for possibly non-ignorable dropout or one may wish to investigate any associations that may exist between the event time of interest and various longitudinal trends. In this paper, we consider a class of random-effects models known as shared parameter models that are particularly useful for jointly analysing such data; namely repeated measurements and event time data. Specific attention will be given to the longitudinal setting where the primary goal is to estimate and compare serial trends over time while adjusting for possible informative censoring due to patient dropout. Parametric and semi-parametric survival models for event times together with generalized linear or non-linear mixed-effects models for repeated measurements are proposed for jointly modelling serial outcome measures and event times. Methods of estimation are based on a generalized non-linear mixed-effects model that may be easily implemented using existing software. This approach allows for flexible modelling of both the distribution of event times and of the relationship of the longitudinal response variable to the event time of interest. The model and methods are illustrated using data from a multi-centre study of the effects of diet and blood pressure control on progression of renal disease, the modification of diet in renal disease study.

Blood Pressure↗
PubMed2004

Recommendations on the use of satellite remote-sensing data for urban air quality.

In the last 5 yr, the capabilities of earth-observing satellites and the technological tools to share and use satellite data have advanced sufficiently to consider using satellite imagery in conjunction with ground-based data for urban-scale air quality monitoring. Satellite data can add synoptic and geospatial information to ground-based air quality data and modeling. An assessment of the integrated use of ground-based and satellite data for air quality monitoring, including several short case studies, was conducted. Findings identified current U.S. satellites with potential for air quality applications, with others available internationally and several more to be launched within the next 5 yr; several of these sensors are described in this paper as illustrations. However, use of these data for air quality applications has been hindered by historical lack of collaboration between air quality and satellite scientists, difficulty accessing and understanding new data, limited resources and agency priorities to develop new techniques, ill-defined needs, and poor understanding of the potential and limitations of the data. Specialization in organizations and funding sources has limited the resources for cross-disciplinary projects. To successfully use these new data sets requires increased collaboration between organizations, streamlined access to data, and resources for project implementation.

Air Pollutants↗
PubMed1997

Development and use of the North American Association of Central Cancer Registries standards for cancer registries.

Lack of standardization in data items, definitions, and codes in cancer registries has complicated analyses of pooled cancer data and has limited sharing of methods and software. The North American Association of Central Cancer Registries (NAACCR) has successfully developed and implemented extensive standards for data items and processes used by cancer registries in the United States and Canada. The article describes NAACCR's approach to achieving concensus and facilitating adoption of standards by combining volunteer and staff efforts, including broad-based representation in committees and providing shared automated software. Specific standards and their rationales are provided.

Data Collection↗
PubMedDate not supplied

The Blue Obelisk-interoperability in chemical informatics.

The Blue Obelisk Movement (http://www.blueobelisk.org/) is the name used by a diverse Internet group promoting reusable chemistry via open source software development, consistent and complimentary chemoinformatics research, open data, and open standards. We outline recent examples of cooperation in the Blue Obelisk group: a shared dictionary of algorithms and implementations in chemoinformatics algorithms drawing from our various software projects; a shared repository of chemoinformatics data including elemental properties, atomic radii, isotopes, atom typing rules, and so forth; and Web services for the platform-independent use of chemoinformatics programs.

Algorithms↗
PubMed2005

Androgenic progestins in oral contraceptives and the risk of epithelial ovarian cancer.

OBJECTIVE: Oral contraceptives (OCs) have been consistently linked to reduced risk of ovarian cancer. Oral contraceptive formulations display varying degrees of androgenicity. Data linking androgens to ovarian cancer suggest that OC androgenicity may impact efficacy in preventing ovarian cancer. The authors investigated whether OC efficacy might differ according to androgenicity by using data from a large, population-based, case-control study (the Steroid Hormones and Reproductions [SHARE] Study). METHODS: Detailed data on OC formulation was obtained by an in-person interview for 568 cases and 1,026 controls. Multivariable logistic regression was used to assess the association of OC androgenicity with ovarian cancer while controlling for the known potential confounders of age, parity, family history of ovarian cancer, and tubal ligation. RESULTS: Androgenic and nonandrogenic OCs conferred a similar and significant reduction in ovarian cancer risk (odds ratio 0.52, 95% confidence interval 0.35-0.76 and odds ratio 0.59, 95% confidence interval 0.45-0.78, respectively). No differences in duration of use, age at first use, and time since last use were found between androgenic and nonandrogenic formulations. CONCLUSION: In general, the androgenicity of an OC does not alter chemopreventive efficacy. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2003

Mapping from a clinical data warehouse to the HL7 Reference Information Model.

Large-scale data integration efforts to support clinical and biologic research are greatly facilitated by the adoption of standards for the representation and exchange of data. As part of a larger project to design the necessary architecture for multi-institutional sharing of disparate biomedical data, we explored the potential of the HL7 Reference Information Model (RIM) for representing the data stored in a local academic clinical data warehouse. A necessary first step in information exchange with such a warehouse is the development and utilization of tools for transforming between local data schemas and standards-based conceptual data models. We describe our initial efforts at mapping clinical concepts from a relational data warehouse to the HL7 RIM.

Computer Communication Networks↗
PubMed1995

HEDIS, what is it? What does it mean to me? How does it affect my practice?

Collection of data to allow for fact based comparison of health coverage is needed. While the intent is commendable, one must contemplate how to deal with the stream of auditors coming into the office Another issue, proposed to be addressed in the 1996 version, is adjustment of the data for severity of illness. Physician-patient populations are not exactly alike and require severity adjustments to enable valid comparison. Results of data analysis should be shared with the physician. Clarification with each health plan is necessary to ascertain if the analyzed data will be used in a punitive manner (deselection) or in a true CQI (continuous quality improvement) process to allow for identification of weakness and subsequent improvement. Hopefully in the future it will be possible for HEDIS data to be collected by one organization with subsequent distribution of the information to the respective health plans. Not only would this decrease intrusions into daily operation of a medical practice, it would also result in a standardization of collection methodology among all health plans. Until the HEDIS process matures, it may be wise to address some of these concerns in the contract between the physician and health plan. HEDIS can be of benefit not only to employers, but to everyone involved in the health care system--purchasers, patients, and physicians. The HEDIS development process must be closely monitored to be certain data collection is consistent ant reliable, the data collected is meaningful, and the data analysis results are used to improve health care quality--not just for cost control and health planning.

Financial Management↗
PubMed2004

Protein folding and unfolding simulations: a new challenge for data mining.

One of the unsolved paradigms in molecular biology is the protein folding problem. In recent years, with the identification of several diseases as protein folding disorders and with the explosion of genome information and the need for efficient ways to predict protein structure, protein folding became a central issue in molecular sciences research. Using molecular dynamics unfolding simulations of an amyloidogenic protein--transthyretin--as an example, we put forward a series of ideas on how simulations of this type may be used to infer rules and unfolding behavior in amyloidogenic proteins, and to extrapolate rules for protein folding in different structural classes of proteins. These, in turn, could help in the development of protein structure prediction methods. The need to analyse different proteins and to run multiple simulations creates a huge amount of data which has to be stored, managed, analyzed and shared (database and Grid technology; data mining). Once the data is captured, the next challenge is to find meaningful patterns (associations, correlations, clusters, rules, relationships) among molecular properties, or their relative importance at different stages of the folding or unfolding processes. This clearly puts new and interesting challenges to the bioinformatics community.

Computational Biology↗
PubMed1985

Transformation of erythroid cells by Rous sarcoma virus (RSV).

RSV transforms several nonhematopoietic cell types and as reported here also has the capacity to transform hematopoietic cells of the erythroid lineage. In vitro, the three RSV isolates tested induced erythroblast-like colonies in infected bone marrow cells that were distinguishable by size and cell arrangement from those induced by avian erythroblastosis virus (AEV). Also in contrast to AEV-transformed erythroblast cultures, isolated cell colonies induced by RSV required complex growth conditions in liquid medium similar to the in vitro conditions necessary for erythroblasts transformed by the acute leukemia virus E26. Temperature-shift experiments using temperature-sensitive (ts) NY68 RSV revealed that when grown at the nonpermissive temperature (42 degrees), mutant-infected cells became benzidine positive and partially differentiated into erythrocytes. Wild-type (wt) RSV-transformed cells did not undergo similar changes. However, both wt RSV-, and to a greater extent, ts RSV-transformed cultures at the permissive temperature (37 degrees) did contain populations of spontaneously differentiating erythroid cells signifying that the transforming activity of the virus did not fully arrest erythroid maturation. In addition, the RSV-transformed cells did express tyrosine kinase activity. When injected intravenously into birds, RSV induced an erythroblastosis-like disease similar to AEV but also caused fibrosarcomas and leg paralysis. These results show that RSV can alter the pattern of erythroid differentiation in a manner similar to, but distinct from, AEV and indicate that the tyrosine-specific pp60src kinase is involved in erythroid cell transformation. Since the src and erb B proteins share a significant amino acid homology, these data suggest that both may also share a common functional homology.

Alpharetrovirus↗
PubMed2000

Cadaveric versus living donor kidney transplantation: a Medicare payment analysis.

BACKGROUND: We found previously that the clinical advantages of living donor (LD) renal transplantation lead to financial cost savings compared to either cadaveric donation (CAD) or dialysis. Here, we analyze the sources of the cost savings of LD versus CAD kidney transplantation. METHODS: We used United States Renal Data System data to merge United Network for Organ Sharing registry information with Medicare claims data for 1991-1996. Information was available for 42,868 CAD and 13,754 LD transplants. More than 5 million Medicare payment records were analyzed. We calculated the difference in average payments made by Medicare for CAD and LD for services provided during the first posttransplant year. RESULTS: Average total payments were $39,534 and $24,652 for CAD and LD, respectively (P<0.0001) during the first posttransplant year. The largest source of the difference in payments was in inpatient hospitals, representing $10,653.67 (P<0.0001). For patients who had Medicare as the primary payer, average transplant charges were significantly higher for CAD donation ($79,730 vs. $69,547, P<0.0001); average transplant payments demonstrated no statistical differences ($28,483 vs. $28,447, P = 0.858). Therefore, inferred profitability was significantly higher for LD. CONCLUSIONS: Medicare payments are remarkably lower for LD compared to CAD in every category. The single largest cost saving comes from inpatient hospital services. A portion of the savings from LD could be invested in programs to expand living kidney donation.

Cadaver↗
PubMed2004

Lessons from the national cooperative growth study.

OBJECTIVE: To review the National Cooperative Growth Study (NCGS), a national post-marketing surveillance program for children treated with biosynthetic growth hormone (GH) products from Genentech. METHODS: Representative data are presented to summarize the extensive experience of the NCGS. This study is a multicenter, observational surveillance registry begun in 1985 in coordination with the release of the first recombinant DNA biosynthetic GH. RESULTS: After almost 20 years, data from over 47 000 patients representing 165 000 patient years have been collected. There are over 12 000 active subjects (estimated to be approximately 75% of all current patients treated with a Genentech GH product) at 435 centers, providing extensive efficacy and safety data. The GrowTrak program is a secure, user-friendly database which encourages a high level of participation by the pediatric endocrine community in the USA. Efficacy has been shown in a variety of clinical diagnoses, including isolated (IGHD) and organic growth hormone deficiency (OGHD), idiopathic short stature (ISS), and Turner syndrome. Safety monitoring of this large population has provided reassuring evidence that leukemia (de novo or relapse), extracranial nonleukemic neoplasms and central nervous system (CNS) tumor recurrence are not associated with GH therapy. A small risk of intracranial hypertension and slipped capital femoral epiphyses has been suggested, especially in children with renal disease or Turner syndrome. NCGS substudies have also provided important insights into actual clinical practice. For example, screening for renal, cardiac, or auditory comorbidities in Turner syndrome is often done less than is recommended by national guidelines (NCGS 9). Furthermore, almost 65% of children referred for short stature may be lost to follow-up before an evaluation is completed (NCGS 8). CONCLUSIONS: The NCGS has proven to be a valuable method of monitoring the safety and efficacy of biosynthetic GH. The study has attracted wide physician participation due to the data collection software used and the extensive sharing of the analyses of that data with the providers.

Body Height↗
PubMed1994

Multiple origins of colonial green flagellates from unicells: evidence from molecular and organismal characters.

Phylogenetic hypotheses generated from cladistic analysis of organismal and molecular data are shown to be generally congruent and/or complementary for comparisons of unicellular and colonial green algae in the Chlorophyceae. Cladistic analysis of organismal character data corroborates the alliance of colonial Stephanosphaera with unicellular Haematococcus (Haematococcaceae sensu Smith), inferred from previous studies of nuclear-encoded rRNA sequence data. The organismal data also support monophyly of the colonial Volvocaceae (sensu Smith). Alliances of other unicellular taxa, including those ascribed to the "Euchlamydomonas" Hauptgruppe (sensu Ettl), are not resolved by organismal characters principally because the structure of the data is skewed to shared ancestral characters (symplesiomorphies) and unique characters (autapomorphies) which define individual taxa only. Reanalysis of rRNA sequence data, with additional sequence data for critical taxa, does not support monophyly of the colonial Volvocaceae (sensu Smith). However, these data are weak in the support of the alternate hypothesis of nonmonophyly. In contrast, relationships among most unicellular flagellates are unambiguously resolved by the molecular data. Although the failure of the sequence data to resolve relationships among colonial flagellates appears to be due to a sampling of conservative sequences, an ancient, rapid radiation event or taxon sampling bias may also be contributing to the ambiguity problem. Results from analysis of a combined data set (organismal and molecular) are generally consistent with the inferences of the organismal character data regarding the colonial flagellates and are also consistent with the inferences of the sequence data regarding the unicellular taxa.

Animals↗
PubMed2005

SNOMED CT: electronic health record enhances anesthesia patient safety.

This article discusses the importance of electronic health records (EHRs) in anesthesiology, emphasizing the critical role of standardized clinical terminology in the EHR's structure. SNOMED Clinical Terms (SNOMED CT), developed by SNOMED International, a division of the College of American Pathologists, in collaboration with the United Kingdom's National Health Service, offers a controlled healthcare terminology with comprehensive coverage of diseases, clinical findings, etiologies, therapies, procedures, and outcomes. Recommended as the core general terminology for electronic patient medical record information in the United States, it offers flexibility in expressing clinical concepts, enabling clinicians to say things in multiple ways and still be understood. SNOMED CT's comprehensive, scientifically validated clinical terminology enables a consistent way of capturing, sharing, and aggregating health data across specialties and sites of care. Its benefits range from facilitating system interoperability to allowing greater shared access to patient health information where and when it is needed. The article concludes by informing readers of access to English and Spanish language editions of SNOMED CT's core content, which recently was licensed through the National Library of Medicine, a part of the National Institutes of Health within Department of Health and Human Services.

Anesthesia↗
PubMed1995

The T-cell receptor beta locus and susceptibility to multiple sclerosis.

Assessments of genetically determined variations in the T-cell antigen receptor in multiple sclerosis (MS) have yielded conflicting results. We used three restriction fragment length polymorphisms (RFLPs) and a polymorphic microsatellite repeat as markers for the T-cell receptor (TCR) beta locus (7q32-35) in multiplex MS families. Affected sibling-pair analysis of the RFLP data failed to show evidence for linkage (127 families) whereas analysis of the microsatellite data (86 families) provided weak evidence for linkage with a maximum lod score of 0.98 (p < 0.05). We repeated the analysis in those families (n = 53) in which the affected sibling pairs were concordant for the HLA haplotype DR15/DQ6. This altered the proportion of affected siblings sharing 0, 1, 2 RFLP haplotypes from 0.24, 0.50, and 0.26 (p = NS) before stratification to 0.16, 0.41, and 0.43 (p < 0.05) in the DR15/DQ6 positive pairs alone; for the microsatellite data, sharing altered from 0.16, 0.50, and 0.34 (p < 0.05) in all pairs to 0.07, 0.49, and 0.44 (p < 0.01) in the DR15/DQ6 concordant siblings.

Adult↗
PubMed1999

Web applications for total quality management.

Total quality management involves the consideration of many quality subjects as part of the management, such as quality processes, quality education, quality assurance, quality planning, quality results and quality document management. But crucial quality elements are also communication, data management and information sharing. Web applications and other associated computer communication applications such as E-mail and newsgroups, for example, offer to the laboratory environment the best tools to achieve proper communication and data management/sharing. These applications, enabling the set-up of Internet and Intranet sites, are used to share the information in the form of simple text pages or of completely interactive pages, which could comprise audio and video files, web page formulae and web data management applications. These applications are being associated to several applications and also being integrated into the laboratory information system (LIS).

Internet↗