Network analysis of comorbidity patterns in Heart Failure patients using administrative data.

Background: Congestive Heart Failure (HF) is a widespread chronic disease characterized by a very high incidence in elder people. The high mortality and readmission rate of HF strongly depends on the complicated morbidity scenario often characterising it. The aim of this paper is to show the potential and the usefulness of Network models when applied to the analysis of comorbidity patterns in HF, as a new methodological tool to be considered within the epidemiological investigation of this complex disease. Methods: Data were retrieved from the healthcare administrative datawarehouse of Lombardy, the most populated regional district in Italy. Network analysis techniques and community detection algorithms are applied to comorbidities registered in hospital discharge papers of HF patients, in 7 cohorts between 2006 and 2012. Results: The relevance network indexes applied to the 7 cohorts identified, hypertension, arrythmia, renal and pulmonary diseases as the most relevant nodes related to death, in terms of prevalence and closeness/strength of the relationship. Moreover, some relevant clusters of nodes have been identified in all the cohorts, i.e. those related to cancer, lung diseases liver diseases and heart/circulation related problems. It seems that such patterns do not evolve along time (i.e., nor indexes of relevance computed on the nodes of the networks neither communities change significantly from one year/cohort to another), featuring HF comorbidity burden as stable over the years. Conclusions: Network analysis can be a useful tool in epidemiologic framework when relational data are the objective of the investigation, since it allows to visualize and make inference on patterns of association among nodes (here HF comorbidities) by means of both qualitative indexes and clustering techniques

The effect of counseling on willingness to use a hypothetical medication and perceptions of medication safety.

BACKGROUND: Poor medication adherence is an ongoing issue, and contributes to increased hospitalizations and healthcare costs. Although most adverse effects are rare, the perceived risk of adverse effects may contribute to low adherence rates. OBJECTIVES: The objective of this study was to determine how adverse effect likelihood and pharmacist counseling on adverse effect prevention affects individuals': (1) willingness to use a hypothetical medication and (2) perceptions of medication safety. METHODS: This study used a 3 × 3 experimental design. Participants (n = 601) viewed a hypothetical scenario asking them to imagine being prescribed an anti-asthma medication that could cause fungal infections of the throat. Participants were randomized to 1 of 9 scenarios that differed on: probability of developing an infection (5%, 20%, no probability mentioned) and whether they were told how to reduce the risk of infection (no prevention strategy discussed, prevention strategy discussed, prevention strategy discussed with explanation for how it works). Participants were recruited through Amazon Mechanical Turk. RESULTS: Participants were less willing to take the medication (F = 12.86, p < 0.0001) and considered it less safe (F = 13.11, p < 0.0001) when the probability of fungal infection was presented as 20% compared to 5% or when no probability information was given. Participants were more willing to take the medication (F = 11.78, p < 0.0001) and considered it safer (F = 11.17, p < 0.0001) when a prevention strategy was given. Finally, there was a non-statistically significant interaction between the probability and prevention strategy information such that provision of prevention information reduced the effect of variation in the probability of infection on both willingness to use the medication and perceived medication safety. CONCLUSIONS: Optimal risk communication involves more than informing patients about possible adverse effects. Pharmacists could potentially improve patient acceptance of therapeutic recommendations, and allay medication safety concerns, by counseling about strategies patients can implement to reduce the perceived risk of adverse effects

Inventaris van het archief van het controlekantoor Beringen van de administratie van het kadaster : overdracht 2010

De belastingdienst ondernam begin negentiende eeuw het reusachtige werk om het onroerend vermogen van elke familie te registreren. Deze inventarisatie wordt tot op heden geactualiseerd. Het kadaster brengt deze informatie ook nog eens in kaart. Het resultaat van al dit werk is een belangrijke bron voor het historisch onderzoek. Het kadastraal archief wordt echter relatief weinig geraadpleegd. De toegankelijkheid van al dit materiaal was lange tijd niet optimaal, en daardoor bleven de waardevolle bronnen onderbenut. Deze inventaris ontsluit een reeks kadastrale documenten uit het controlekantoor van Beringen - de oudste leggers en tafels zijn ruim 150 jaar oud en vormen een onafgebroken reeks archiefbescheiden van onschatbare waarde. Onderzoekers vinden hierin de toegang tot een veelzijdige bron voor de geschiedschrijving van de (deel)gemeenten Beringen, Beverlo, Heusden, Koersel, Kwaadmechelen, Oostham, Paal, Tessenderlo en Zolder

Nuove strategie terapeutiche nel trattamento delle ferite difficili

Introduzione. Il trattamento medico-chirurgico delle ferite difficili rappresenta un problema socio-sanitario in continua crescita, colpendo attualmente nel nostro Paese circa 2.000.000 di persone. La “ferita difficile” non è altro che una perdita di sostanza cutanea, a patogenesi multifattoriale, che non tende alla guarigione in modo spontaneo. Numerosi studi presenti in letteratura hanno evidenziato che l’uso delle medicazioni avanzate consente di raggiungere migliori risultati clinici ed economici nel processo di guarigione delle ferite difficili, assicurando sia una permanenza superiore sulla lesione che accorciando il tempo di trattamento, in quanto viene richiesto un minor numero di applicazioni rispetto alle medicazioni tradizionali. La Wound Bed Preparation (WBP) può essere definita come la gestione globale e coordinata della lesione cutanea atta a rimuovere le barriere locali alla guarigione o a promuovere l’efficacia di misure terapeutiche innovative. La medicazione avanzata non è altro che un materiale di copertura che possiede caratteristiche di biocompatibilità. Scopo della medicazione avanzata è quello di creare l’ambiente ideale per il processo di cicatrizzazione isolando la ferita da eventuali traumi ed infezioni esterne. Pazienti e metodi. Nell’Ambulatorio “Ferite Difficili” della Cattedra di Chirurgia Plastica e Ricostruttiva del Policlinico Umberto I di Roma, dal gennaio al dicembre 2006, sono stati trattati 570 pazienti (308 uomini – 262 donne), con un’età variabile dai 2 giorni agli 85 anni, affetti da ulcere di varia natura. Nell’ambito dei nostri casi clinici sono stati selezionati 200 soggetti divisi casualmente in due gruppi: gruppo A - 100 pazienti trattati unicamente con medicazioni tradizionali; gruppo B - 100 pazienti trattati unicamente con medicazioni avanzate. Ogni paziente è stato trattato localmente con medicazioni periodiche, specifiche a seconda del tipo di ferita difficile presentata. Inoltre si è proceduto all’individuazione ed alla cura dei fattori sistemici, concause dell’ulcera. Il nostro protocollo prevedeva medicazioni due o tre volte alla settimana a seconda che si trattasse di ferite infette o non infette, per un periodo cha poteva variare da un mese per i casi meno gravi ad un anno per le forme croniche. Risultati. È risultata evidente una più alta percentuale di guarigione ottenuta attraverso l’utilizzo delle medicazioni avanzate. Nel Gruppo A si sono ottenuti i seguenti risultati: la guarigione del 53% delle ferite; il restante 47% non è guarito, ma nel 17%, le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali); nel rimanente 30%, invece, è stato ottenuto solo un modestissimo miglioramento della lesione che è ancora in fase di trattamento. Nel Gruppo B si è ottenuta la guarigione del 65% delle ferite; nel restante 35% non guarito, nel 15% le medicazioni sono state di ausilio alla preparazione del letto vascolare per l’esecuzione di un intervento definitivo (applicazione di innesti o lembi locali) mentre nel rimanente 20% si è raggiunto comunque un notevole miglioramento della lesione (con riduzione delle dimensioni, scomparsa dell’infezione e miglioramento della qualità di vita del paziente). Discussione e conclusioni. In sintesi, emerge che le medicazioni avanzate, se correttamente impiegate, offrono vantaggi in termini di efficacia clinica (velocità di guarigione della lesione), di qualità della vita del paziente e di economicità. Non ultimo è da considerare che la ferita difficile è spesso l’epifenomeno di una malattia sistemica. La ferita difficile richiede, quindi, un trattamento multidisciplinare. difficile richiede, quindi, un trattamento multidisciplinare. Results. The results showed a higher percentage of recovery reached by using the advanced dressings. Group A showed the followings results: the 53% of patients recovered from wounds; the remaining 47% patients did’nt not recover but in 17% cases medications showed to be of some help in the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges), while the remaining 30% has shown a scarce improvement of the injury and they are still under treatment. Group B showed the 65% of patients recovered from wounds; as for the remaining 35% not recovered patients, medications represented an auxiliary aid to the preparation of the vascular bed for the execution of a definitive operation (application of grafts or local edges) for the 15% of patients, while the remaining 20%, even if not completely recovered, showed a notable improvement of the injury (reduction of the dimensions and disappearance of the infection and improvement of the patient quality of life). Conclusions. In synthesis, it emerges that the advanced dressings, if correctly used, offer advantages in terms of clinical effectiveness (rapid recovery from the injury), patient quality of the life and cheapness. It has also to be considered that the difficult wound is often the epiphenomenon of a systemic illness. The difficult wound requires, therefore, a multidisciplinary treatment

Principal Perceptions of the Relationship Between Professional Development Designs and the Qualities, Proficiencies, and Leadership Skills Required of West Virginia Principals

The purpose of this study was to determine if principals perceive a relationship between six job-required abilities and ten designs of professional development. The Larry Survey: A Web-based Questionnaire was used to gather demographics of participating principals, designs of professional development in which principals participate and those in which they would participate if given a choice, and the value principals believe specific designs have for their use/knowledge of job-required abilities. The study’s population was West Virginia’s 720 principals; 470 principals participated in the study. A quantitative, nonexperimental, correlational research design was used. Mean scores, a multiple regression test, and the Pearson Product Moment Correlation were used for data analysis. An alpha level of .05 served as the level of significance. The Statistical Package for Social Sciences software was used for entering and manipulating data. Results of the study indicated the professional development design in which most principals have participated is the traditional “one-shot” workshop or session with journal writing being the design of least participation. If given the choice, the design in which most would participate is that of school visitations. Journal writing is the one of least choice. Principals reported team training for school improvement as the design of most value for all six job-required abilities. In addition, principals reported the design of support networks was of equal value for the abilities of professional and systems. For all six job-required abilities, principals reported the traditional “oneshot” workshop or session as the design having the least value. Results of the study found a significant relationship between the principals’ demographic characteristics of programmatic level and age and the design of support networks, between the demographic characteristic of sex and the design of team training for school improvement, and between the demographic characteristic of sex and the design of a “series of related workshops or sessions.” Principals perceived a moderate relationship between vision, management and environment, and community and the designs of school visitations and coaching and a moderate relationship between systems and the designs of peer study groups and support networks

Mathematical modelling of polyamine metabolism in bloodstream-form trypanosoma brucei: An application to drug target identification

© 2013 Gu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedThis article has been made available through the Brunel Open Access Publishing Fund.We present the first computational kinetic model of polyamine metabolism in bloodstream-form Trypanosoma brucei, the causative agent of human African trypanosomiasis. We systematically extracted the polyamine pathway from the complete metabolic network while still maintaining the predictive capability of the pathway. The kinetic model is constructed on the basis of information gleaned from the experimental biology literature and defined as a set of ordinary differential equations. We applied Michaelis-Menten kinetics featuring regulatory factors to describe enzymatic activities that are well defined. Uncharacterised enzyme kinetics were approximated and justified with available physiological properties of the system. Optimisation-based dynamic simulations were performed to train the model with experimental data and inconsistent predictions prompted an iterative procedure of model refinement. Good agreement between simulation results and measured data reported in various experimental conditions shows that the model has good applicability in spite of there being gaps in the required data. With this kinetic model, the relative importance of the individual pathway enzymes was assessed. We observed that, at low-to-moderate levels of inhibition, enzymes catalysing reactions of de novo AdoMet (MAT) and ornithine production (OrnPt) have more efficient inhibitory effect on total trypanothione content in comparison to other enzymes in the pathway. In our model, prozyme and TSHSyn (the production catalyst of total trypanothione) were also found to exhibit potent control on total trypanothione content but only when they were strongly inhibited. Different chemotherapeutic strategies against T. brucei were investigated using this model and interruption of polyamine synthesis via joint inhibition of MAT or OrnPt together with other polyamine enzymes was identified as an optimal therapeutic strategy.The work was carried out under a PhD programme partly funded by Prof. Ray Welland, School of Computing Science, University of Glasgo

Network analysis of comorbidity patterns in heart failure patients using administrative data

Background: Congestive Heart Failure (HF) is a widespread chronic disease characterized by a very high incidence in elder people. The high mortality and readmission rate of HF strongly depends on the complicated morbidity scenario often characterising it. Methods: Data were retrieved from the healthcare administrative datawarehouse of Lombardy, the most populated regional district in Italy. Network analysis techniques and community detection algorithms are applied to comorbidities registered in hospital discharge papers of HF patients, in 7 cohorts between 2006 and 2012.Results: The relevance network indexes applied to the 7 cohorts identified death, ipertension, arrythmia, renal and pulmonary diseases as the most relevant nodes related to HF, in terms of prevalence and closeness/strenght of the relationship. Moreover, 3 clusters of nodes have been identified in all the cohorts, i.e. those related to cancer, lung diseases and heart/circulation related problems.Conclusions: Network analysis can be a useful tool in epidemiologic framework when relational data are the objective of the investigation, since it allows to visualize and make inference on patterns of association among nodes (here HF comorbidities) by means of both qualitative indexes and clustering techniques