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Background Most healthcare data sources store information within their own unique schemas, making reliable and reproducible research challenging. Consequently, researchers have adopted various data models to improve the efficiency of research. Transforming and loading data into these models is a labor-intensive process that can alter the semantics of the original data. Therefore, we created a data model with a hierarchical structure that simplifies the transformation process and minimizes data alteration. Methods There were two design goals in constructing the tables and table relationships for the Generalized Data Model (GDM). The first was to focus on clinical codes in their original vocabularies to retain the original semantic representation of the data. The second was to retain hierarchical information present in the original data while retaining provenance. The model was tested by transforming synthetic Medicare data; Surveillance, Epidemiology, and End Results data linked to Medicare claims; and electronic health records from the Clinical Practice Research Datalink. We also tested a subsequent transformation from the GDM into the Sentinel data model. Results The resulting data model contains 19 tables, with the Clinical Codes, Contexts, and Collections tables serving as the core of the model, and containing most of the clinical, provenance, and hierarchical information. In addition, a Mapping table allows users to apply an arbitrarily complex set of relationships among vocabulary elements to facilitate automated analyses. Conclusions The GDM offers researchers a simpler process for transforming data, clear data provenance, and a path for users to transform their data into other data models. The GDM is designed to retain hierarchical relationships among data elements as well as the original semantic representation of the data, ensuring consistency in protocol implementation as part of a complete data pipeline for researchers.

Background In end-stage kidney disease, patients may undergo parathyroidectomy if secondary hyperparathyroidism cannot be managed medically. This study was designed to estimate the parathyroidectomy rate in the United States (US) and to quantify changes in costs and other outcomes after parathyroidectomy. Methods This was a retrospective observational cohort study using US Renal Data System data for 2015–2018. Parathyroidectomy rates were estimated for adult hemodialysis and peritoneal dialysis patients alive at the beginning of 2016, 2017, and 2018 who were followed for a year or until parathyroidectomy, death, or transplant. Incremental differences in economic and clinical outcomes were compared before and after parathyroidectomy in adult hemodialysis and peritoneal dialysis patients who received a parathyroidectomy in 2016 and 2017. Results The rate of parathyroidectomy per 1,000 person-years decreased from 6.5 (95% CI 6.2-6.8) in 2016 to 5.3 (95% CI 5.0-5.6) in 2018. The incremental increase in 12-month cost after versus before parathyroidectomy was $25,314 (95% CI $23,777-$27,078). By the second month after parathyroidectomy, 58% of patients had a corrected calcium level < 8.5 mg/dL. In the year after parathyroidectomy (versus before), hospitalizations increased by 1.4 per person-year (95% CI 1.3-1.5), hospital days increased by 12.1 per person-year (95% CI 11.2-13.0), dialysis visits decreased by 5.2 per person-year (95% CI 4.4-5.9), and office visits declined by 1.3 per person-year (95% CI 1.0-1.5). The incremental rate per 1,000 person years for hematoma/bleed was 224.4 (95% CI 152.5-303.1), for vocal cord paralysis was 124.6 (95% CI 59.1-232.1), and for seroma was 27.4 (95% CI 0.4-59.0). Conclusions Parathyroidectomy was a relatively uncommon event in the hemodialysis and peritoneal dialysis populations. The incremental cost of parathyroidectomy was mostly attributable to the cost of the parathyroidectomy hospitalization. Hypocalcemia occurred in over half of patients, and calcium and phosphate levels were reduced. Clinicians, payers, and patients should understand the potential clinical and economic outcomes when considering parathyroidectomy.

Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher  (P≤0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.

Background: Most healthcare data sources store information within their own unique schemas, making reliable and reproducible research challenging. Consequently, researchers have adopted various data models to improve the efficiency of research. Transforming and loading data into these models is a labor-intensive process that can alter the semantics of the original data. Therefore, we created a data model with a hierarchical structure that simplifies the transformation process and minimizes data alteration. Methods: There were two design goals in constructing the tables and table relationships for the Generalized Data Model (GDM). The first was to focus on clinical codes in their original vocabularies to retain the original semantic representation of the data. The second was to retain hierarchical information present in the original data while retaining provenance. The model was tested by transforming synthetic Medicare data; Surveillance, Epidemiology, and End Results data linked to Medicare claims; and electronic health records from the Clinical Practice Research Datalink. We also tested a subsequent transformation from the GDM into the Sentinel data model. Results: The resulting data model contains 19 tables, with the Clinical Codes, Contexts, and Collections tables serving as the core of the model, and containing most of the clinical, provenance, and hierarchical information. In addition, a Mapping table allows users to apply an arbitrarily complex set of relationships among vocabulary elements to facilitate automated analyses. Conclusions: The GDM offers researchers a simpler process for transforming data, clear data provenance, and a path for users to transform their data into other data models. The GDM is designed to retain hierarchical relationships among data elements as well as the original semantic representation of the data, ensuring consistency in protocol implementation as part of a complete data pipeline for researchers. Footnotes * This version clarifies some of the language. It also clarifies that the GDM does not require mappings to work.

Roy Wilson Jr., 36, was charged with a second-degree misdemeanor for ignoring a Florida law that gives blind and other disabled people full and equal access to places where the general public is invited. Blind people are allowed to be accompanied by guide dogs, Assistant State Attorney Henry Lavandera said. Wilson said the two men could come inside, but he refused to let [Marion] Gwizdala's dog, Diamond, come with them. Wilson said the dog would violate the health code, he told Gwizdala.

Brenda or Les Eighmey would pick up the phone and find someone on the other end complaining about the Eighmeys' choice of tenants for a home they rent out on S Bayshore Boulevard. Mrs. Eighmey said her husband, the director of the county road and streets maintenance department, thinks it was arson. Mrs. Eighmey (pronounced AY-me) said she doesn't know what to think. [Audrey] Hairston discovered the fire about 12:20 a.m. Monday, when she and her boyfriend returned from the grocery store. Her 13-year-old sister, Miriam, was babysitting Hairston's daughter and the son of Hairston's friend. Hairston's other sister was staying overnight at a friend's house.

Now, an Air Force pharmacist who was stationed in Saudi Arabia says that to relieve tension and boredom, troops turned low-grade drugs into \"a common substitute for beer\" during Operation Desert Storm. The pharmacist, Capt. Roger E. Mansfield, who is stationed at MacDill Air Force Base, is facing court-martial on charges that he stole and used pharmaceutical drugs while working with the 56th Medical Group in Riyadh, Saudi Arabia. But Mansfield said he is being made a scapegoat by the Air Force. He said Air Force officials are refusing to acknowledge what he calls a widespread drug problem during the war because it could tarnish the glow from the allied victory against Iraq.

But 800 invitations bearing the wrong title for the queen of England are curling the collective lip of royals watchers and etiquette mavens, nonetheless. Trained eyes have picked out no fewer than eight errors in the one-page invitation. Foremost: The titles of the queen and her husband, Prince Philip, are wrong. Her Royal Highness, which appears in the invitation, is a title reserved for lesser royalty. Similarly, Prince Philip should have been referred to as His Royal Highness, Prince Philip, Duke of Edinburgh. He is simply called the Duke of Edinburgh in the invitation.

Police were searching for Sedrick McKinney, the teen-ager convicted of shooting and paralyzing a 1-year-old boy during a crack deal in 1988, in connection with an armed robbery Monday night. Police could not say whether McKinney was in the vehicle they were chasing. They continued to search for the car and McKinney late Monday. The error was corrected after McKinney was freed for about a day. State officials said at the time that McKinney probably would serve about 16 months in prison.

New county Fire Chief J. K. Callahan learned of the business relationship between the county and Capt. Ronny Jay Russell during a review of department operations and ordered a stop to the practice, officials said. In a memo to Assistant County Administrator Larry Blick, Callahan wrote that he thought Russell had \"a direct conflict of interest\" between his employment and his role as president of Mobile Link Cellular Phones, which has done $3,020 in business with the fire department. Russell could not be reached for comment Thursday. Callahan also could not be reached. James Brady, chief of operations for the fire department, said fire department officials knew of the relationship but neither they nor Russell realized it was a problem.