bluuebunny/crossref_metadata_2025 huggingface dataset:
The Risk and Consequences of Clinical Miscoding Due to Inadequate Medical Documentation: A Case Study of the Impact on Health Services Funding
Authors: Cheng Ping , Gilchrist Annette , Robinson Kerin M , Paul Lindsay
Published: March 2016

As coded clinical data are used in a variety of areas (e.g. health services funding, epidemiology, health sciences research), coding errors have the potential to produce far-reaching consequences. In this study the causes and consequences of miscoding were reviewed. In particular, the impact of miscoding due to inadequate medical documentation on hospital funding was examined. Appropriate reimbursement of hospital revenue in the casemix-based (output-based) funding system in the state of Victoria, Australia relies upon accurate, comprehensive, and timely clinical coding. In order to assess the reliability of these data in a Melbourne tertiary hospital, this study aimed to: (a) measure discrepancies in clinical code assignment; (b) identify resultant Diagnosis Related Group (DRG) changes; (c) identify revenue shifts associated with the DRG changes; (d) identify the underlying causes of coding error and DRG change; and (e) recommend strategies to address the aforementioned. An internal audit was conducted on 752 surgical inpatient discharges from the hospital within a six-month period. In a blind audit, each episode was re-coded. Comparisons were made between the original codes and the auditor-assigned codes, and coding errors were grouped and statistically analysed by categories. Changes in DRGs and weighted inlier-equivalent separations (WIES) were compared and analysed, and underlying factors were identified. Approximately 16% of the 752 cases audited reflected a DRG change, equating to a significant revenue increase of nearly AU$575,300. Fifty-six percent of DRG change cases were due to documentation issues. Incorrect selection or coding of the principal diagnosis accounted for a further 13% of the DRG changes, and missing additional diagnosis codes for 29%.The most significant of the factors underlying coding error and DRG change was poor quality of documentation. It was concluded that the auditing process plays a critical role in the identification of causes of coding inaccuracy and, thence, in the improvement of coding accuracy in routine disease and procedure classification and in securing proper financial reimbursement.
Australian Hospital Data: Not Just for Funding
Authors: Michel Jude L , Jackson Terri J
Published: March 2016

Collections of routine, or ‘administrative’, hospital data have many applications in health care and are now recognised as valuable sources of information. In recent decades, administrative data have been seen primarily as funding and billing tools to assist with the reimbursement of hospitals for services provided; this purpose remains the primary focus of the clinical coder workforce. More recently, hospital data have been recognised as valuable resources for a range of health system improvement processes beyond funding. The focus of this paper is to review and demonstrate the diverse uses of administrative data in health services research and quality improvement. By gaining an understanding of how the data are used, we can appreciate the importance of good quality data from the perspective of its multiple uses. This paper describes a sample of the studies conducted in Australia using administrative data in health care improvement.
‘Sailing the Seven Cs’ with the Clinical Coders' Creed. The Eighth ‘C’: Private Sector Coding
Authors: Prudames Fiona
Published: March 2016

This article briefly relates the experience of a clinical coder working in the private healthcare sector in the Australian state of New South Wales and questions whether it is possible to work in this environment while adhering to the Clinical Coders‘ Creed. Private facilities in Australia that handle acute, psychiatric, respite and rehabilitation cases, rely mainly upon health insurance funds for reimbursement for episodes of care, which are funded according to DRGs based on codes assigned by clinical coders. The point is made that while all coders strive to fully and accurately describe the clinical episode of care regardless of healthcare setting, a distinction can be drawn between public and private sector coding in relation to financial contracts, which form the basis of private health care. Therefore, it is recommended that private sector coders familiarise themselves with this “C” as well as the other seven “Cs” of the Clinical Coders’ Creed.
The Role of the Health Information Manager in a Research-Based Information Technology Project
Authors: Freyne Alice
Published: March 2016

Information technology advances in healthcare provide many and varied opportunities for the Health Information Manager. Here is one example involving a Melbourne-based research project and an innovative approach to patient information delivery. The research project area of study is multimedia content delivery in the following applications: as an adjunct to the surgical informed consent process, patient information or instruction presentation and clinical education. The objective is to develop evidence-based, effective and accessible information and knowledge resources for patients and health care providers.
DH & DHS Data Reform Program (Victoria): Progress to Date
Authors: McKenzie Zoe , Perry Catherine , Ashley Jonathan , Dalton Nyssa
Published: March 2016

The Department of Health and Department of Human Services (DH & DHS) Data Reform Program (formerly the DH & DHS Information Management (IM) Strategy) was established to improve the efficiency of data collection and reporting arrangements between the departments and external organisations and individuals. The Data Reform Program is being undertaken incrementally and focuses on reducing the proliferation and duplication of program data collections, improving program data integrity and the timely feedback of collected information to program data providers. To achieve the objectives of the Data Reform Program, the Department of Health has centralised and strengthened governance processes to improve the management and impact of its data collection and reporting requirements of external organisations and individuals. As part of the Data Reform Program, specialist data management tools and resources have also been developed to support data reform within DH and DHS.
Pofessional Practice and Innovation: Geographical Information Systems: An Effective Planning and Decision-Making Platform for Community Health Coalitions in Australia
Authors: Baum Scott , Kendall Elizabeth , Muenchberger Heidi , Gudes Ori , Yigitcanlar Tan
Published: March 2016

The development of locally-based healthcare initiatives, such as community health coalitions that focus on capacity building programs and multi-faceted responses to long-term health problems, have become an increasingly important part of the public health landscape. As a result of their complexity and the level of investment, it has become necessary to develop innovative ways to help manage these new healthcare approaches. Geographical Information Systems (GIS) have been suggested as one of the innovative approaches that will allow community health coalitions to better manage and plan their activities. The focus of this paper is to provide a commentary on the use of GIS as a tool for community coalitions and discuss some of the potential benefits and issues surrounding the development of these tools.
Professional Practice and Innovation: The Coding Masterpiece: A Framework for the Formal Pathways and Processes of Health Classification
Authors: Price Emily , Robinson Kerin
Published: March 2016

This article empirically defines the formal pathways and processes that enable and frame hospital clinical classification in an activity-based funding environment. These structured actions include: learning and training; abstracting; clinical knowledge locating and confirming; coder-doctor communication; coder-coder communication; the complicated sub-set of code searching and decision-making processes that constitute practical clinical ‘coding’; allocation to diagnosis-related groups; confirmation of financial reimbursement; auditing; and quality management practices to ensure the integrity of the multiple outputs and outcomes of clinical coding. An analogy of these complex, exacting, and knowledge-dense work practices is made with the 20th century avant-garde art movement of Cubism: the creation of Pablo Picasso's The three musicians is used as a metaphor for clinical/health classification work.
Citizens, Patients and Policy: A Challenge for Australia's National Electronic Health Record
Authors: Showell Christopher Morris
Published: March 2016

Australia will implement a personally controlled electronic health record (PCEHR) over the next three to five years. Development of an e-health policy framework to support this initiative has involved healthcare providers and patients, but the discussion appears to have bypassed non-patient citizens. There is a risk that this omission may result in difficulties with implementation and uptake of the new system.
Smart Use of Data, Information and Communication: The INFORM-Ed Best Local Practice Project — Grafton Base Hospital
Authors: Lloyd Sheree , Collie Jean , McInnes Alastair , King Kevin , Lollback Alison , Garland Angie
Published: March 2016

This paper describes current progress for an information management project in a medium-sized rural hospital after the first four months of the one-year project. In particular, the article examines some of the project outcomes to date as these relate to the National Hospitals and Health Reform recommendations for the smart use of data, information and communication. The paper identifies a number of important challenges and issues that have been addressed by the project and proposes that the project findings may be used to inform similar projects in other settings. These findings relate to clinician requirements for reports, investment in human resources, development, and time for information management activities. An understanding of data collected, information systems, and presentation of clinician data are also important. The benefits of information sharing in assisting quality improvement activities are particularly relevant but, more importantly, they can engage and involve clinicians in the use of information. The importance of local data, information, and knowledge is described. Finally, issues for the health information management profession, such as working collegially and sharing knowledge and expertise, are outlined.
Who Owns the Information in the Medical Record? Copyright Issues
Authors: Mair Judith
Published: March 2016

As part of every private healthcare practice and healthcare facility, documentation of patients' healthcare, diagnoses and treatment are an ongoing requirement with legal connotations. The question that may arise is whether copyright can subsist in patient medical records, and if so, what benefit may arise from ownership of such copyright.
Evaluation of Treatment with Oseltamivir during the 2009 H1N1 (Swine Flu) Pandemic: The Problem of Incomplete Clinical Information
Authors: Hanafi Somayeh , Hayatshahi Alireza , Torkamandi Hassan , Javadi Mohammad Reza
Published: March 2016

During the H1N1 (swine flu) pandemic of 2009, the World Health Organization (WHO) confirmed more than 14,000 deaths globally; this included a death toll of 147 in Iran. In order to evaluate (a) the appropriateness of the Oseltamivir dose through calculation of a patient's creatinine clearance (CrCl) and (b) the quality of data in the medical charts, we conducted a retrospective study at the Shariati Hospital in Tehran. All admissions to the hospital between the dates i October 2009 and 31 January 2010 were evaluated, amounting to a total of 51 patients' charts, including 8 outpatient charts. Of these 51 charts, 26 (51%) contained all the information necessary to evaluate the CrCl. However, there was at least one piece of information missing (e.g. the patient's weight; serum creatinine) from each of the remaining 25 charts (49% of the sample), which made it impossible for us to evaluate the dose. These results demonstrate how crucially important it is to ensure that all the necessary patient information is correctly registered at the time of admission in order to minimise medication errors.
Application of Case Classification in Healthcare Quality Assessment in China
Authors: Xu Ping , Li Meina , Zhang Lulu , Sun Qingwen , Lv Shiwei , Lian Bin , Wei Min , Kan Zhang
Published: March 2016

The purpose of this study was to build a healthcare quality assessment system with disease category as the basic unit of assessment based on the principles of case classification, and to assess the quality of care in a large hospital in Shanghai. Using the Delphi method, four quality indicators were selected. The data of 124,125 patients discharged from a large general hospital in Shanghai, from October 1, 2004 to September 30, 2007, were used to establish quality indicators estimates for each disease. The data of 51,760 discharged patients from October 1, 2007 to September 30, 2008 were used as the testing sample, and the standard scores of each quality indicator for each clinical department were calculated. Then the total score of various clinical departments in the hospital was calculated based on the differences between the practical scores and the standard. Based on quality assessment scores, we found that the quality of healthcare in departments of thyroid and mammary gland surgery, obstetrics and gynaecology, stomatology, dermatology, and paediatrics was better than in other departments. Implementation of the case classification for healthcare quality assessment permitted the comparison of quality among different healthcare departments.
Sustainability of Health Information Systems in Developing Countries: The Case of Fiji
Authors: Soar Jeffrey , Gow Jeff , Caniogo Vili
Published: March 2016

This paper examines the future sustainability of the Fijian Ministry of Health's (MoH) information and communication technology (ITC) system for patient management (PATIS). PATIS was developed with AusAID funding and, as the owner of the system, AusAID has no commercial competence or interest in further development of the system. Thus, the question that arises is: should Fiji adopt a commercially available patient administration system or retain the existing PATIS? In-depth consultations with senior executives and line managers of units that were major users of PATIS were undertaken. Semi-structured interviews and focus group discussion approaches were utilised. The consensus or majority views of the users were that the existing PATIS performed more than adequately. The future sustainability of the system is threatened by the lack of investment in resources (e.g. hardware maintenance and human resources) required to keep the system operating at its optimum. It was found that PATIS provides Fiji with a satisfactory patient administration system. The identified problems with the system are not related to the application per se but rather to an under-investment in resources for its utilisation.
Capture and Documentation of Coded Data on Adverse Drug Reactions: An Overview
Authors: Paul Lindsay , Robinson Kerin M.
Published: March 2016

Allergic responses to prescription drugs are largely preventable, and incur significant cost to the community both financially and in terms of healthcare outcomes. The capacity to minimise the effects of repeated events rests predominantly with the reliability of allergy documentation in medical records and computerised physician order entry systems (CPOES) with decision support such as allergy alerts. This paper presents an overview of the nature and extent of adverse drug reactions (ADRS) in Australia and other developed countries, a discussion and evaluation of strategies which have been devised to address this issue, and a commentary on the role of coded data in informing this patient safety issue. It is not concerned with pharmacovigilance systems that monitor ADRs on a global scale. There are conflicting reports regarding the efficacy of these strategies. Although in many cases allergy alerts are effective, lack of sensitivity and contextual relevance can often induce doctors to override alerts. Human factors such as user fatigue and inadequate adverse drug event reporting, including ADRS, are commonplace. The quality of and response to allergy documentation can be enhanced by the participation of nurses and pharmacists, particularly in medication reconciliation. The International Classification of Diseases (ICD) coding of drug allergies potentially yields valuable evidence, but the quality of local and national level coded data is hampered by under-documenting and under-coding.
Moving Health Promotion Communities Online: A Review of the Literature
Authors: Sunderland Naomi , Beekhuyzen Jenine , Kendall Elizabeth , Wolski Malcolm
Published: March 2016

There is a need to enhance the effectiveness and reach of complex health promotion initiatives by providing opportunities for diverse health promotion practitioners and others to interact in online settings. This paper reviews the existing literature on how to take health promotion communities and networks into online settings. A scoping review of relevant bodies of literature and empirical evidence was undertaken to provide an interpretive synthesis of existing knowledge on the topic. Sixteen studies were identified between 1986 and 2007. Relatively little research has been conducted on the process of taking existing offline communities and networks into online settings. However, more research has focused on offline (i.e. not mediated via computer networks); ‘virtual’ (purely online with no offline interpersonal contact); and ‘multiplex’ communities (i.e. those that interact across both online and offline settings). Results are summarised under three themes: characteristics of communities in online and offline settings; issues in moving offline communities online, and designing online communities to match community needs. Existing health promotion initiatives can benefit from online platforms that promote community building and knowledge sharing. Online e-health promotion settings and communities can successfully integrate with existing offline settings and communities to form ‘multiplex’ communities (i.e. communities that operate fluently across both online and offline settings).
Discretionary Use of Family Practice Information Systems: An Empirical Examination in Turkey
Authors: Ada Serkan , Bal Canan Gamze , Çelik Adnan , Akgemci Tahir
Published: March 2016

This study examined the antecedents and consequences of the discretionary use of the family practice information systems (FPIS) by family physicians in Turkey. A structured survey was conducted among family physicians located in Kahramanmaras, a southern province in Turkey. The partial least squares (PLS) method was used to analyse the survey data. Findings showed that (1) physicians' discretionary use of FPIS is positively related to their perceived value of patient care; (2) physicians' computer self-efficacy is positively related to their discretionary use of FPIS; (3) physicians' innovativeness in information technology (IT) is positively related to their computer self-efficacy; and (4) physicians' innovativeness in IT does not significantly impact on their discretionary use of FPIS. The present study's findings revealed that physicians should be adequately informed about the discretionary use of FPIS, and policies should be established to improve family physicians' understanding and competence of information systems, including computer self-efficacy.
A Comparison of State and National Australian Data on External Cause of Injury Due to Falls
Authors: Cunningham Janet , Williamson Dianne , Robinson Kerin M. , Paul Lindsay
Published: March 2016

Falls are the leading cause of hospital-treated injuries in Australia. Injury surveillance data are analysed to identify common causes and types of fall injuries, risk factors for particular activities, location of injury occurrence, and age groups at risk of injury. External cause of injury data include cause of injury, place of occurrence, and activity when injured. These are collected in hospitals, where ICD-10-AM codes are assigned by Health Information Managers and clinical coders, based on medical record documentation. The current study examined the extent and quality of Victorian coded data on external cause of injury due to a fall, assessed its usefulness for injury prevention, and compared the Victorian and Australia-wide data. This involved an analysis, using the Victorian Admitted Episode Dataset, of 38,153 hospital separations in 2007–08 for fall injuries and a comparison with the 2003–04 national data. This showed similar usage of External cause codes in Victoria and Australia-wide. There was overuse of residual categories such as Other and Unspecified, these being assigned in 73.8% of separations in Victoria and 71.6% nationally. The problem of overuse of Unspecified external cause codes for hospitalised fall injuries is arguably multifactorial. Inevitably, this overuse reduces the value of the coded data for injury surveillance and prevention, and for monitoring of the public health.
Analysis of Questions regarding Morbidity Coding Posted to the Online Coding Clinic of the Korean Medical Record Association
Authors: Boo Yookyung , Han Whiejong M. , Lim Hyunsook , Choi Youngjin
Published: March 2016

Accuracy and consistency in morbidity coding are important in both clinical research and practice. However, Health Information Managers (HIMs) sometimes face difficulties in assigning morbidity codes. To assist them, the Korean Medical Record Association operates an online coding clinic bulletin board, on which HIMs can post questions and receive answers. Frequency analysis and Fisher's exact testing were performed to identify differences among the types of questions posted and the characteristics of the HIMs who posted them. Through statistical analysis, it was found that HIMs working at hospitals with fewer than 500 beds and those with more than 10 years of work experience were found to post more questions than other HIMs. The study also identified the characteristics of HIMs who require more coding education and particular diagnoses for which further training is required. Our findings will assist the development of coding procedures, guidelines, education programs, and a more user-friendly database.
Continuous Glucose Monitoring in Type 1 Diabetes
Authors: Borges Uirassu , Kubiak Thomas
Published: March 2016

Background:

Continuous glucose monitoring (CGM) patient systems have been shown to improve diabetes self-treatment when used consistently. The meaningful integration of this technology into everyday life, however, can vary greatly among CGM users and not all people with diabetes use CGM to its full potential. To address this issue, the study pursued 2 aims: first, to identify patient characteristics that underlie the acceptance of CGM in people with type 1 diabetes and, second, to examine the effects of different levels of experience with CGM use.

Methods:

Guided by a model based on the technology acceptance model (TAM), structural equation modeling (SEM) was employed to model the patient characteristics as predictors of CGM acceptance. In all, 111 participants (60.4% female, mean = 37.6 years, SD = 11.2) participated in a web-based survey; 40 were current CGM users, 18 were former users and 53 had no experience with CGM systems.

Results:

In general, participants evaluated CGM positively; however, the feeling of information overload represented a major barrier to the sustained use of CGM, while perceptions of usefulness and ease of use constituted incentives for using this technology. Moreover, patients without CGM experience imagined more information overload than current users reported. Current users showed more intention to use CGM than former users.

Conclusion:

This study highlights the importance of CGM user experience for the effective use of this technology.
Recurrent Endocrine Cycles
Authors: Minor James M. , Rickey Leslie M. , Bergenstal Richard M.
Published: March 2016

Background:

The chaotic nature of blood glucose creates a formidable clinical challenge for diabetes healthcare. The recent discovery of recurrent endocrine cycles offers the advantage of advanced-prediction (proactive) health care.

Methods:

Historical studies covering 111 patients and 1 subject collected several months of glucose readings and their daily metrics. Phase portraits and phase analytics can detect recurrent metric cycles and test their ability to anticipate serious glycemic conditions.

Results:

Recurrent patterns were detected having a rate of ~7 days per complete cycle. Plots and risk models based on these cycles produced advanced alerts for acute glycemia, capturing greater than 96% of true-positive days with a 5% false-positive rate.

Conclusions:

This method can be implemented graphically and functionally within a BG monitoring system to warn doctors and patients of impending serious glycemic levels.
Humans and fire: Changing relations in early agricultural and built environments in the Zagros, Iran, Iraq
Authors: Matthews Wendy
Published: March 2016

Fire-centred studies have recently been highlighted as powerful avenues for investigation of energy flows and relations between humans, materials, environments and other species. The aim in this paper is to evaluate this potential first by reviewing the diverse theories and methods that can be applied to investigate the ecological and social significance of anthropogenic fire, and second by applying these to new and existing data sets in archaeology. This paper examines how fire-centred approaches can inform on one of the most significant step-changes in human lifeways and inter-relations with environment and other species – the transition from mobile hunting-gathering to more sedentary agriculture in a key heartland of change, the Zagros region of Iraq and Iran, c. 12,000–8,000 BP. In the review and case studies multiple links are investigated between human fire use and environment, ecology, energy use, technology, the built environment, health, social roles and relations, cultural practices and catastrophic events.
Course, Predictors, and Outcomes of Depressed Mood in a Cohort of Norwegian Adolescents Followed From Age 13 Into Adulthood Age 30
Authors: Holsen Ingrid , Birkeland Marianne Skogbrott
Published: March 2016

This study used latent growth modeling to examine continuity and changes in depressed mood, predictors, and outcomes in a cohort of Norwegian adolescents followed from age 13 into adulthood age 30. First, the average development of depressed mood can be described by a slight increase in adolescence followed by a decrease in emerging adulthood. There were considerable individual differences in baseline level and rate of change in depressed mood, especially among females. Second, relationship with parents was associated with the stability component of depressed mood for both genders, as were father’s education for males. Third, a general trajectory of increasing levels of depressed mood was associated with lower probability of achievement of adulthood milestones and lower income and occupational status at age 30. Finally, both high levels of depressed mood at baseline and an increasing trajectory of depressed mood were associated with lower levels of life satisfaction at age 30.
Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial
Authors: Tagliafico Alberto S. , Calabrese Massimo , Mariscotti Giovanna , Durando Manuela , Tosto Simona , Monetti Francesco , Airaldi Sonia , Bignotti Bianca , Nori Jacopo , Bagni Antonella , Signori Alessio , Sormani Maria Pia , Houssami Nehmat
Published: March 2016

Purpose

Debate on adjunct screening in women with dense breasts has followed legislation requiring that women be informed about their mammographic density and related adjunct imaging. Ultrasound or tomosynthesis can detect breast cancer (BC) in mammography-negative dense breasts, but these modalities have not been directly compared in prospective trials. We conducted a trial of adjunct screening to compare, within the same participants, incremental BC detection by tomosynthesis and ultrasound in mammography-negative dense breasts.

Patients and Methods

Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts is a prospective multicenter study recruiting asymptomatic women with mammography-negative screens and dense breasts. Eligible women had tomosynthesis and physician-performed ultrasound with independent interpretation of adjunct imaging. Outcome measures included cancer detection rate (CDR), number of false-positive (FP) recalls, and incremental CDR for each modality; these were compared using McNemar’s test for paired binary data in a preplanned interim analysis.

Results

Among 3,231 mammography-negative screening participants (median age, 51 years; interquartile range, 44 to 78 years) with dense breasts, 24 additional BCs were detected (23 invasive): 13 tomosynthesis-detected BCs (incremental CDR, 4.0 per 1,000 screens; 95% CI, 1.8 to 6.2) versus 23 ultrasound-detected BCs (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.2 to 10.0), P = .006. Incremental FP recall occurred in 107 participants (3.33%; 95% CI, 2.72% to 3.96%). FP recall (any testing) did not differ between tomosynthesis (FP = 53) and ultrasound (FP = 65), P = .26; FP recall (biopsy) also did not differ between tomosynthesis (FP = 22) and ultrasound (FP = 24), P = .86.

Conclusion

The Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts’ interim analysis shows that ultrasound has better incremental BC detection than tomosynthesis in mammography-negative dense breasts at a similar FP-recall rate. However, future application of adjunct screening should consider that tomosynthesis detected more than 50% of the additional BCs in these women and could potentially be the primary screening modality.
Opportunistic Breast Cancer Education and Screening in Rural Honduras
Authors: Kennedy Linda S. , Bejarano Suyapa A. , Onega Tracy L. , Stenquist Derek S. , Chamberlin Mary D.
Published: March 2016

Purpose

In Honduras, the breast cancer burden is high, and access to women’s health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format.

Methods

The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended.

Results

Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women’s health services in a low-tech rural setting.

Conclusion

The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women’s health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.
NGT-3D: a simple nematode cultivation system to studyCaenorhabditiselegansbiology in 3D
Authors: Lee Tong Young , Yoon Kyoung-hye , Lee Jin Il
Published: March 2016

The nematode Caenorhabditiselegans is one of the premier experimental model organisms today. In the laboratory, they display characteristic development, fertility, and behaviors in a two dimensional habitat. In nature, however, C. elegans is found in three dimensional environments such as rotting fruit. To investigate the biology of C. elegans in a 3D controlled environment we designed a nematode cultivation habitat which we term the nematode growth tube or NGT-3D. NGT-3D allows for the growth of both nematodes and the bacteria they consume. Worms show comparable rates of growth, reproduction and lifespan when bacterial colonies in the 3D matrix are abundant. However, when bacteria are sparse, growth and brood size fail to reach levels observed in standard 2D plates. Using NGT-3D we observe drastic deficits in fertility in a sensory mutant in 3D compared to 2D, and this defect was likely due to an inability to locate bacteria. Overall, NGT-3D will sharpen our understanding of nematode biology and allow scientists to investigate questions of nematode ecology and evolutionary fitness in the laboratory.
Anatomy of a Contract Change
Authors: Jayaraman Rajshri , Ray Debraj , de Véricourt Francis
Published: March 2016

We study a contract change for tea pluckers on an Indian plantation, with a higher government-stipulated baseline wage. Incentive piece rates were lowered or kept unchanged. Yet, in the following month, output increased by 20 to 80 percent. This response contradicts the standard model and several variants, is only partly explicable by greater supervision, and appears to be “behavioral.” But in subsequent months, the increase is comprehensively reversed. Though not an unequivocal indictment of “behavioral” models, these findings suggest that nonstandard responses may be ephemeral, and should ideally be tracked over an extended period of time. (JEL D82, D86, J33, J41, J43, O13, Q12)
Transcatheter aortic valve implantation: past, present and future
Authors: Keshavarzi Freidoon , MacCarthy Philip
Published: March 2016

Transcatheter aortic valve implantation is one of the most significant technological advances in cardiovascular medicine. It offers a safe alternative in high risk cardiac patients with proven durability, economical viability and survival advantage. Current trials may expand its application in intermediate or low risk groups.
The assessment of aortic stenosis: echocardiography and beyond
Authors: Chambers John B
Published: March 2016

Aortic stenosis is the most common primary valve problem. This article describes its assessment and clinical interpretation using echocardiography and also shows how magnetic resonance, cardiac computed tomography and stress testing may be useful.
Transforming surgery through biomaterial template technology
Authors: Hodde Jason , Hiles Michael
Published: March 2016

Templates inserted into surgical wounds strongly influence the healing responses in humans. The science of these templates, in the form of extracellular matrix biomaterials, is rapidly evolving and improving as the natural interactions with the body become better understood.
The Evaluation of the Potency of Newly Developed Oximes (K727, K733) and Trimedoxime to Counteract Acute Neurotoxic Effects of Tabun in Rats
Authors: Kassa Jiří , Hatlapatková Jana , Žďárová Karasová Jana
Published: March 2016

Aim: The ability of two newly developed oximes (K727, K733) to reduce tabun-induced acute neurotoxic signs and symptoms was evaluated and compared with currently available trimedoxime in rats. Methods: The neuroprotective effects of the oximes studied combined with atropine on Wistar rats poisoned with tabun at a lethal dose (380 µg/kg i.m.; 90% of LD50 value) were evaluated. Tabun-induced neurotoxicity was monitored by the functional observational battery consisting of 38 measurements of sensory, motor and autonomic nervous functions at 2 hours following tabun challenge. Results: All tested oximes combined with atropine enable tabun-poisoned rats to survive till the end of experiment. Both newly developed oximes (K727, K733) combined with atropine were able to decrease tabun-induced neurotoxicity in the case of lethal poisoning although they did not eliminate all tabun-induced acute neurotoxic signs and symptoms. Conclusion: The ability of both novel bispyridinium oximes to decrease tabun-induced acute neurotoxicity was slightly lower than that of trimedoxime. Therefore, the newly developed oximes are not suitable for the replacement of commonly used oximes such as trimedoxime in the treatment of acute tabun poisonings.
Pneumoperitoneum in in-vitro Conceived Quadruplet Neonate: Rare Manifestation of Hirschsprungʼs Disease – Report of a Case
Authors: Mihanović Jakov , Jurić Ivo , Pogorelić Zenon , Mrklić Ivana , Jukić Miro , Furlan Dubravko
Published: March 2016

Introduction: Hirschsprung’s disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy. Case presentation: We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung’s disease. Conclusion: Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung’s disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung’s disease.
Geometric structures of collapsing Riemannian manifolds II
Authors: Naber Aaron , Tian Gang
Published: March 2016

In this paper we study collapsing sequences

M
i

→
GH

X

M_{i}\xrightarrow{\rm GH}X

of Riemannian manifolds with curvature bounded or bounded away from a controlled subset. We introduce a structure over X which in an appropriate sense is dual to the N-structure of Cheeger, Fukaya and Gromov. As opposed to the N-structure, which live over the

M
i

{M_{i}}

themselves, this structure lives over X and allows for a convenient notion of global convergence as well as the appropriate background structure for doing analysis on X. This structure is new even in the case of uniformly bounded curvature and as an application we give a generalization of Gromov’s Almost Flat Theorem and prove new Ricci pinching theorems which extend those known in the noncollapsed setting. There are also interesting topological consequences to the structure.
Prediction of the Shoppers Loyalty with Aggregated Data Streams
Authors: Nikulin Vladimir
Published: March 2016

Consumer brands often offer discounts to attract new shoppers to buy their products. The most valuable customers are those who return after this initial incentive purchase. With enough purchase history, it is possible to predict which shoppers, when presented an offer, will buy a new item. While dealing with Big Data and with data streams in particular, it is a common practice to summarize or aggregate customers’ transaction history to the periods of few months. As an outcome, we compress the given huge volume of data, and transfer the data stream to the standard rectangular format. Consequently, we can explore a variety of practically or theoretically motivated tasks. For example, we can rank the given field of customers in accordance to their loyalty or intension to repurchase in the near future. This objective has very important practical application. It leads to preferential treatment of the right customers. We tested our model (with competitive results) online during Kaggle-based Acquire Valued Shoppers Challenge in 2014.
Users-Centric Adaptive Learning System Based on Interval Type-2 Fuzzy Logic for Massively Crowded E-Learning Platforms
Authors: Almohammadi Khalid , Hagras Hani , Alghazzawi Daniyal , Aldabbagh Ghadah
Published: March 2016

Technological advancements within the educational sector and online learning promoted portable data-based adaptive techniques to influence the developments within transformative learning and enhancing the learning experience. However, many common adaptive educational systems tend to focus on adopting learning content that revolves around pre-black box learner modelling and teaching models that depend on the ideas of a few experts. Such views might be characterized by various sources of uncertainty about the learner response evaluation with adaptive educational system, linked to learner reception of instruction. High linguistic uncertainty levels in e-learning settings result in different user interpretations and responses to the same techniques, words, or terms according to their plans, cognition, pre-knowledge, and motivation levels. Hence, adaptive teaching models must be targeted to individual learners’ needs. Thus, developing a teaching model based on the knowledge of how learners interact with the learning environment in readable and interpretable white box models is critical in the guidance of the adaptation approach for learners’ needs as well as understanding the way learning is achieved.

This paper presents a novel interval type-2 fuzzy logic-based system which is capable of identifying learners’ preferred learning strategies and knowledge delivery needs that revolves around characteristics of learners and the existing knowledge level in generating an adaptive learning environment. We have conducted a large scale evaluation of the proposed system via real-word experiments on 1458 students within a massively crowded e-learning platform. Such evaluations have shown the proposed interval type-2 fuzzy logic system’s capability of handling the encountered uncertainties which enabled to achieve superior performance with regard to better completion and success rates as well as enhanced learning compared to the non-adaptive systems, adaptive system versions led by the teacher, and type-1-based fuzzy based counterparts.
Evaluation Of Bucharest Soil Liquefaction Potential
Authors: Cristian Arion , Elena Calarasu , Cristian Neagu
Published: March 2016

The paper contains the experimental research performed in Bucharest like the borehole data (Standard Penetration Test) and the data obtained from seismic investigations (down-hole prospecting and surface-wave methods). The evaluation of the soils liquefaction resistance based on the results of the SPT, down-hole prospecting and surface-wave method tests and the use of the earthquake records will be presented.
Awareness and Attitude Towards Green IS in Slovenian Enterprises
Authors: Baggia Alenka , Brezavšček Alenka , Maletič Matjaž , Šparl Petra , Raharjo Hendry , Žnidaršič Anja
Published: March 2016

Background: This study draws upon the use of Information Systems in support of achieving sustainability, known as Green IS. Furthermore, this study builds on the premise that Green IS offers the opportunity for organizations to act proactively in terms of environmental preservation as well as to mitigate the effects of global climate change and other environmental problems.

Aim: In particular, this study aims to assess the extent of awareness among managers regarding the use and the acceptance of Green IS in Slovenian enterprises.

Method: Using empirical data based on a large-scale survey among senior managers within Slovenian enterprises this study utilized several statistical methods (such as t-test, analysis of variance and multiple linear regression) to analyse the research questions.

Results: In general, findings seem to suggest that institutional mechanisms might be a plausible explanation for differences regarding the attitude towards Green IS adoption. For instance, enterprises with at least one implemented sustainability related certificate expressed higher levels of willingness to use Green IS in order to facilitate the achievement of sustainable development. Moreover, the results of the regression analysis revealed that both Institutional Mimetic pressure and Internal Environment Impact has positive impact on Green IS adoption.

Conclusion: The main conclusion is that the internal environmental impact is considered the most influential factor of the attitude towards Green IS adoption. The culture or individual perception of managers and employees play an important role in the Green IS adoption. Indeed, enterprises that have no intention of improving their environmental performance, but adopt Green IS by the means of seeking legitimacy among external stakeholders, cannot provide a sustainable improvement in environmental management.
On combined optical solitons of the one-dimensional Schrödinger’s equation with time dependent coefficients
Authors: Kilic Bulent , Inc Mustafa , Baleanu Dumitru
Published: March 2016

This paper integrates dispersive optical solitons in special optical metamaterials with a time dependent coefficient. We obtained some optical solitons of the aforementioned equation. It is shown that the examined dependent coefficients are affected by the velocity of the wave. The first integral method (FIM) and ansatz method are applied to reach the optical soliton solutions of the one-dimensional nonlinear Schrödinger’s equation (NLSE) with time dependent coefficients.
Consent for Surgery in View of an Ambigious Court Decision – Case Report
Authors: Lewińska Teresa , Modrzejewski Andrzej , Parafiniuk Mirosław
Published: March 2016

Guardianship courts seem to issue decisions in case of the need to obtain consent for surgery, amongst other things, when the patient is unable to consciously express written consent, and at the same time does not have a legal representative or a statutory representative does exist, but settlement with him is impossible. The presented study case demonstrated the abnormalities of applying court procedures, as well as the responsibilities and dilemmas posed in front of a surgeon. A specialist surgeon wanted to help the patient and he was able to accomplish his mission.
Regionale Versorgungsunterschiede
Authors: Wildner Manfred
Published: March 2016

Das Thema regionaler Versorgungsunterschiede erfährt zunehmende Aufmerksamkeit. Facetten dieses Themas umfassen die Strukturqualität wie die Verteilung von Krankenhausbetten und Einrichtungen der ambulanten Versorgung, die Prozess- und Output-Variabilität z.B. bei der Antibiotikaverordnung oder die Häufigkeit chirurgischer Eingriffe und damit auch die Qualität der gesundheitlichen Ergebnisse. Aktuelle Ansätze zur Bewältigung dieser Herausforderungen werden aufgezeigt.
Zusammenhang zwischen sozioregionaler Lage und ambulant-ärztlichem Versorgungsbedarf
Authors: Schulz Mandy , Czihal Thomas , Erhart Michael , Bätzing-Feigenbaum Jörg , von Stillfried Dominik
Published: March 2016

Wie in mehreren Untersuchungen gezeigt wurde, ist die bevölkerungsbezogene Morbidität und damit auch die Inanspruchnahme medizinischer Leistungen mit dem Ausmaß räumlicher sozialer Deprivation assoziiert. Der vorliegende Beitrag zeigt darüber hinaus, dass auch der Grad an Urbanität als bisher nicht beachtetes sozioregionales Merkmal bei der Beurteilung von bedarfsgerechter Versorgung berücksichtigt werden sollte.