Annual league tables of mortality in neonatal intensive care units: longitudinal study

Objective: To assess whether crude league tables of mortality and league tables of risk adjusted mortality accurately reflect the performance of hospitals. Design: Longitudinal study of mortality occurring in hospital. Setting: 9 neonatal intensive care units in the United Kingdom. Subjects: 2671 very low birth weight or preterm infants admitted to neonatal intensive care units between 1988 and 1994. Main outcome measures: Crude hospital mortality and hospital mortality adjusted using the clinical risk index for babies (CRIB) score. Results: Hospitals had wide and overlapping confidence intervals when ranked by mortality in annual league tables; this made it impossible to discriminate between hospitals reliably. In most years there was no significant difference between hospitals, only random variation. The apparent performance of individual hospitals fluctuated substantially from year to year. Conclusions: Annual league tables are not reliable indicators of performance or best practice; they do not reflect consistent differences between hospitals. Any action prompted by the annual league tables would have been equally likely to have been beneficial, detrimental, or irrelevant. Mortality should be compared between groups of hospitals using specific criteria—such as differences in the volume of patients, staffing policy, training of staff, or aspects of clinical practice—after adjusting for risk. This will produce more reliable estimates with narrower confidence intervals, and more reliable and rapid conclusions.

Key messages

• League tables are being used increasingly to evaluate hospital performance in the United Kingdom
• In annual league tables the rankings of nine neonatal intensive care units in different hospitals had wide and overlapping confidence intervals and their rankings fluctuated substantially over six years
• Annual league tables of hospital mortality were inherently unreliable for comparing hospital performance or for indicating best practices
• The UK government’s commitment to using annual league tables of outcomes such as mortality to monitor services and the spread of best practices should be reconsidered
• Prospective studies of risk adjusted outcome in hospitals grouped according to specific characteristics would provide better information and be a better use of resources

     

An In Vivo Study of Self-Regulated Study Sequencing in Introductory Psychology Courses

Study sequence can have a profound influence on learning. In this study we investigated how students decide to sequence their study in a naturalistic context and whether their choices result in improved learning. In the study reported here, 2061 undergraduate students enrolled in an Introductory Psychology course completed an online homework tutorial on measures of central tendency, a topic relevant to an exam that counted towards their grades. One group of students was enabled to choose their own study sequence during the tutorial (Self-Regulated group), while the other group of students studied the same materials in sequences chosen by other students (Yoked group). Students who chose their sequence of study showed a clear tendency to block their study by concept, and this tendency was positively associated with subsequent exam performance. In the Yoked group, study sequence had no effect on exam performance. These results suggest that despite findings that blocked study is maladaptive when assigned by an experimenter, it may actually be adaptive when chosen by the learner in a naturalistic context.     

Does Poor Quality Schooling and/or Teacher Quality Hurt Black South African Students Enrolling for a Degree at the University of KwaZulu-Natal?

AbstractWealthy schools appoint better qualified teachers, less wealthy schools under qualified teachers. Added to this mix is a powerful teacher’s union whose policies attempt to entrench the job security of teachers in the less wealthy schools irrespective of whether they can teach their subjects or not. Can one isolate these effects from that of other socio-demographic factors that may also be affecting the performance of students when they enrol for a degree at the University of KwaZulu-Natal (UKZN)? An outcome variable that subtracts the number of courses that have been failed from the number of courses that have been passed, dividing this by the total number of years that they have spent studying for a particular degree will be used as a response variable for this paper.ObjectivesThe system of secondary education in South Africa is highly polarized. On the one hand, we have a group of mainly Black African students, forming about 80% of the total student population, that come from a vastly under-resourced rural or township based community. On the other hand, we have a group of predominantly White and Indian students who are able to attend a far better resourced set of private schools. Added to this mix, we have 240,000 of South Africa’s total number of 390,000 primary and secondary school teachers who belong to a powerful teacher’s union which enjoys a strong political alliance with the ruling party in South Africa. With most of their union members teaching in the less wealthy schools in South Africa, `school background’ now includes a politically motivated component that focuses on teacher self–interest rather than the education of the child. What sort of effect does school background have on the performance of students when they enter an institution of higher learning? More importantly, can one isolate the effect of school background from that of other possibly confounding factors such as gender, financial aid and the receipt of some form of residence based accommodation that will also impact on their performance while at university?MethodA total of 6,183 students enrolling for a degree at the University of KwaZulu-Natal (UKZN) over the period 2008 to 2012 were used a dataset for this study. Permission to use this dataset was given by the Teaching and Learning Office at UKZN. The database that was used for this study was obtained from the Division of Management Information (DMI) office at UKZN. The percentage based marks that students have managed to record for Mathematics, English, Biology and Accounting in their school leaving exams together with some other important but observable socio-economic factors were included in a regression model to determine how students will perform at UKZN. Socio-economic variables relating to gender, race and whether they have receivd some form of financial aid or residence based accommodation while studying at university were also included as predictor variables in our regression based model structure.

Results and Conclusions

An interaction effect associated with being a Black African student who has been privileged enough to attend a quintile five school was found to be significant. A main effect associated with being able to attend a more privileged quintile 5 school however was found to be nonsignificant even after an adjustment has been made for gender, race, the receipt of some form of financial aid and residence based accommodation. Given that UKZN already has a number of bridging programs in place that target students who have come from a less privileged background, for university based policymakers, this result may help to justify the targeted selection of Black African students from the less privileged schools that is taking place. Because some of the disparity in matric performance that we are observing may also be associated with teacher competency and the protective influence of a powerful teacher’s union, this paper may also help to highlight some of the economic costs related with having under-prepared students. “A mind is a terrible thing to waste”–United Negro College Fund.     

The effect of marriage on utilization of colorectal endoscopy exam in the United States

Purpose: This study examines the association between marriage and colorectal endoscopy exam, and whether this association varies by gender and financial benefits of marriage including improved access to health insurance and pooled family income. Methods: Representative survey data of the non-institutionalized United States population were used from the 2000, 2005, and 2008 National Health Interview Survey. Analyses targeted persons 50-85 years of age without a personal history of cancer and with complete information on all study variables (n=21,760). Multivariate logistic regression was used to model marital status differences in the probability of undergoing a colorectal endoscopy exam with interaction effects used to model variation over time by gender, health insurance, and poverty level. Results: Married persons were more likely than unmarried persons to report ever having undergone a colorectal endoscopy exam (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12-1.29), and the difference between married and unmarried persons in the probability of undergoing a colorectal endoscopy exam remained stable over time. Married persons were more likely than unmarried persons to report having undergone a colorectal endoscopy exam within the past 10 years (OR, 1.49; 95% CI, 1.15-1.95). For each survey year, married men were significantly more likely than women and unmarried men to report having undergone a colorectal endoscopy exam. For example, in 2008, 56% of married men reported having undergone a colorectal endoscopy exam, compared to 49% of unmarried men, 52% of married women, and 50% of unmarried women. Among persons with health insurance, married persons were significantly more likely than unmarried persons to have undergone a colorectal endoscopy exam. Among persons who were poor, there was no difference by marital status in the likelihood of having undergone a colorectal endoscopy exam. However, among persons who were not poor, married persons were more likely than unmarried persons to have undergone a colorectal endoscopy exam. Conclusion: Given that colorectal endoscopy exams are a potentially life-saving procedure, persistently higher uptake of colorectal endoscopy for married persons over time may be an important health promoting benefit of marriage. Therefore, clinicians and policy makers should focus on improving the use of cancer prevention services among unmarried persons.     

Ecological consequences of altered hydrological regimes in fragmented ecosystems in southern Australia: Impacts and possible management responses

Abstract Although the potential impacts of rising water tables and secondary salinization on agricultural land in southern Australia have been recognized for some time, it is only recently that the impacts on native vegetation have been considered. Despite the likely extent and severity of the problem, no comprehensive approach to assessing the impact of salinity upon native vegetation has been attempted to date. In the present paper, we discuss the causes and impacts of rising water tables and dryland salinity, assess the levels of risk in different ecosystem types and consider the possibilities for the maintenance of biodiversity and ecosystem function in vegetation at risk. We examine the salinity risk to woodland vegetation in the Western Australian (WA) wheatbelt, and consider both broad‐scale context and finer‐scale variation within individual patches of vegetation. From this information, we develop a set of conceptual models of the potential impacts of shallow saline water tables on ecosystem structure and processes in remnant vegetation in agricultural areas, particularly in the WA wheatbelt. First, we suggest that fine‐scale variability in surface topography and soil characteristics may play an important role in limiting the impacts of rising saline water tables. The outcome will depend on the interaction of the heterogeneity of the impact, species distribution in relation to small‐scale environmental heterogeneity and variation in species response to hydrological change. Second, we suggest that shallow saline water tables can be considered to cause an ‘edge effect’, which moves inwards from the edge of remnants of native vegetation. Finally, we consider how saline surface flows exacerbate the effects of shallow saline water tables and hasten vegetation decline in remnant areas. We put these models forward as hypotheses to be tested in different situations. We contrast the situation of secondary salinization in Australian vegetation with that of naturally saline systems in Australia and elsewhere, and suggest that these systems may provide important signposts toward developing management approaches for vegetation at risk. In conclusion, we consider the need to set priorities for the protection and restoration of natural vegetation at risk from altered hydrology, based on an assessment of relative threat and probability of persistence or recovery. We highlight the urgency for action that protects native vegetation from the increasing risks of rising water tables.     

Enhanced schooling performance in lateralized fishes

The occurrence of functional left-right cerebral asymmetries has been documented in a wide range of animals, suggesting that the lateralization of cognitive functions enjoys some kind of selective advantage over the bilateral control of the same functions. Here, we compared schooling performance of fishes with high or low degree of lateralization, which were obtained through selective breeding. Schools of lateralized fishes moving in a novel environment showed significantly more cohesion and coordination than schools of non-lateralized (NL) fishes. Pairs of fishes lateralized in opposite directions were as efficient as pairs of same laterality, suggesting that the performance of lateralized fishes derives from a computational advantage rather than being the consequence of a behavioural similarity among schoolmates. In schools composed of both lateralized and NL fishes, the latter were more often at the periphery of the school while lateralized fishes occupied the core, a position normally safer and energetically less expensive.     

Reproductive effort and herbivory timing in a perennial herb: fitness components at the individual and population levels

We experimentally investigated how pollinator- and herbivore-induced changes influence the performance of the long-lived herb Primula veris. Eight treatments that corresponded to natural factors normally affecting this species were designed to enhance or reduce reproductive success and resource availability (flower removal, supplementary pollination, defoliation). During the experimental season and in the following year we quantified responses in terms of survival, growth, and seed production of reproductive plants. Matrix population models were used to calculate population growth rate using the demographic parameters recorded in permanent plots and respective treatment groups. Seed production was not limited by pollen availability, and we found no evidence of a cost of reproduction. Leaf removal had either no effect or a negative effect on future performance, depending on the timing of removal. Defoliation early in the season reduced current seed production and future growth, whereas removal during fruit development affected performance in the following year. Demographic models suggest that leaf damage has a smaller negative impact than flower removal on overall performance in this population. Our results suggest that the source-sink paths vary over the season and that the timing of herbivory may influence the extent to which effects are carried over to subsequent reproductive seasons.     

Social jetlag negatively correlates with academic performance in undergraduates

Discrepancies between sleep timing on workdays and weekends, also known as social jetlag (SJL), affect the majority of the population and have been found to be associated with increased health risk and health-impairing behaviors. In this study, we explored the relationship between SJL and academic performance in a sample of undergraduates of the Semmelweis University. We assessed SJL and other sleep-related parameters with the Munich ChronoType Questionnaire (MCTQ) (n?=?753). Academic performance was measured by the average grade based on weekly test results as well as scores acquired on the final test (n?=?247). The average mid-sleep point on free days in the Hungarian sample fits well the regression line plotted for longitudes within the Central European Time Zone and chronotypes, confirming that sunlight has a major impact on chronotype. Multivariate analysis showed negative effect of SJL on the weekly average grade (p?=?0.028, n?=?247) during the lecture term with its highly regular teaching schedules, while this association disappeared in the exam period (p?=?0.871, n?=?247) when students had no scheduled obligations (lower SJL). We also analyzed the relationship between the time of the weekly tests and academic performance and found that students with later sleep times on free days achieved worse in the morning (p?=?0.017, n?=?129), while the inverse tendency was observed for the afternoon test-takers (p?=?0.10, n?=?118). We did not find significant association between academic performance and sleep duration or sleep debt on work days. Our data suggest that circadian misalignment can have a significant negative effect on academic performance. One possible reason for this misalignment is socially enforced sleep times.     

Exam experience and some reactions to exam stress

The aim of this study was to assess the effects of previous exam experience on some psychophysiological reactions before, during and after repeated exams. A sample of 15 first year psychology students took part in the study. While the subjects were expecting a oral exam for the first time, their levels of exam apprehension, high activation and state anxiety were measured a day before, an hour before the exam and the following day. Furthermore, subjects' cardiac R-R intervals were continuously recorded from five minutes before the exam to five minutes after the exam. Four, out of 15 subjects, passed the exams at first sitting, while the rest of them failed and had to repeat it. These 11 students underwent the same procedure for the second time. The levels of exam apprehension, high activation and anxiety did not show any differences between the first and the second exam sittings. R-R interval parameters indicated a higher stress before and after the second exam sitting, while the stress level was more or less the same during both exams.     

Exam experience and some reactions to exam stress

The aim of this study was to assess the effects of previous exam experience on some psychophysiological reactions before, during and after repeated exams. A sample of 15 first year psychology students took part in the study. While the subjects were expecting a oral exam for the first time, their levels of exam apprehension, high activation and state anxiety were measured a day before, an hour before the exam and the following day. Furthermore, subjects’ cardiac R-R intervals were continuously recorded from five minutes before the exam to five minutes after the exam. Four, out of 15 subjects, passed the exams at first sitting, while the rest of them failed and had to repeat it. These 11 students underwent the same procedure for the second time. The levels of exam apprehension, high activation and anxiety did not show any differences between the first and the second exam sittings. R-R interval parameters indicated a higher stress before and after the second exam sitting, while the stress level was more or less the same during both exams.     

Use and misuse of correspondence analysis in codon usage studies

Correspondence analysis has frequently been used for codon usage studies but this method is often misused. Because amino acid composition exerts constraints on codon usage, it is common to use tables containing relative codon frequencies (or ratios of frequencies) instead of simple codon counts to get rid of these amino acid biases. The problem is that some important properties of correspondence analysis, such as rows weighting, are lost in the process. Moreover, the use of relative measures sometimes introduces other biases and often diminishes the quantity of information to analyse, occasionally resulting in interpretation errors. For instance, in the case of an organism such as Borrelia burgdorferi, the use of relative measures led to the conclusion that there was no translational selection, while analyses based on codon counts show that there is a possibility of a selective effect at that level. In this paper, we expose these problems and we propose alternative strategies to correspondence analysis for studying codon usage biases when amino acid composition effects must be removed.     

A Biochemistry of Human Disease course for undergraduate and graduate students

This paper describes the experience of members of a medical school faculty who have been offering for more than 10 years a two-course series in the biochemistry of human disease to undergraduate students majoring in biochemistry, biology, or chemistry. Each of the two 3-credit courses meets twice a week for 90 min per session. The courses are divided into five three-week blocs (total number of sessions per bloc, six), each of which is taught by a different instructor. The sixth and last class in each of the blocs is devoted to an exam; there is no cumulative final exam. The topics that are covered include the following: diabetes mellitus, alcoholism, Alzheimer's disease, trophoblastic diseases of pregnancy, molecular and cellular mechanisms of cancer (including chemical carcinogenesis), disorders of calcium metabolism, biochemical and nutritional causes of anemia, collagen diseases, and gene replacement therapy. The various teaching formats and kinds of reading assignments that are used are discussed, as are the reactions of selected faculty who have participated in these courses. The positive experience we have had with a bloc approach to topics-based, multi-instructor courses in human disease should encourage basic science faculty at other medical schools in the US and elsewhere to become involved in teaching specialized, advanced courses to undergraduate, pre-professional students.     

The Effect of Therapy Dogs on Exam Stress and Memory

Therapy dogs have been shown in many different situations to reduce stress and improve outcomes, but their effects on academic performance are unknown. I hypothesized that interaction with therapy dogs prior to exams would reduce stress in students and improve exam scores. In study 1, participants who chose to interact with the therapy dogs showed a significantly larger stress decrease and scored 5.5 points higher on their final exam than those who did not interact. In study 2, investigating memory retrieval, participants assigned to interact with therapy dogs immediately prior to their final exam showed a marginally larger stress reduction, but no difference in exam score, compared with those who watched a movie about dogs. To investigate memory consolidation, in study 3, participants were assigned to interact with therapy dogs or watch a movie immediately after learning some material. A significant interaction between condition and exam question type suggests that, compared with those who watched a movie about dogs, interacting with therapy dogs impaired memory for material learned just prior to the manipulation, but enhanced memory for material encountered at other times. Overall, interaction with therapy dogs appears to reduce stress, but had no effect on memory retrieval in study 2, and differentially affected memory consolidation of associated material in study 3.     

Mortality factors affecting Bemisia tabaci populations on cotton in Turkey

Cohort‐based, partial life tables were constructed to determine the sources and rates of mortality factors affecting Bemisia tabaci (Gennadius) (Homoptera: Aleyrodidae) on cotton in the eastern Mediterranean region of Turkey over a two year period. Mortality factors were recorded as due to predation, parasitism, dislodgement and unknown for five developmental stages. Across 10 independent cohorts, the highest median rate of marginal mortality pooled over all stages was attributed to parasitism (0.69) followed by predation (0.67). The key factor was hypothesized to be parasitism based on graphical and regression‐based comparison of individual factor k‐values to total generational mortality. The greatest amount of marginal immature mortality occurred during the fourth nymphal stadium (median = 0.77) and mortality during this stage was also most predictive of variation in total mortality. Pooled over all developmental stages, the highest rates of irreplaceable mortality were associated with parasitism (median: 0.112), followed by predation (0.088), dislodgement (0.020) and unknown (0.017). Although crawler mortality was not explicitly measured, sensitivity analyses indicated that mortality during this stage would have changed total mortality by only 0.45–1.21% and had no effect on identification of key factors. There was no significant effect of cotton cultivar on any mortality factor or total mortality over the two years of study. Results suggest that conservation of natural enemies, particularly parasitoids, may provide for more sustainable management of B. tabaci on cotton in Turkey.     

NMR spectroscopy in structure-based drug design

NMR methods for the study of motion in proteins continue to improve, and a number of studies of protein-ligand complexes relevant to drug design have been reported over the past year, for example, studies of fatty-acid-binding protein and SH2 and SH3 domains. These studies have begun to give a picture of the structural dynamics of protein-ligand complexes and to relate the changes in dynamics on ligand binding to the origins of specificity. NMR is also valuable in locating binding sites, both qualitatively from changes in chemical shift and more precisely from distances measured from relaxation effects. The conformation of the bound ligand can provide useful information for drug design, and over the past year improvements in methods have made it easier to obtain quantitative information from transferred nuclear Overhauser effect experiments.     

Functional restraints on the patterns of amino acid substitutions: application to sequence-structure homology recognition

Amino acid residues that are involved in functional interactions in proteins have strong evolutionary pressure to remain unchanged and consequently their substitution patterns are different from those that are noninteracting. To characterize and quantify the differences between amino acid substitution patterns due to structural restraints and those under functional restraints, we have made a comparative analysis of families of homologous proteins. Residues classified as having the same amino acid type, secondary structure, accessibility, and side-chain hydrogen bonds are shown to be better conserved if they are close to the active site. We have focused on enzyme families for this analysis since they have functional sites that are easily defined by their catalytic residues. We have derived new sets of environment-specific substitution tables, which we term function-dependent environment-specific substitution tables, where amino acid residues are classified according to their distance from the functional sites. The residues that are within a distance of 9 A from the active site have distinct amino acid substitution patterns when compared to the other sites. The function-dependent environment-specific substitution tables have been tested using the sequence-structure homology recognition program FUGUE and the results compared with the recognition performance obtained using the standard environment-specific substitution tables. Significant improvements are obtained in both recognition performance and alignment accuracy using the function-dependent environment-specific substitution tables (P-value = 0.02, according to the Wilcoxon signed rank test for alignment accuracy). The alignments near the active site are greatly improved with pronounced improvements at lower percentage identities (less than 30%).     

Frequentist performance of Bayesian confidence intervals for comparing proportions in 2 x 2 contingency tables

This article investigates the performance, in a frequentist sense, of Bayesian confidence intervals (CIs) for the difference of proportions, relative risk, and odds ratio in 2 x 2 contingency tables. We consider beta priors, logit-normal priors, and related correlated priors for the two binomial parameters. The goal was to analyze whether certain settings for prior parameters tend to provide good coverage performance regardless of the true association parameter values. For the relative risk and odds ratio, we recommend tail intervals over highest posterior density (HPD) intervals, for invariance reasons. To protect against potentially very poor coverage probabilities when the effect is large, it is best to use a diffuse prior, and we recommend the Jeffreys prior. Otherwise, with relatively small samples, Bayesian CIs using more informative (even uniform) priors tend to have poorer performance than the frequentist CIs based on inverting score tests, which perform uniformly quite well for these parameters.     

Netgram: Visualizing Communities in Evolving Networks

Real-world complex networks are dynamic in nature and change over time. The change is usually observed in the interactions within the network over time. Complex networks exhibit community like structures. A key feature of the dynamics of complex networks is the evolution of communities over time. Several methods have been proposed to detect and track the evolution of these groups over time. However, there is no generic tool which visualizes all the aspects of group evolution in dynamic networks including birth, death, splitting, merging, expansion, shrinkage and continuation of groups. In this paper, we propose Netgram: a tool for visualizing evolution of communities in time-evolving graphs. Netgram maintains evolution of communities over 2 consecutive time-stamps in tables which are used to create a query database using the sql outer-join operation. It uses a line-based visualization technique which adheres to certain design principles and aesthetic guidelines. Netgram uses a greedy solution to order the initial community information provided by the evolutionary clustering technique such that we have fewer line cross-overs in the visualization. This makes it easier to track the progress of individual communities in time evolving graphs. Netgram is a generic toolkit which can be used with any evolutionary community detection algorithm as illustrated in our experiments. We use Netgram for visualization of topic evolution in the NIPS conference over a period of 11 years and observe the emergence and merging of several disciplines in the field of information processing systems.     

Aging and Sensory Substitution in a Virtual Navigation Task

Virtual environments are becoming ubiquitous, and used in a variety of contexts–from entertainment to training and rehabilitation. Recently, technology for making them more accessible to blind or visually impaired users has been developed, by using sound to represent visual information. The ability of older individuals to interpret these cues has not yet been studied. In this experiment, we studied the effects of age and sensory modality (visual or auditory) on navigation through a virtual maze. We added a layer of complexity by conducting the experiment in a rotating room, in order to test the effect of the spatial bias induced by the rotation on performance. Results from 29 participants showed that with the auditory cues, it took participants a longer time to complete the mazes, they took a longer path length through the maze, they paused more, and had more collisions with the walls, compared to navigation with the visual cues. The older group took a longer time to complete the mazes, they paused more, and had more collisions with the walls, compared to the younger group. There was no effect of room rotation on the performance, nor were there any significant interactions among age, feedback modality and room rotation. We conclude that there is a decline in performance with age, and that while navigation with auditory cues is possible even at an old age, it presents more challenges than visual navigation.     

Evaluating the efficacy of a student-centered active learning environment for undergraduate programs (SCALE-UP) classroom for major and non-major biology students

During the 2012–2013 academic year the University of North Dakota (UND) piloted the use of a Student Centered Active Learning Environment for Undergraduate Programs (SCALE-UP) classroom. Genetics, a 300 level class for Biology majors, and Concepts of Biology, an introductory course for non-majors were two of the classes piloted. Here, we examine the effects of this transition on overall academic performance, grade distribution, exam question performance classified by Bloom’s Taxonomy, student performance by quartile, and University Student Assessment of Teaching (USAT) surveys. Comparisons are made to historical data from a lecture-based setting to examine the effects of switching from an instructor-centered to a learner-centered format. Following the transition, both courses showed a higher proportion of students receiving an A/B/C grade and a concomitant decrease in D/F/W grades, and students continued to have positive perceptions about themselves, the course and the instructor. Paradoxically, both courses experienced a concerning decrease in performance by lower quartile students on comparable exam questions.