Physical Sciences and Mathematics Commons^™

Adjusting Medicare Capitation Payments Using Prior Hospitalization Data, Arlene Ash, Frank Porell, Leonard Gruenberg, Eric Sawitz, Alexa Beiser

Frank Porell

The diagnostic cost group approach to a reimbursement model for health maintenance organizations is presented. Diagnostic information about previous hospitalizations is used to create empirically determined risk groups, using only diagnoses involving little or no discretion in the decision to hospitalize. Diagnostic cost group and other models (including Medicare's current formula and other prior-use models) are tested for their ability to predict future costs, using R2 values and new measures of predictive performance. The diagnostic cost group models perform relatively well with respect to a range of criteria, including administrative feasibility, resistance to provider manipulation, and statistical accuracy.

Testing For Improvement In Prediction Model Performance, Margaret S. Pepe Phd, Kathleen F. Kerr Phd, Gary Longton, Zheyu Wang Phd

Margaret S Pepe PhD

New methodology has been proposed in recent years for evaluating the improvement in prediction performance gained by adding a new predictor, Y, to a risk model containing a set of baseline predictors, X, for a binary outcome D. We prove theoretically that null hypotheses concerning no improvement in performance are equivalent to the simple null hypothesis that the coefficient for Y is zero in the risk model, P(D=1|X,Y). Therefore, testing for improvement in prediction performance is redundant if Y has already been shown to be a risk factor. We investigate properties of tests through simulation studies, focusing on the change …

Introducing Functional Data Analysis To Neuroimaging, And Vice Versa, Philip T. Reiss

Philip T. Reiss

No abstract provided.

Diabetes Prediction In Pima Indians Using Ann And Statistical Techniques, Kuldeep Kumar, Ping Zhang

Kuldeep Kumar

Due to the fact that Pima Indian tribe has lived in the same location for an unmitigated number of years, a vast source of information of these people has been gained, which helps researchers for the study of diabetes and possible genetic factors of the disease. In this paper, we use Artificial Neural Network (ANN) and some statistical techniques for the prediction of diabetes. All the prediction models are evaluated with ROC curves.

When Is Informed Consent Required In Cluster Randomized Trials In Health Research?, Andrew Mcrae, Charles Weijer, Ariella Binik, Jeremy Grimshaw, Robert Boruch, Jamie Brehaut, Allan Donner, Martin P Eccles, Raphael Saginur, Angela White, Monica Taljaard

Charles Weijer

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the second of the questions posed, namely, from whom, when, and how must informed consent be obtained in CRTs in health research? The ethical principle of respect for persons implies that researchers are generally obligated to obtain the informed consent of research subjects. Aspects of CRT …

Advancing Stage Of Female Reproductive Life Associated With Bipolar Illness Exacerbation, Wendy K. Marsh, Terence Ketter, Sybil L. Crawford, Julia V. Johnson, Anthony J. Rothschild

Sybil L. Crawford

Introduction: Perimenopause confers an increased risk of depression in the general population, yet bipolar disorder mood course remains unknown. Methods: Clinic visits in 519 premenopausal, 116 perimenopausal including 13 women transitioning from peri- to postmenopause, and 133 postmenopausal women with bipolar disorder who received naturalistic treatment in the multisite STEP-Bipolar Disorder study over 19.8 +/- 15.5 months were analyzed for mood state. Results: Advancing female reproductive stage was associated with significant decline in mood elevation; significant decline in euthymia; no significant difference in major depression; and symptomatic significant increase. Conclusions: Advancing stage of female reproductive life was associated with bipolar …

The Effects Of 24 Weeks Of Resistance Training With Simultaneous Elastic And Free Weight Loading On Muscular Performance Of Novice Lifters, Todd C. Shoepe, David A. Ramirez, Robert J. Rovetti, David R. Kohler, Hawley C. Almstedt

Hawley Almstedt

The purpose of this investigation was to assess the effectiveness of variable resistance as provided through elastic plus free weight techniques in college aged males and females. Twenty novice lifters were randomly assigned to a traditional free weight only (6 males and 5 females) or elastic band plus free weight group (5 males and 5 females) and 9 more normally active controls (5 males and 4 females), were recruited to maintain normal activity for the duration of the study. No differences existed between control, free weight and elastic band at baseline for age, body height, body mass, body mass index, …

The Effects Of 24 Weeks Of Resistance Training With Simultaneous Elastic And Free Weight Loading On Muscular Performance Of Novice Lifters, Todd C. Shoepe, David A. Ramirez, Robert J. Rovetti, David R. Kohler, Hawley C. Almstedt

Todd Shoepe

The purpose of this investigation was to assess the effectiveness of variable resistance as provided through elastic plus free weight techniques in college aged males and females. Twenty novice lifters were randomly assigned to a traditional free weight only (6 males and 5 females) or elastic band plus free weight group (5 males and 5 females) and 9 more normally active controls (5 males and 4 females), were recruited to maintain normal activity for the duration of the study. No differences existed between control, free weight and elastic band at baseline for age, body height, body mass, body mass index, …

Who Is The Research Subject In Cluster Randomized Trials In Health Research?, Andrew Mcrae, Charles Weijer, Ariella Binik, Angela White, Jeremy Grimshaw, Robert Boruch, Jamie Brehaut, Allan Donner, Martin Eccles, Raphael Saginur, Merrick Zwarenstein, Monica Taljaard

Charles Weijer

This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs) in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the first of the questions posed, namely, who is the research subject in a CRT in health research? The identification of human research subjects is logically prior to the application of protections as set out in research ethics and regulation. Aspects of CRT design, including the fact …

Asymptotic Theory For Cross-Validated Targeted Maximum Likelihood Estimation, Wenjing Zheng, Mark J. Van Der Laan

Wenjing Zheng

We consider a targeted maximum likelihood estimator of a path-wise differentiable parameter of the data generating distribution in a semi-parametric model based on observing n independent and identically distributed observations. The targeted maximum likelihood estimator (TMLE) uses V-fold sample splitting for the initial estimator in order to make the TMLE maximally robust in its bias reduction step. We prove a general theorem that states asymptotic efficiency (and thereby regularity) of the targeted maximum likelihood estimator when the initial estimator is consistent and a second order term converges to zero in probability at a rate faster than the square root of …

Massively Parallel Nonparametrics [Hds 2011 Slides], Philip T. Reiss, Lei Huang

Philip T. Reiss

No abstract provided.

Flexible Dependence Of Functional Responses On Scalar Predictors, Philip T. Reiss, Lei Huang

Philip T. Reiss

No abstract provided.

30-Year Trends In Heart Failure In Patients Hospitalized With Acute Myocardial Infarction, David Mcmanus, Marcello Chinali, Jane Saczynski, Joel Gore, Jorge Yarzebski, Frederick Spencer, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

Despite significant advances in its treatment, acute myocardial infarction (AMI) remains an important cause of heart failure (HF). Contemporary data remain lacking, however, describing long-term trends in incidence rates, demographic and clinical profiles, and outcomes of patients who develop HF as a complication of AMI. Our study sample consisted of 11,061 residents of the Worcester (Massachusetts) metropolitan area hospitalized with AMI at all greater Worcester hospitals in 15 annual study periods from 1975 to 2005. Overall, 32.4% of patients (n = 3,582) with AMI developed new-onset HF during their acute hospitalization. Patients who developed HF were generally older, more likely …

Recent Trends In The Incidence, Treatment, And Outcomes Of Patients With Stemi And Nstemi, David Mcmanus, Joel Gore, Jorge Yarzebski, Frederick Spencer, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: despite the widespread use of electrocardiographic changes to characterize patients presenting with acute myocardial infarction, little is known about recent trends in the incidence rates, treatment, and outcomes of patients admitted for acute myocardial infarction further classified according to the presence of ST-segment elevation. The objectives of this population-based study were to examine recent trends in the incidence and death rates associated with the 2 major types of acute myocardial infarction in residents of a large central Massachusetts metropolitan area. METHODS: We reviewed the medical records of 5383 residents of the Worcester (MA) metropolitan area hospitalized for either ST-segment …

Declining Length Of Stay For Patients Hospitalized With Ami: Impact On Mortality And Readmissions, Jane Saczynski, Darleen Lessard, Frederick Spencer, Jerry Gurwitz, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Length of hospital stay after acute myocardial infarction decreased significantly in the 1980s and 1990s. Whether length of stay has continued to decrease during the 2000s, and the impact of decreasing length of stay on rehospitalization and mortality, is unclear. We describe decade-long (1995-2005) trends in length of stay after acute myocardial infarction, and examine whether declining length of stay has impacted early rehospitalization and postdischarge mortality in a population-based sample of hospitalized patients.

METHODS: The study sample consisted of 4184 patients hospitalized with acute myocardial infarction in a central New England metropolitan area during 6 annual periods (1995, …

Management And Outcomes Of Renal Disease And Acute Myocardial Infarction, Paul Santolucito, Dennis Tighe, David Mcmanus, Jorge Yarzebski, Darleen Lessard, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Contemporary trends in the management and outcomes of chronic kidney disease patients who develop an acute myocardial infarction have not been adequately described, particularly from the more generalizable perspective of a population-based investigation. METHODS: The study population consisted of 6219 residents of the Worcester, Massachusetts, metropolitan area who were hospitalized with acute myocardial infarction in 6 annual periods between 1995 and 2005. Patients were categorized as having preserved kidney function (n=3154), mild to moderate chronic kidney disease (n=2313), or severe chronic kidney disease (n=752) at the time of hospital admission. RESULTS: Patients with chronic kidney disease were more likely …

Clustering With Exclusion Zones: Genomic Applications, Mark Segal, Yuanyuan Xiao, Fred Huffer

Mark R Segal

Methods for formally evaluating the clustering of events in space or time, notably the scan statistic, have been richly developed and widely applied. In order to utilize the scan statistic and related approaches, it is necessary to know the extent of the spatial or temporal domains wherein the events arise. Implicit in their usage is that these domains have no “holes”—hereafter “exclusion zones”—regions in which events a priori cannot occur. However, in many contexts, this requirement is not met. When the exclusion zones are known, it is straightforward to correct the scan statistic for their occurrence by simply adjusting the …

Cross-Validated Targeted Minimum-Loss-Based Estimation, Wenjing Zheng, Mark Van Der Laan

Wenjing Zheng

No abstract provided.

Extracting Information From Functional Connectivity Maps Via Function-On-Scalar Regression, Philip T. Reiss, Maarten Mennes, Eva Petkova, Lei Huang, Matthew J. Hoptman, Bharat B. Biswal, Stanley J. Colcombe, Xi-Nian Zuo, Michael P. Milham

Lei Huang

Functional connectivity of an individual human brain is often studied by acquiring a resting state functional magnetic resonance imaging scan, and mapping the correlation of each voxel's BOLD time series with that of a seed region. As large collections of such maps become available, including multisite data sets, there is an increasing need for ways to distill the information in these maps in a readily visualized form. Here we propose a two-step analytic strategy. First, we construct connectivity-distance profiles, which summarize the connectivity of each voxel in the brain as a function of distance from the seed, a functional relationship …

A Practical Ad-Hoc Adjustment To The Simes P-Value, Chris Lloyd

Chris J. Lloyd

The Simes P-value is more powerful than Bonferroni but still suffers from some conservatism when the tests are correlated. Based on a massive simulation study, I develop a formula that corrects for this conservatism. it requires the number of experimental arms which is known. It also requires the correlation and skewness of the underlying test statistics, which will need analytic approximation in practice.

National Estimates Of The Prevalence Of Alzheimer's Disease In The United States, Ron Brookmeyer, Denis Evans, Liesi Hebert, Langa Kenneth, Heeringa Steven, Plassman Brenda, Kukull Kenneth

Ron Brookmeyer

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer’s disease and dementia. …

Statistical Considerations In Determining Hiv Incidence From Changes In Hiv Prevalence, Ron Brookmeyer, Jacob Konikoff

Ron Brookmeyer

The development of methods for estimating HIV incidence is critical for tracking the epidemic and for designing, targeting and evaluating HIV prevention efforts. One method for estimating incidence is based on changes in HIV prevalence. That method is attracting increased attention because national population-based HIV prevalence surveys, such as Demographic and Health Surveys, are being conducted throughout the world. Here, we consider some statistical issues associated with estimating HIV incidence from two population-based HIV prevalence surveys conducted at two different points in time. We show that the incidence estimator depends on the relative survival rate. We evaluate the sensitivity of …

An Introduction To Propensity-Score Methods For Reducing Confounding In Observational Studies, Peter C. Austin

Peter Austin

The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (non-randomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. We describe four different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the …

Extracting Information From Functional Connectivity Maps Via Function-On-Scalar Regression, Philip T. Reiss, Maarten Mennes, Eva Petkova, Lei Huang, Matthew J. Hoptman, Bharat B. Biswal, Stanley J. Colcombe, Xi-Nian Zuo, Michael P. Milham

Philip T. Reiss

Functional connectivity of an individual human brain is often studied by acquiring a resting state functional magnetic resonance imaging scan, and mapping the correlation of each voxel's BOLD time series with that of a seed region. As large collections of such maps become available, including multisite data sets, there is an increasing need for ways to distill the information in these maps in a readily visualized form. Here we propose a two-step analytic strategy. First, we construct connectivity-distance profiles, which summarize the connectivity of each voxel in the brain as a function of distance from the seed, a functional relationship …