Standard Quality Measures Research Articles

Surgical Hand Antisepsis and Surgical Site Infections.

Surgical site infections (SSI) remain a significant problem to both the patients and the healthcare system. Value care and standardized quality measures continue to promote improvement in surgical asepsis, but certain debates remain unresolved in the field of surgical hand antisepsis. Review of relevant accounts and literature. Controversy has existed regarding the U.S. Food and Drug Administration (FDA)'s 1994 Tentative Final Monograph (TFM), which defined how surgical hand antisepsis products are assessed. Issues involving neutralizers and demonstration of a cumulative effect were addressed in the FDA's Proposed Rule in 2015. Few studies have used SSI as a primary outcome and instead have used a surrogate marker (colony-forming units [CFU]). Quantitative microbiology studies suggest a minimum bacterial inoculum of 105-107 CFU/mL is necessary to cause a clinical infection. Outcomes of antisepsis likely are driven by both active ingredient(s) and overall product formulation. Povidone-iodine aqueous scrubs are inferior to chlorhexidine gluconate (CHG) 4% aqueous scrubs and alcohol-based rubs (ABR). The SSI and CFU outcomes studies support the equivalence or superiority of ABR over CHG. Both ABRs and CHG 4% are preferred to povidone-iodine for surgical hand antisepsis. Well-powered randomized controlled trials measuring SSI as a primary outcome, as well as those designed according to either TFM or European methodology, with appropriate controls and neutralizers, are warranted. These trials should incorporate different ABR formulations and CHG 4%, as well as skin tolerance assessments and a cost analysis.

A Multicenter Study: North American Islet Donor Score in Donor Pancreas Selection for Human Islet Isolation for Transplantation

Selection of an optimal donor pancreas is the first key task for successful islet isolation. We conducted a retrospective multicenter study in 11 centers in North America to develop an islet donor scoring system using donor variables. The data set consisting of 1,056 deceased donors was used for development of a scoring system to predict islet isolation success (defined as postpurification islet yield >400,000 islet equivalents). With the aid of univariate logistic regression analyses, we developed the North American Islet Donor Score (NAIDS) ranging from 0 to 100 points. The c index in the development cohort was 0.73 (95% confidence interval 0.70-0.76). The success rate increased proportionally as the NAIDS increased, from 6.8% success in the NAIDS < 50 points to 53.7% success in the NAIDS ≥ 80 points. We further validated the NAIDS using a separate set of data consisting of 179 islet isolations. A comparable outcome of the NAIDS was observed in the validation cohort. The NAIDS may be a useful tool for donor pancreas selection in clinical practice. Apart from its utility in clinical decision making, the NAIDS may also be used in a research setting as a standardized measurement of pancreas quality.

Barriers to Quality End-of-Life Care for Patients With Blood Cancers.

Patients with blood cancers have been shown to receive suboptimal care at the end of life (EOL) when assessed with standard oncology quality measures (eg, no chemotherapy ≤ 14 days before death). As they were developed primarily for solid tumors, it is unclear if these measures are appropriate for patients with hematologic malignancies. Moreover, barriers to high-quality EOL care for this specific patient population are largely unknown. In 2015, we asked a national cohort of hematologic oncologists about the acceptability of eight standard EOL quality measures. Building on prior qualitative work, we prespecified that measures achieving agreement among at least 55% of respondents would be considered acceptable. We also explored perspectives regarding barriers to quality EOL care. We received 349 surveys (response rate = 57.3%). Six of the standard measures met the threshold of acceptability, and four were acceptable to > 75% of respondents: hospice admission > 7 days before death, no chemotherapy ≤ 14 days before death, no intubation in the last 30 days of life, and no cardiopulmonary resuscitation in the last 30 days of life. The highest-ranked barriers to quality EOL care reported were "unrealistic patient expectations" (97.3%), "clinician concern about taking away hope" (71.3%), and "unrealistic clinician expectations" (59.0%). In this large national cohort of hematologic oncologists, standard EOL quality measures were highly acceptable. The top barrier to quality EOL care reported was unrealistic patient expectations, which may be best addressed with more timely and effective advance care discussions.

18 One Page User Friendly Proforma Delivers Dramatic Improvements in Heart Failure Management in a Busy District General Hospital

<h3>Background</h3> Heart failure affects almost one million people in the UK with survival rates comparable to or worse than many cancers. Recent publications of the NICOR National Heart Failure Audit have focused attention on the need for improvement. This challenge is particularly acute in busy district general hospitals in London such as Whipps Cross University Hospital. <h3>Objective</h3> We aimed to investigate if the implementation of a simple one-page user friendly Whipps Cross Heart Failure Improvement Proforma- the ‘WHIP form’ in all medical wards could help improve the management of patients admitted with heart failure against standard quality measures. <h3>Methods</h3> The ‘WHIP form’ was introduced and implemented in all medical wards supported with a one-day educational seminar and a new dedicated heart failure email service. <h3>Results</h3> Between June to September 2015, 106 patients with a primary admission diagnosis of heart failure were enrolled and managed using the ‘WHIP form’. Inpatient mortality remained stable at 11.3% with an average hospital stay of 13.5 days. The 30-day readmission rate halved from 14% to 7%. Patients with documented left ventricular systolic dysfunction on Echocardiogram had significant improvements in the prescription of prognostic medication on discharge: ACEi/ARBs prescription increased from 78% from 88% [10% improvement]. B-Blockers prescription increased from 68% to 95% [27% improvement]. <h3>Conclusion</h3> The initiation of an “easy to use” one page heart failure management proforma led to a dramatic reduction in 30-day readmission rates and significant increase in the prescription of prognostically important ACE inhibitors and B-blockers. If the reductions in 30-day readmissions are sustained, we estimate that our cost neutral intervention could translate to yearly savings of nearly £80K for Whipps Cross University Hospital alone.

PTU-079 Effect of Inflammation on Liver Stiffness in Active Autoimmune Liver Disease: A Simultaneous Biopsy-Controlled Study Using Acoustic Radiation Force Impulse (ARFI) Elastography

Introduction ARFI elastography (virtual touch quantification,VTq ™) is a well validated technique for non-invasive assessment of liver fibrosis in viral hepatitis. The interpretation of shear velocity readings in active autoimmune liver disease (AILD) may be affected by a number of factors. However, few studies have specifically examined the effect of inflammation on liver stiffness (LS) in this group. We report the results of a preliminary study in which LS and histology have been sampled simultaneously from the same region of liver tissue in a large cohort with active AILD. Methods Our local database of 101 patients with AILD (63 autoimmune hepatitis AICH +/- overlap, 38 cholestatic-PBC or PSC) was investigated. LS estimation by ARFI was performed using a standard validated protocol by a single operator. Biopsies were performed from the same region of liver using an 18 G Biopince™ needle, immediately after LS measurement. Clinical, biochemical, ultrasonic and histopathological data were collated retrospectively. ARFI/histological variance (AHV) was defined as a difference of more than 1 Metavir or 2 Ishak stages from that predicted by ARFI, according to standard calibration. 1 Results Sixty one ARFI + liver biopsies performed at the same session were identified out of a total of 164 ARFI and 114 liver biopsies. Patients included group 1: 37 active AICH (diagnosis/flare on therapy); group 2: 7 AICH remission; and group 3: 17 cholestatic liver disease. Co-pathology was seen in 8. Standard ARFI quality measures were validated in 93%. Mean ARFI shear velocities were significantly higher in group 1 compared with 2 and 3–2.41, 1.29 and 1.64 m/sec, respectively (p = 0.001). AHV occurred in 44.1, 28.6 and 29.4%, AHV prevalence was 41% overall, with 100% in group 1 and 88% overall reflecting overestimation of fibrosis. Across all groups, Ishak necro-inflammatory grade was strongly correlated with both ARFI shear velocity (r = 0.58,p Conclusion These data show that variance between ARFI shear velocity and histology is common in active AILD, usually overestimating predicted fibrosis stage. Strong positive correlations were seen between histological inflammatory grade with both shear velocity and AHV, suggesting that inflammation is implicated in the observed increase in LS in this group. Confirmation of this association in further studies would suggest a potential role for ARFI elastography in monitoring resolution of inflammation during treatment of AILD. Reference 1 D. Sherman, et al . J Hepatol 2014; 60 (Suppl 1):S413. Disclosure of Interest None Declared

Repeatability Evaluation of a Contrast Sensitivity System for Transfer to the Eye Clinic

The Contrast Sensitivity Function (CSF) is a valuable tool which can be used to characterize functional vision and also for the diagnosis and management of patients with different eye diseases. In spite of its usefulness, the CSF is currently hardly ever used in clinical practice. The aim of this study was to validate the use of the system called FVC-100 (Tecnovinc-UNT-CONICET, Argentina), which calculates the CSF, in order to transfer this important tool to ophthalmological clinics. The validation was carried out through the design of a repeatability test and the subsequent analysis of the results. Furthermore, we evaluated the impact of different factors influencing the repeatability of the measurements such as age and previous training. The tests were based on the discrimination of sinusoidal gratings for different spatial frequencies (1, 4 and 12 c/°) in both eyes of 12 people, aged between 20 and 70. The results show that the calculated values of SC of each subject have a high repeatability and are not dependent on age or training. These results allow us to conclude positively regarding the effectiveness of the FVC-100, and to validate its use in clinics for the calculation of the FSC as a standard measure of functional vision quality.

A longitudinal study of emotional adjustment, quality of life and adaptive function in attenuated MPS II

ObjectivesThe behavioral, adaptive and quality of life characteristics of attenuated mucopolysaccharidosis type II (MPS II) have not been well studied. Understanding changes over time in the attenuated phenotype may assist in helping achieve better outcomes in long-term function. This longitudinal study investigates these outcomes in relation to age, somatic disease burden, and IQ. Specifically, somatic disease burden is a major challenge for these patients, even with treatment with enzyme replacement therapy. Methods15 patients, 10 between ages 6 and <12 and 5 between ages ≥12 and 18, were selected who had at least 2 yearly visits. The occurrence of physical signs, the Physical Symptom Score, and IQ in these two groups was studied as well as the longitudinal association of age with standardized measures of quality of life, adaptive function, and behavioral symptoms as rated by parents and the child's self-report. Slopes by age across and within patients were calculated for these measures. ResultsAll but one child had hearing loss, most had joint contractures and short stature. Somatic disease burden increased with age. IQ, although normal for most, also improved with age in those under 12years of age. Physical quality of life decreased while psychosocial quality of life increased with age. Although other adaptive skills were in the broad average range, daily living skills were low at baseline relative to normative data and decreased over time. Behavior ratings indicated improvement in attention and hyperactivity over time. No patient had severe psychopathology, but older children reported an increasing sense of inadequacy and low self-esteem on self-report, presumably due to increasing awareness of differences from peers over time. ConclusionsAttenuated MPS II patients have increasing somatic disease burden and poor physical quality of life as they develop as well as decreasing self-esteem and sense of adequacy. Psychosocial quality of life, adaptive skills, and attention improve. Recognition of and intervention around these issues will be beneficial to MPS II attenuated patients who have the resources to use such assistance to improve their long-term outcomes.

The political drivers of renewable energies policies

This paper empirically analyzes how political factors affect the deployment of renewable energy (RE) sources and compares their explanatory power to that of other economic, energy and environmental drivers that have received greater attention in the literature so far. The sample encompasses the EU countries bound to attain the target of 20% share of gross final energy consumption by 2020. The panel data analysis shows that lobbying by the manufacturing industry negatively affects RE deployment, whereas standard measures of government quality show a positive effect; furthermore, left-wing parties promote the deployment of RE more than right-wing parties.

An examination of the equivalency of self-report measures obtained from crowdsourced versus undergraduate student samples.

Increasingly, researchers have begun to explore the potential of the Internet to reach beyond the traditional undergraduate sample. In the present study, we sought to compare the data obtained from a conventional undergraduate college-student sample to data collected via two online survey recruitment platforms. In order to examine whether the data sampled from the three populations were equivalent, we conducted a test of equivalency using inferential confidence intervals-an approach that differs from the more traditional null hypothesis significance testing. The results showed that the data obtained via the two online recruitment platforms, the Amazon Mechanical Turk crowdsourcing site and the virtual environment of Second Life, were statistically equivalent to the data obtained from the college sample, on the basis of means of standardized measures of psychological stress and sleep quality. Additionally, correlations between the sleep and stress measures were not statistically different between the groups. These results, along with practical considerations for the use of these recruitment platforms, are discussed, and recommendations for other researchers who may be considering the use of these platforms are provided.

Discovering biomedical semantic relations in PubMed queries for information retrieval and database curation.

Identifying relevant papers from the literature is a common task in biocuration. Most current biomedical literature search systems primarily rely on matching user keywords. Semantic search, on the other hand, seeks to improve search accuracy by understanding the entities and contextual relations in user keywords. However, past research has mostly focused on semantically identifying biological entities (e.g. chemicals, diseases and genes) with little effort on discovering semantic relations. In this work, we aim to discover biomedical semantic relations in PubMed queries in an automated and unsupervised fashion. Specifically, we focus on extracting and understanding the contextual information (or context patterns) that is used by PubMed users to represent semantic relations between entities such as ‘CHEMICAL-1 compared to CHEMICAL-2.’ With the advances in automatic named entity recognition, we first tag entities in PubMed queries and then use tagged entities as knowledge to recognize pattern semantics. More specifically, we transform PubMed queries into context patterns involving participating entities, which are subsequently projected to latent topics via latent semantic analysis (LSA) to avoid the data sparseness and specificity issues. Finally, we mine semantically similar contextual patterns or semantic relations based on LSA topic distributions. Our two separate evaluation experiments of chemical-chemical (CC) and chemical–disease (CD) relations show that the proposed approach significantly outperforms a baseline method, which simply measures pattern semantics by similarity in participating entities. The highest performance achieved by our approach is nearly 0.9 and 0.85 respectively for the CC and CD task when compared against the ground truth in terms of normalized discounted cumulative gain (nDCG), a standard measure of ranking quality. These results suggest that our approach can effectively identify and return related semantic patterns in a ranked order covering diverse bio-entity relations. To assess the potential utility of our automated top-ranked patterns of a given relation in semantic search, we performed a pilot study on frequently sought semantic relations in PubMed and observed improved literature retrieval effectiveness based on post-hoc human relevance evaluation. Further investigation in larger tests and in real-world scenarios is warranted.

Organic field trials to promote Hungarian organic cereal production – testing wheat varieties

Among various factors affecting the cultivation of organic cereals, the biological basis is one of the most important ones. Within organic arable cropping the cash crop grown on the largest surface in Hungary is common wheat ( Triticum aestivum ). 2012-2015 we conducted a series of participatory on-farm experiments involving a number of organic farmers from all over Hungary in order to identify best suited wheat varieties for Hungarian organic farming. We studied the most important standard quality measures (protein, gluten, falling number) and yields, which strongly affect the economy of organic cereal production. Results show that there is a gap between conventional breeding aims and demands in organic farming. Moreover, even farmers’ proven varieties cannot guaranty premium quality yield in climatically difficult years. There is strong need to continue variety testing and identification of well adapted cultivars. Keywords: organic wheat variety test, on-farm research, Hungary

Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients.

Most patients cope well with an implantable cardioverter defibrillator (ICD), but psychological distress and ICD-related concerns have been reported in about 20% of ICD recipients. Many previous studies have not distinguished between genders. In this nationwide study we compared quality of life, anxiety, and depression symptoms between the genders in ICD recipients, and determined predictors of each of these variables in men and women. All adult Swedish ICD recipients were invited by mail to participate and 2,771 patients (66 ± 12 years) completed standardized measures of quality of life, symptoms of anxiety, and depression. Time since implantation ranged from 1 year to 23 years with a mean of 4.7 ± 3.9. Women reported worse quality of life (mean index 0.790 vs 0.825) and higher prevalence of anxiety (20.5% vs 14.7%) than did men (P < 0.001 for both comparisons), while there were no differences in symptoms of depression (8.8% vs 8.2%). Most ICD recipients report a good quality of life, without emotional distress, but among the minority with distress, women fare worse than men.

Subjective Quality Assessment of Underwater Video for Scientific Applications.

Underwater video services could be a key application in the better scientific knowledge of the vast oceanic resources in our planet. However, limitations in the capacity of current available technology for underwater networks (UWSNs) raise the question of the feasibility of these services. When transmitting video, the main constraints are the limited bandwidth and the high propagation delays. At the same time the service performance depends on the needs of the target group. This paper considers the problems of estimations for the Mean Opinion Score (a standard quality measure) in UWSNs based on objective methods and addresses the topic of quality assessment in potential underwater video services from a subjective point of view. The experimental design and the results of a test planned according standardized psychometric methods are presented. The subjects used in the quality assessment test were ocean scientists. Video sequences were recorded in actual exploration expeditions and were processed to simulate conditions similar to those that might be found in UWSNs. Our experimental results show how videos are considered to be useful for scientific purposes even in very low bitrate conditions.

Measuring Quality of End-of-Life Care for Blood Cancers: A National Survey of Hematologic Oncologists

Background: Hematologic malignancies have been associated with poor performance on standard measures of quality of end-of-life (EOL) care in oncology (eg, Hui, Cancer, 2014); however, these measures were originally developed primarily for solid tumors, and they may not appropriately address EOL quality issues for patients with blood cancers. We sought to explore hematologic oncologists' perspectives regarding the acceptability of current oncology EOL quality measures, hypothesizing that they would report them to be largely unacceptable.Methods: In 2014, we mailed a 30-item survey to a national sample of hematologic oncologists randomly selected from the American Society of Hematology clinical directory. The survey was developed through focus groups (n=20) and cognitive debriefing (n=5) with hematologists whose practices focus on patients with blood cancers. In the resulting survey, we provided a list of standard EOL quality measures (Earle, JCO, 2003; Keating, Cancer, 2010; Phelps, JAMA, 2009; see table) and two novel hematology-based measures (no red cell transfusions ≤ 7 days before death, and no platelet transfusions ≤ 7 days before death) and asked "Please indicate whether or not you feel each is an acceptable indicator of good quality EOL care for patients with hematologic malignancies." We decided a priori that we would consider a measure to be "highly acceptable" if there were at least 75% agreement among hematologic oncologists on its acceptability. Worrying that they might reject them all, we also asked them to identify three measures they would choose in a scenario where three had to be adopted.Results: We received 349 surveys from 48 states (response rate: 57.3%). Non-responders were not significantly different across known variables (gender and region of practice). Among respondents, median age was 52 years, median time in practice was 25 years, and 43% practiced primarily in tertiary centers. Eighty-seven percent were board-certified in oncology, 81% in hematology, and 71% in both specialties. The table below shows acceptability of the quality measures as rated by respondents.In the exercise where three measures had to be chosen, the one chosen most often was no CPR within 30 days of death (54%), followed by enrollment in hospice >7 days before death (46%).Conclusions: In contrast to our hypothesis, all of the measures we presented were considered acceptable by a substantial proportion of the hematologic oncologists in our national cohort. Moreover, while four of the measures reached our a priori designation of being highly acceptable, the two hematology-focused measures did not meet this same threshold. These data suggest that in hematologic oncology, resources should be directed towards addressing barriers to performance on established EOL quality measures in addition to creating new ones. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings

ObjectiveTo describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages.MethodsAs part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary...

Time in Therapeutic Range and Percentage of International Normalized Ratio in the Therapeutic Range as a Measure of Quality of Anticoagulation Control in Patients With Atrial Fibrillation

BackgroundTime in therapeutic range (TTR), albeit the standard measure of quality of anticoagulation control for warfarin, is underused in everyday clinical practice because of its tedious calculation. In contrast, the percentage of international normalized ratio measurements in range (PINRR) is a convenient alternative. Our objective was to investigate the correlation between PINRR and TTR and whether PINRR has clinical utility for prediction of ischemic stroke and intracranial hemorrhage in a “real-world” atrial fibrillation (AF) cohort. MethodsThis is an observational study based on a hospital-based AF registry. ResultsAmong 1428 Chinese patients with AF who were taking warfarin (76.2 ± 8.7 years; mean CHA2DS2-VASc, 4.2 ± 1.6 and HAS-BLED, 2.3 ± 0.9), mean and median TTR values were 38.2% ± 24.4% and 38.8% (interquartile range, 17.9% and 56.2%), respectively. Patients with TTR ≥ 65% (14.8%) had a lower annual risk of ischemic stroke (3.04% per year) than did those with TTR < 65% (5.35% per year). Mean and median PINRR were 34.3% ± 17.1% and 34.2% (interquartile range, 22.7% and 46.0%), respectively. TTR significantly correlated with PINRR in a linear fashion (r = 0.81; P < 0.0001). A cutoff of PINRR ≤ 56.1% was a good discriminator of TTR < 65%, with a high sensitivity (98.3%) and positive predictive value (91.9%). The annual ischemic stroke risk in patients with PINRR > 56.1% was 2.56% per year, lower than those with TTR ≥ 65% (3.04% per year). Patients with PINRR > 56.1% had an annual incidence of intracranial hemorrhage comparable to those with TTR ≥ 65% (0.49% per year vs 0.68% per year). ConclusionsAmong patients with AF who are taking warfarin, the PINRR is a user-friendly alternative to TTR, having a high sensitivity and positive predictive value in predicting TTR. As with TTR, PINRR is associated with clinical adverse events, ie, ischemic stroke and intracranial hemorrhage.

Taming Healthcare Costs: Promise and Pitfalls for Women's Health.

When it comes to healthcare, women are often the primary decision makers for their families. Therefore, focusing on women and their health needs can have a profound effect on health reform efforts to control costs and improve quality for all segments of the population. The promise and pitfalls of cost containment reform in Massachusetts can serve as an informative case study for policymakers at the local, state, and federal levels as they attempt to reduce costs while maintaining quality of care. Massachusetts cost containment law, Chapter 224, seeks to control the healthcare cost growth through innovative approaches to increase efficiency and transparency including the adoption of new delivery system models, investments in wellness and prevention programs, and implementation of standard quality and evaluation measures. In this paper, we outline four approaches to delivering on the promise of cost containment reform to maximize women's access to comprehensive, quality healthcare while avoiding the pitfalls of cost containment's adverse impact on women's health.

Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases

Background and purpose — Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment.Patients and methods — We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1–3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test.Results — There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29–52 and a 6-minute walk test improvement range of 37–84 meters.Interpretation — It is possible to combine TKR with osseointegrated implants.

ClassiMap: A New Dimension Reduction Technique for Exploratory Data Analysis of Labeled Data

Multidimensional scaling techniques are unsupervised Dimension Reduction (DR) techniques which use multidimensional data pairwise similarities to represent data into a plane enabling their visual exploratory analysis. Considering labeled data, the DR techniques face two objectives with potentially different priorities: one is to account for the data points' similarities, the other for the data classes' structures. Unsupervised DR techniques attempt to preserve original data similarities, but they do not consider their class label hence they can map originally separated classes as overlapping ones. Conversely, the state-of-the-art so-called supervised DR techniques naturally handle labeled data, but they do so in a predictive modeling framework where they attempt to separate the classes in order to improve a classification accuracy measure in the low-dimensional space, hence they can map as separated even originally overlapping classes. We propose ClassiMap, a DR technique which optimizes a new objective function enabling Exploratory Data Analysis (EDA) of labeled data. Mapping distortions known as tears and false neighborhoods cannot be avoided in general due to the reduction of the data dimension. ClassiMap intends primarily to preserve data similarities but tends to distribute preferentially unavoidable tears among the different-label data and unavoidable false neighbors among the same-label data. Standard quality measures to evaluate the quality of unsupervised mappings cannot tell about the preservation of within-class or between-class structures, while classification accuracy used to evaluate supervised mappings is only relevant to the framework of predictive modeling. We propose two measures better suited to the evaluation of DR of labeled data in an EDA framework. We use these two label-aware indices and four other standard unsupervised indices to compare ClassiMap to other state-of-the-art supervised and unsupervised DR techniques on synthetic and real datasets. ClassiMap appears to provide a better tradeoff between pairwise similarities and class structure preservation according to these new measures.

Commentary to: Association of BMI and pediatric urologic postoperative events: Results from pediatric NSQIP

I found this study interesting e not only in its findings, but also in the author’s use of 30-day readmission as a measure of surgical complications. Thirty-day readmission has long been a standard measure of quality, but has recently become a hot topic. It’s been under fire since 2012 when it was linked to reimbursement for the medical conditions of acute myocardial infarction, pneumonia, and congestive heart failure by the Hospital Readmissions Reduction Program (HRRP). Several criticisms have been voiced: that the 30-day time period should not be applied to all conditions (one size does not fit all); that the measure includes readmissions for all causes as well as planned readmissions; and that readmission for medical conditions doesn’t correlate with other known quality measures. In 2015, the HRRP included the surgical procedures of total hip and knee replacement in the hospital readmission adjustment factor. The extent that readmission for surgical conditions is related to quality is now under scrutiny. Unlike readmission for medical conditions, readmission for surgical conditions has been found to correlate with hospital volume, mortality and processes of care [1], suggesting that it is associated with quality. But does readmission reflect surgical complications? A recent study in adults says yes e for the most part. Merkow et al. found the most common reasons for readmission are surgical site infection, small bowel obstruction and ileus. They concluded that surgical readmissions mostly reflect post-operative complications [2]. But the story does not end there. Socioeconomic status also influences readmission both for medical conditions and surgical procedures [3,4]. Income, insurance status, access to primary care follow-up, and social resources all play a part in both the patient’s recovery and a physician’s decision to readmit.When applied to the pediatric population, socioeconomic factors becomemore complexas theyextendnotonly to the patient, but also to the parents.