Intermediate reading exercises for use with the Durrell Analysis of Reading Difficulty.

Thesis (Ed.M.)--Boston Universit

Incidence of surgical site infection following mastectomy with and without immediate reconstruction using private insurer claims data

OBJECTIVE: The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. DESIGN: Retrospective cohort study. PATIENTS: Commercially-insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from 1/1/2004–12/31/2011. METHODS: Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidence of SSI after mastectomy +/− immediate reconstruction was compared by the chi-square test. RESULTS: From 2004–2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 (58%) procedures. The 180-day incidence of SSI following mastectomy with or without reconstruction was 8.1% (1,520/18,696). Forty-nine percent of SSIs were identified within 30 days post-mastectomy, 24.5% between 31–60 days, 10.5% between 61–90 days, and 15.7% between 91–180 days. The incidence of SSI was 5.0% (395/7,860) after mastectomy-only, 10.3% (848/8,217) after mastectomy plus implant, 10.7% (207/1,942) after mastectomy plus flap, and 10.3% (70/677) after mastectomy plus flap and implant (p<0.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with (11.4% vs. 9.4%, p=0.001) and without (6.1% vs. 4.7%, p=0.021) immediate reconstruction. CONCLUSIONS: SSI incidence was two-fold higher after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest stratification by procedure type will facilitate comparison of SSI rates after breast operations between facilities

Validation of ICD-9-CM diagnosis codes for surgical site infection and noninfectious wound complications after mastectomy

BACKGROUNDFew studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.OBJECTIVESTo determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.METHODSWe reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.RESULTSThe PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).CONCLUSIONSOur results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).Infect Control Hosp Epidemiol 2017;38:334–339</jats:sec

Physical activity, sedentary behavior, and depressive symptoms among adolescents

BACKGROUND: This study examined cross-sectional and longitudinal associations between physical activity, sedentary behavior, and depressive symptoms among adolescents. METHODS: Participants were 155 adolescents (14.4 years±0.61) in 2004 (40% boys). Data collection occurred in 2004 and again in 2006. At both time points, participants completed the Centers for Epidemiological Studies Depression Scale for Children (CES-DC), from which they were classified as having depressive symptoms (≥15) or not (<15). Organized sport and TV viewing were self-reported and moderate-to-vigorous (MVPA) and vigorous (VPA) physical activity and sedentary time were objectively measured. Logistic and linear regression analyses examined cross-sectional and longitudinal associations between MVPA, VPA, organized sport, TV viewing, sedentary time, and symptoms of depression. RESULTS: There were no cross-sectional or longitudinal associations between MVPA, VPA, organized sport, sedentary time, and symptoms of depression among boys or girls. However, having symptoms of depression in 2004 did predict higher TV viewing among adolescent girls in 2006 (approximately 168 minutes/week more TV viewing; P≤.001). CONCLUSIONS: MVPA, VPA, organized sport and objectively-measured sedentary time appeared unrelated to depressive symptoms in this sample, but depressive symptoms predicted increased TV viewing over time among adolescent girls. Further research is required to determine the clinical relevance of this finding.Clare Hume, Anna Timperio, Jenny Veitch, Jo Salmon, David Crawford, and Kylie Bal

Can intrinsic and extrinsic metacognitive cues shield against distraction in problem solving?

We investigated the capacity for two different forms of metacognitive cue to shield against auditory distraction in problem solving with Compound Remote Associates Tasks (CRATs). Experiment 1 demonstrated that an intrinsic metacognitive cue in the form of processing disfluency (manipulated using an easy-to-read vs. difficult-to-read font) could increase focal task engagement so as to mitigate the detrimental impact of distraction on solution rates for CRATs. Experiment 2 showed that an extrinsic metacognitive cue that took the form of an incentive for good task performance (i.e., 80% or better CRAT solutions) could likewise eliminate the negative impact of distraction on CRAT solution rates. Overall, these findings support the view that both intrinsic and extrinsic metacognitive cues have remarkably similar effects. This suggests that metacognitive cues operate via a common underlying mechanism whereby a participant applies increased focal attention to the primary task so as to ensure more steadfast task engagement that is not so easily diverted by task-irrelevant stimuli

Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?

Objective To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women.Design Cross-sectional survey.Setting Community-based sample from metropolitan Melbourne, Australia.Subjects A sample of 1136 women aged 18&ndash;65 years, randomly selected from the electoral roll.Results Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily.Conclusions Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.<br /

Inconsistency of the judgment matrix in the AHP method and the decision maker's knowledge

In this paper we propose a method for a quantitative estimation of the decision maker's knowledge in the context of the Analytic Hierarchy Process (AHP) in cases, where the judgment matrix is inconsistent. We show that the matrix of deviation from the transitivity condition corresponds to the rate matrix for transaction costs in the financial market. For the quantitative estimation of the decision maker's professionalism, we apply the Ising model and thermodynamics tools.Comment: 17 page