Standardized Coding Research Articles

Estratégias e resultados da prevenção do câncer bucal em idosos de São Paulo, Brasil, 2001 a 2009

To describe the strategies and results obtained by the early diagnosis and prevention of an oral cancer campaign targeting the population aged 60 years or older developed since 2001 in the state of São Paulo. The main strategies used to develop the campaign were described based on the review of documents issued by the Health Ministry, National Cancer Institute, São Paulo State Health Department, Oncocentro Foundation of São Paulo, São Paulo City Health Department, School of Public Health at the University of São Paulo (USP), and Santa Marcelina Health Care Center. The impact of the campaign on the incidence of new cases of oral cancer in the target population was evaluated. In 2001, 90,886 elderly were examined vs. 629,613 in 2009. The following strategies were identified: training of professionals, development of printed materials to guide municipal governments in developing the campaign and using standardized codes and criteria, guidelines for data consolidation, establishment of patient referral flows, practical training with a specialist at the basic health care unit after the follow-up examination of individuals presenting changes in soft tissues, and increase in the number of oral diagnosis services. Between 2005 and 2009, there was a significant reduction in the rate of confirmed cases of oral cancer per 100,000 individuals examined, from 20.89 to 11.12 (P = 0.00003). The campaign was beneficial to the oral health of the elderly and could be extended to include other age groups and regions of the country. It may also provide a basis for the development of oral cancer prevention actions in other countries, as long as local characteristics are taken into account.

The Accuracy of Administrative Data for Identifying the Presence and Timing of Admission to Intensive Care Units in a Canadian Province

A prerequisite for using administrative data to study the care of critically ill patients in intensive care units (ICUs) is that it accurately identifies such care. Only limited data exist on this subject. To assess the accuracy of administrative data in the Canadian province of Manitoba for identifying the existence, number, and timing of admissions to adult ICUs. For the period 1999 to 2008, we compared information about ICU care from Manitoba hospital abstracts, with the criterion standard of a clinical ICU database that includes all admissions to adult ICUs in its largest city of Winnipeg. Comparisons were made before and after a national change in administrative data requirements that mandated specific data elements identifying the existence and timing of ICU care. In both time intervals, hospital abstracts were extremely accurate in identifying the presence of ICU care, with positive predictive values exceeding 98% and negative predictive values exceeding 99%. Administrative data correctly identified the number of separate ICU admissions for 93% of ICU-containing hospitalizations; inaccuracy increased with more ICU stays per hospitalization. Hospital abstracts were highly accurate for identifying the timing of ICU care, but only for hospitalizations containing a single ICU admission. Under current national-reporting requirements, hospital administrative data in Canada can be used to accurately identify and quantify ICU care. The high accuracy of Manitoba administrative data under the previous reporting standards, which lacked standardized coding elements specific to ICU care, may not be generalizable to other Canadian jurisdictions.

Surveillance system using HL7 CDA in Korea

Objective: The current process for reporting infectious disease in Korea is a complex work ow based on manual entry and veri cation of data and requires transmission of report via obsolete technologies such as FAX. As such, it incurs unnecessary time and eort that hinder real time monitoring of epidemic outbreak. Further, the lack of standardized coding of data in the report makes it di cult to manage and analyze the data from dierent sources. We propose an interoperable infectious disease reporting system based on HL7 standards that simpli es the reporting work ow and enables near real time reporting in Korea. Method: We rst analyze the current process of infectious disease reporting in Korea and identify its shortcomings in detail. Next we analyze KRFID (Korea Report Form of Infectious Disease) and related regulations to draw a data architecture design. Finally we take existing HL7 CDA implementation guides such as PHIN and Healthcare Associated Infection (HAI) Reports Template and conduct a comparative analysis to derive our design of CDA. Result: The nal design of CDA consists of Patient and Infection sections. The Patient section includes 4 entries and the Patient section has 6 entries. KRFID is composed of 24 data items, of which 14 are included in the CDA header and the other in the body. The value of each entry is encoded using either SNOMED-CT or LOINC. Conclusion: The system we developed enables fast reporting by eliminating unnecessary workload and delays. In the reporting process, the steps for manual entry, printing a form, and sending it via FAX at healthcare providers can be omitted and the procedure in which employees at Regional Health Centers manually enter data through KCDC web portal can also be removed. The system also oers interoperability by using international standards. Speci cally, we adopted HL7 CDA for the report form and LOINC and SNOMED-CT for encoding data. Finally, due to the regulatory requirement that all infectious disease reports should be documented and archived, the adoption of CDA as the electronic format of KRFID satis es the regulation as well as the need for real time monitoring of infectious diseases in Korea.

Toward automating a human behavioral coding system for married couples’ interactions using speech acoustic features

Observational methods are fundamental to the study of human behavior in the behavioral sciences. For example, in the context of research on intimate relationships, psychologists’ hypotheses are often empirically tested by video recording interactions of couples and manually coding relevant behaviors using standardized coding systems. This coding process can be time-consuming, and the resulting coded data may have a high degree of variability because of a number of factors (e.g., inter-evaluator differences). These challenges provide an opportunity to employ engineering methods to aid in automatically coding human behavioral data. In this work, we analyzed a large corpus of married couples’ problem-solving interactions. Each spouse was manually coded with multiple session-level behavioral observations (e.g., level of blame toward other spouse), and we used acoustic speech features to automatically classify extreme instances for six selected codes (e.g., “low” vs. “high” blame). Specifically, we extracted prosodic, spectral, and voice quality features to capture global acoustic properties for each spouse and trained gender-specific and gender-independent classifiers. The best overall automatic system correctly classified 74.1% of the instances, an improvement of 3.95% absolute (5.63% relative) over our previously reported best results. We compare performance for the various factors: across codes, gender, classifier type, and feature type.

OT1-02-11: MotHER: A Registry Developed for Women with Breast Cancer Who Have Received Trastuzumab within 6 Months Prior to Conception or during Pregnancy.

Abstract Background: Trastuzumab is a humanized monoclonal antibody that targets HER2, a protein that is overexpressed in approximately 20% of patients with breast cancer (BC). Trastuzumab is approved for the treatment of HER2−positive BC in both the metastatic and adjuvant settings, and is classified as US Food and Drug Administration (FDA) Pregnancy Category D, which indicates evidence of fetal harm, but benefit may outweigh risk. In the postmarketing setting, oligohydramnios has been reported in patients who received trastuzumab during pregnancy either alone, or in combination with chemotherapy. As a result, this registry was requested by the FDA and was established as part of a post-marketing commitment. Study Design: MotHER uses a prospective, observational cohort design to evaluate the outcomes of pregnancies in women exposed to trastuzumab within 6 months prior to conception or during pregnancy. Women are followed until pregnancy outcome is known; infants are followed through the first year of life. Medical information is primarily collected from the patient's healthcare providers (HCPs) (ob/gyn, oncologist, pediatrician). Using a standardized recording and coding system, information collected on potential defects noted at birth or during the pediatric follow-up period is evaluated and classified by a birth defect evaluator/clinical geneticist. Eligibility Criteria: Enrollment is voluntary and must be initiated by the patient before the pregnancy outcome. Enrollment may be suggested by an HCP. A verbal informed consent process is used. Patients with known prenatal testing results may enroll; however, to reduce the potential for bias, patients with knowledge of prenatal testing results (either normal or abnormal) will be analyzed as a separate subset. Aims: The aim of this study is to evaluate the effects of trastuzumab therapy on pregnancy outcome in women who were administered trastuzumab while pregnant. The MotHER registry is the first prospective cohort study to be established for investigating the effects of a targeted cancer therapy on pregnancy outcome. The greatest challenge for this registry is to enroll a sufficient number of patients from the relatively small population of trastuzumab-exposed women who become pregnant. Analysis Methods: Primary outcome measures are the occurrences of oligohydramnios, live births, fetal deaths/stillbirths (≥20 weeks gestation), and fetal/infant major malformations, deformations, disruptions or functional deficits. Secondary outcomes include pre-term births, elective terminations, miscarriages, fetal growth abnormalities, and pregnancy or delivery complications. The sample size has not been pre-specified. The study is descriptive: event proportions and associated confidence intervals will be calculated; statistical testing is inappropriate. Accrual: This registry was activated in December 2008 and will accrue in the US over a 10-year period. As of June 20, 2011, 5 patients had been enrolled. Contact Information: Patient and HCP awareness of the registry and willingness to participate are crucial to its ultimate success. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-02-11.

The Strange Animal Situation Test

ABSTRACTMany tools assess the reactions of humans encountering familiar or unfamiliar partners or environments. Companion animals belong to our everyday environment and influence our lives. Whereas many standardized tools test companion animals' reactions to humans, few evaluate humans' reactions to companion animals. We present here a test with a guinea pig that can be applied to a wide range of people in the home environment. This standardized test and simple coding system enabled us to characterize individual behavioral profiles of children and compare them in relation to different factors (e.g., gender, age, pet ownership). We observed 59 children (32 girls, 27 boys), aged between 6 and 12 years old. Our results show that most children first looked at the guinea pig (72%), smiled when they saw it (49%), and then went directly towards it without looking at their parent (79%). Many children touched the animal without hesitation (86%). Moreover, this test reveals more than the mere interest of children in guinea pigs. Indeed, a cluster analysis differentiated four behavioral profiles that reflected aspects of the children's experience, gender, and lifestyles. When encountering the unfamiliar guinea pig, children could be “confident” (go straight to the animal and touch it; 64%), “anxious” (look at parent; 12%), “indirect” (hesitate and touch; 14%), or “careful” (emit vocal and/or verbal behaviors; 10%). The potential future application of this research is to compare behavioral profiles quantitatively over the long term, taking into account the development and experiences of people with typical development and those with atypical development (e.g., autistic disorders).

Developing a community-based genetic nomenclature for anole lizards.

BackgroundComparative studies of amniotes have been hindered by a dearth of reptilian molecular sequences. With the genomic assembly of the green anole, Anolis carolinensis available, non-avian reptilian genes can now be compared to mammalian, avian, and amphibian homologs. Furthermore, with more than 350 extant species in the genus Anolis, anoles are an unparalleled example of tetrapod genetic diversity and divergence. As an important ecological, genetic and now genomic reference, it is imperative to develop a standardized Anolis gene nomenclature alongside associated vocabularies and other useful metrics.ResultsHere we report the formation of the Anolis Gene Nomenclature Committee (AGNC) and propose a standardized evolutionary characterization code that will help researchers to define gene orthology and paralogy with tetrapod homologs, provide a system for naming novel genes in Anolis and other reptiles, furnish abbreviations to facilitate comparative studies among the Anolis species and related iguanid squamates, and classify the geographical origins of Anolis subpopulations.ConclusionsThis report has been generated in close consultation with members of the Anolis and genomic research communities, and using public database resources including NCBI and Ensembl. Updates will continue to be regularly posted to new research community websites such as lizardbase. We anticipate that this standardized gene nomenclature will facilitate the accessibility of reptilian sequences for comparative studies among tetrapods and will further serve as a template for other communities in their sequencing and annotation initiatives.

Challenges and Benefits of Adding Laboratory Data to a Mortality Risk Adjustment Method

There is increased interest in improving the clinical acceptance and statistical performance of hospital mortality rate comparisons. This study assessed the feasibility of linking separate electronic feeds of laboratory data and claims-based information and, if successful, to identify laboratory data elements that significantly improved mortality rate predictions for All-Patient Refined Diagnosis Related Groups (APRDRGs), a risk of mortality (ROM) classification tool in regular use for public reporting purposes. The Florida Agency for Health Care Administration recruited 15 hospitals to supply computerized administrative and laboratory information that could be linked at the patient level. The hospitals, standardized computer code terminology, which was then merged with administrative data. We evaluated the ability of the merged data to improve APRDRG ROM predictions. We describe the procedures that the laboratory information systems used to link the electronic laboratory data with standard claims data. The addition of 11 clinical laboratory test results increased the C statistic by 0.574% and R2 by 4.53%. This study supports the feasibility of linking laboratory data elements with claims-based administrative data to enhance ROM assessments. This linkage resulted in modest statistical improvement in a commonly used ROM model.

Failure Analysis of an Effluent Treatment Plant in an Oral Care Industry

Reports of environmental pollution by industries worldwide call for an urgent need to assess wastewater treatment facilities in various industries. This study presents an assessment of a wastewater treatment plant in an oral care (toothpaste) industry. The industry was visited, facilities for wastewater treatment were assessed (based only on efficacy to remove selected environmental and human’s health-related pollutants) and measurement of essential design parameters and facility characteristics were conducted. The study revealed that the averages of flow rate, biochemical oxygen demand at 5 days (BOD5), chemical oxygen demand (COD), suspended solids (SS), iron concentration, and total solids (TS) in the influent wastewater into the plant were 4.96 ± 0.6 m3/d; 90 ± 5 mg/L; 224 ± 8 mg/L; 1266.78 ± 10.24 mg/L; 0.31 ± 0.11 mg/L, and 2198.65 ± 20.44 mg/L, respectively. Individual efficacies were as follows: 0.49, 0.28, and 0.38% for SS, TS, and calcium, respectively. The overall efficacy of the wastewater treatment facility was found to be 0.020% which was significantly lower than expected. This indicates that no treatment was conducted on the wastewater and that the wastewater is being discharged into the environment essentially untreated. Equalization time (t eq) was found to be 2.0 h with equivalent equalized BOD5 concentration of 90 ± 5 mg/L, while expected volume for the equalization tank is 1.5 m3. It was concluded that failure (lower overall efficacy) of the system can be attributed to lack of an equalization tank, inadequate treatment processes, and refusal to apply standardized engineering code and practices. Although such conditions are rare in developed nations, these results demonstrate the problems in pollution control in developing communities.

Establishing a Baseline Measure of School Wellness-Related Policies Implemented in a Nationally Representative Sample of School Districts

The Child Nutrition and WIC Reauthorization Act of 2004 required school districts to establish a local school wellness policy by the first day of the 2006-2007 school year. To provide a baseline measure of the extent to which wellness-related policies were implemented in school districts nationwide in 2006, this study analyzed data from the 2006 School Health Policies and Programs Study (SHPPS). SHPPS used a cross-sectional design to measure policies and practices among a nationally representative sample of 538 public school districts. The authors applied a standardized wellness policy coding system to the data by matching each element to relevant questions from SHPPS and calculated the percentage of school districts meeting each element in the coding system. Statistical analyses included calculation of 95% confidence intervals for percentages and mean number of elements met in each area. In 2006, none of the districts met all elements included in the coding system for local wellness policies. In addition, the percentage of districts meeting each element varied widely. On average, districts met the greatest number of elements in the area of nutrition education and the least number of elements in the area of physical activity. By applying a coding system for district policies to an existing dataset, this study used a novel approach to determine areas of strength and weakness in the implementation of local school wellness-related policies in 2006.

P01-331-Family functioning of adolescents with a major depressive disorder – a comparative study

IntroductionPsychiatric disorders occur in a complex context of human relations in its social and psychological aspects. Family functioning is closely related to physical and psychological well-being of family members and its impairment affects the family as a whole.ObjectivesTo evaluate family functioning in two groups of adolescents (13–18 years): cases (with major depressive disorder) and controls (with no DSM-IV psychiatric disorders based on the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime/K-SADS-PL).MethodFamilies of cases (N = 9) and controls (N = 9) were matched by adolescent's age, gender and education, number and age of siblings, parental marital status and occupational activity, and family income. An experienced systemic family therapist applied the Structured Family Interview to each family. Nine dimensions of family functioning were evaluated: communication, rules, roles, leadership, conflict, aggressiveness, affect, individuation and integration. Session transcripts were independently evaluated by two other systemic family therapists blind to the family case-control category.ResultsRaters scored all interview items using a standardized coding system (overall agreement = 83.5%). Cases exhibited lower mean scores in seven family dimensions, specially affect (p = 0.0078). Differences were not found regarding rules and leadership.ConclusionDifficulty in expressing affect in parent-child relationships was the main characteristic of families with a depressive adolescent. Improvement of family functioning can contribute to minimize the negative influence of psychosocial and family factors on the reoccurrence, and severity of depressive episodes among depressed adolescents.

Failure Analysis of a Dissolved Air Flotation Treatment Plant in a Dairy Industry

Environmental pollution in Nigeria presents an urgent need to assess wastewater treatment facilities in various industries. This article presents an assessment of dissolved air flotation (DAF) operation in a dairy industry. The industry was visited, wastewater treatment facilities were assessed (based only on efficacy to remove selected environmental health-related pollutants) and measurements of essential design and characterization parameters were taken. The study revealed that the averages of flow rate, biochemical oxygen demand at 5 days (BOD5), chemical oxygen demand (COD), suspended solids (SS) and total solids (TS) of the influent wastewater into the plant (DAF) were 3.45 L/s, 1652.37, 3304.67, 2333.82, and 4396.10 mg/L compared to effluent quality of 560.37, 1127.33, 172.33, and 1866.67 mg/L for BOD5, COD, SS, and TS, respectively. The pH of the wastewater is being adjusted by addition of lime before the effluent equalization tank and individual efficacies of the system were 66.09, 65.89, 65.89, 57.54, 8.68, and 94.49% for BOD5, COD, SS, TS, DS, and total nitrogen, respectively, with overall efficacy of 38.10%. It was concluded that failure (lower overall efficacy) of the system can be attributed to setting of lime in the oversized equalization tank (50 m3 instead of 16.82 m3 per 8 h shift), the lack of application of standardized engineering code and practices (provision of underground tank in the process, lack of complete coagulation processes, coagulation and flocculation units), lack of adequate aeration unit and lack of reliable systems for automatically adjusting dosage of coagulant and flocculant. Although, DAF unit is the centerpiece of a DAF-based system design, there are several other supporting systems important to optimal DAF operation. These observations, coupled with the analysis in this report, demonstrate that the facilities necessary to minimize continuous environmental pollution are lacking. Pollution will become an increasing problem unless pollution preventing codes and standards are developed; incorporated into government regulations and the regulations are enforced.

ASTRA-Matlab Integration for the Control of Tokamaks

The current increment in energy consumption has renewed the interest in the development of alternatives to fossil fuels. In this regard, the interest in solving the different control problems existing in nuclear fusion reactors like Tokamaks has been intensified. The aim of this manuscript is to show how the ASTRA code, which is used to simulate the performance of Tokamaks, can be integrated into the Matlab-Simulink tool in order to make easier the development of suitable controllers for Tokamaks. As a demonstrative case study to show the feasibility and the goodness of the proposed integration, a modified anti-windup PID-based controller coupled with an optimization algorithm for the loop voltage has been implemented. This integration represents an original and innovative work in the Tokamak control area and it provides new possibilities for the development and application of advanced control schemes to the standardized ASTRA code.

Standardization In The Home Building Industry: An Empirical Investigation Into The Compatibility Between Accounting And Estimating Cost Codes

<p class="MsoNormal" style="text-align: justify; text-indent: 0in; margin: 0in 0.5in 0pt; mso-pagination: none;"><span style="font-family: Times New Roman;"><em style="mso-bidi-font-style: normal;"><span style="color: black; font-size: 10pt; mso-themecolor: text1;">The purpose of this study was to investigate the utilization of standardized cost codes for the estimating and accounting functions related to the scale of operations by Pennsylvania’s home building contractors.<span style="mso-spacerun: yes;">  </span>Firm size was examined as to its impact on three issues in construction standardization practice:<span style="mso-spacerun: yes;">  </span>1) the use of a standardized number system for estimating, 2) the use of a standardized number system for accounting, and 3) the use of the same standardized number system for both estimating and accounting.<span style="mso-spacerun: yes;">  </span>Significant differences existed among firm sizes regarding all three items relating to standardized cost codes - a standardized numbering system used for estimating, a standardized numbering system used for accounting, and the same standardized numbering system used for both estimating and accounting functions</span></em><span style="color: black; font-size: 10pt; mso-themecolor: text1;">.<span style="mso-spacerun: yes;">  </span><em style="mso-bidi-font-style: normal;">Overall, however, a large percentage of Pennsylvania home building firms are behind the curve with regard to their knowledge and utilization of standardized cost codes.</em></span></span></p>

Evidence-Based Maintenance

In Brief Almost since the beginning of clinical engineering as a profession, the need for scheduled maintenance (mostly safety and performance inspections) and its appropriate frequency have been debated extensively but could not be resolved conclusively because of the lack of comparable data. The combination of regulatory requirements typically based on manufacturers' recommendations and concern for patient safety discouraged experimentation by clinical engineering professionals and thus limited the possibility of comparisons within the same organization. Lateral comparisons among different hospitals have been difficult because of different computerized maintenance management systems, failure classification, and reluctance to share information. Using a small set of standardized failure codes, more than 62,000 work orders were classified by dozens of biomedical technicians at 8 hospitals for almost 2 years. These data were used to compare different maintenance strategies adopted for 7 types of medical equipment commonly encountered in acute-care hospitals. No prominent differences were found among the data collected from hospitals that adopted different maintenance frequencies, statistical sampling, and even run-to-failure strategies. Most of the small differences were comparable to the SDs calculated from the data for each maintenance strategy. These results suggest that it is justifiable to adopt a less resource-demanding maintenance strategy for most equipment types, except for the scheduled replacement of wearable parts that was outside the scope of this study. Almost since the beginning of clinical engineering as a profession, the need for scheduled maintenance (mostly safety and performance inspections) and its appropriate frequency have been debated extensively but could not be resolved conclusively because of the lack of comparable data. The combination of regulatory requirements typically based on manufacturers' recommendations and concern for patient safety discouraged experimentation by clinical engineering professionals and thus limited the possibility of comparisons within the same organization. Lateral comparisons among different hospitals have been difficult because of different computerized maintenance management systems, failure classification, and reluctance to share information. Using a small set of standardized failure codes, more than 62,000 work orders were classified by dozens of biomedical technicians at 8 hospitals for almost 2 years. These data were used to compare different maintenance strategies adopted for 7 types of medical equipment commonly encountered in acute-care hospitals. No prominent differences were found among the data collected from hospitals that adopted different maintenance frequencies, statistical sampling, and even run-to-failure strategies. Most of the small differences were comparable to the SDs calculated from the data for each maintenance strategy. These results suggest that it is justifiable to adopt a less resource-demanding maintenance strategy for most equipment types, except for the scheduled replacement of wearable parts that was outside the scope if this study.

Energy Benefits of Electronic Controls at Small and Medium Sized U.S. Manufacturers

Energy Benefits of Electronic Controls at Small and Medium Sized U.S. Manufacturers

Resort to war: a data guide to inter-state, extra-state, intra-state, and non-state wars, 1816-2007

This is the benchmark reference for understanding the phenomenon of war. What do we know about war? This much-anticipated reference book analyzes more than a thousand wars waged from 1816 to 2008 using authoritative, highly standardized, and systematic coding methods from the Correlates of Project, which aims to reveal the underlying patterns and causes of war. Resort to War lists and categorizes all violent conflicts with 1,000 or more battle deaths and provides an insightful narrative for each struggle. This volume distinguishes between traditional interstate war, the phenomenon of extra-state war as evidenced by the Al-Qaeda - USA conflagration, intra-state war, and the new category of nonstate ethnic wars. After explaining how to determine what a 'state' is and how to classify different types of wars, the authors describe each encounter and highlight major patterns across eras and regions, identifying which categories of war are becoming more or less prevalent over time, and revealing connections between the different types of war. Resort to War, the second title in The Correlates of Series, is a definitive source for students and researchers examining patterns of international conflict; it is the essential guide to the data, trends, and context of these violent encounters. It features a unique study of the patterns of war. It highlights different patterns of interstate, intra-state, and extra-state conflicts. It includes an authoritative data, newly discovered trends, and insightful narrative.

Prospects and challenges in R package development

R, a software package for statistical computing and graphics, has evolved into the lingua franca of (computational) statistics. One of the cornerstones of R’s success is the decentralized and modularized way of creating software using a multi-tiered development model: The R Development Core Team provides the “base system”, which delivers basic statistical functionality, and many other developers contribute code in the form of extensions in a standardized format via so-called packages. In order to be accessible by a broader audience, packages are made available via standardized source code repositories. To support such a loosely coupled development model, repositories should be able to verify that the provided packages meet certain formal quality criteria and “work”: both relative to the development of the base R system as well as with other packages (interoperability). However, established quality assurance systems and collaborative infrastructures typically face several challenges, some of which we will discuss in this paper.

Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations.

Shared Decision Making (SDM) is widely accepted as the preferred method for reaching treatment decisions in the oncology setting including those about clinical trial participation: however, there is some disagreement between researchers over the components of SDM. Specific standardized coding systems are needed to help overcome this difficulty. The first objective was to describe the development of an oncology specific SDM coding system, the DAS-O. The second objective was to provide reliability and validity data supporting the DAS-O. Consultation data were available from tertiary cancer center out patient oncology clinics in: Australia, New Zealand (ANZ), Switzerland, Germany and Austria (SGA). Patients were women with a confirmed diagnosis of early stage breast cancer. Reliability data were from 18 randomly selected coded transcripts drawn from ANZ and SGA. Concurrent validity data are from 55 (ANZ) consultations. Inter and Intra rater reliability data was evaluated using Kappa correlation statistics and correlation coefficients. Correlation coefficients were used to assess concurrent validity between the DAS-O and two other SDM coding systems, OPTION and DSAT. Inter and Intra rater reliability for the system were high with average Kappas of 0.58 and 0.65 respectively. Correlation coefficients between DAS-O and OPTION was 0.73 and >0.5 for DSAT. We have developed a reliable and valid coding system for identifying and rating the quality of SDM in breast cancer consultations.

Iterative Multisymbol Noncoherent Reception of Coded CPFSK

A system involving the multisymbol noncoherent reception of coded continuous-phase frequency-shift keying is developed, optimized, and analyzed. Unlike coherent systems, the modulation index of the waveform does not need to be rational with a small denominator, and the oscillator only needs to be stable for the duration of a small block of symbols. The achievable performance over AWGN and Rayleigh block-fading channels is determined by computing the average mutual information, which is the capacity of a channel using the given modulation format and receiver architecture under the constraint of uniformly distributed input symbols. The code rate and modulation index are jointly optimized with respect to average mutual information under a bandwidth constraint. For binary and quaternary signaling, the information-theoretic results are corroborated by bit-error-rate curves generated using a standardized turbo code in conjunction with iterative demodulation and decoding. It is shown that, while more robust than a system with coherent reception, the proposed system offers superior energy efficiency compared with conventional single-symbol noncoherent reception.