Improving Estimates of Neighborhood Change with Constant Tract Boundaries.

Social scientists routinely rely on methods of interpolation to adjust available data to their research needs. Spatial data from different sources often are based on different geographies that need to be reconciled, and some boundaries (e.g., administrative or political boundaries) change frequently. This study calls attention to the potential for substantial error in efforts to harmonize data to constant boundaries using standard approaches to areal and population interpolation. The case in point is census tract boundaries in the United States, which are redefined before every decennial census. Research on neighborhood effects and neighborhood change rely heavily on estimates of local area characteristics for a consistent area of time, for which they now routinely use estimates based on interpolation offered by sources such as the Neighborhood Change Data Base (NCDB) and Longitudinal Tract Data Base (LTDB). We identify a fundamental problem with how these estimates are created, and we reveal an alarming level of error in estimates of population characteristics in 2000 within 2010 boundaries. We do this by comparing estimates from one of these sources (the LTDB) to true values calculated by re-aggregating original 2000 census microdata to 2010 tract areas. We then demonstrate an alternative approach that allows the re-aggregated values to be publicly disclosed, using "differential privacy" (DP) methods to inject random noise that meets Census Bureau standards for protecting confidentiality of the raw data. We show that the DP estimates are considerably more accurate than the LTDB estimates based on interpolation, and we examine conditions under which interpolation is more susceptible to error. This study reveals cause for greater caution in the use of interpolated estimates from any source. Until and unless DP estimates can be publicly disclosed for a wide range of variables and years, research on neighborhood change should routinely examine data for signs of estimation error that may be substantial in a large share of tracts that experienced complex boundary changes.

Electronic Medical Record Reporting Enhances Proactive Psychiatric Consultation.

BACKGROUND: Numerous studies have demonstrated that psychiatric and substance use issues in general hospital inpatients result in increased length of stay and associated costs. Additional studies have demonstrated that proactive consultation models in psychiatry can effectively address these problems. Selecting patients for proactive interventions is less well studied. OBJECTIVE: We sought to develop an automated, electronic medical record-based screening tool to select patients who might benefit from proactive psychiatric consultation. METHODS: An automated daily report was developed using information stored in electronic medical record and billing systems. Discrete data fields populating the report included diagnoses, orders, and nursing care plans. RESULTS: Over a 9-month period, the report identified 2177 patients (19% of the total nonpsychiatric adult admissions) as potentially benefitting from proactive psychiatric interventions. Of these, 367 were confirmed as likely to benefit from intervention; 139 (38%) were randomized to the proactive psychiatric consultation group. Of those patients randomized to "treatment as usual," a subset later required psychiatric consultation, which was requested an average of 4 days after the time they were flagged by the report. CONCLUSIONS: The use of an electronic medical record-based automated report is feasible to select patients for proactive psychiatric interventions on admission and throughout the hospital stay. Early identification of patients may decrease length of stay and improve patient outcomes.

Linking the 1940 U.S. Census with Modern Data.

The U.S. Census Bureau has created a set of linkable census, survey, and administrative records that provides longitudinal data on the American population across the past eight decades. While these files include modern decennial censuses, Census Bureau surveys, and administrative records files from other federal agencies, the long time span is only possible with the addition of the complete count 1940 Census microdata. In this paper, we discuss the development of this linked data infrastructure and provide an overview of the record linkage techniques used. We primarily focus on the techniques used to produce a beta version of a linkable 1940 Census microdata file and discuss the potential to further document and extend the infrastructure.

Frozen Film and FOSDIC Forms: Restoring the 1960 U.S. Census of Population and Housing.

In this article, the authors describe a collaboration of the Minnesota Population Center (MPC), the U.S. Census Bureau, and the National Archives and Records Administration to restore the lost data from the 1960 Census. The data survived on refrigerated microfilm in a cave in Lenexa, Kansas. The MPC is now converting the data to usable form. Once the restored data are processed, the authors intend to develop three new data sources based on the 1960 census. These data will replace the most inadequate sample in the series of public-use census microdata spanning the years from 1850 to 2000, extend the chronological scope of the public census summary files, and provide a powerful new resource for the Census Bureau and its Research Data Centers.

Cardiofaciocutaneous syndrome (CFC) with congenital peripheral neuropathy and nonorganic malnutrition: an autopsy study.

Many phenotypic manifestations have been reported in cardiofaciocutaneous (CFC) syndrome, but none, to date, are pathognomonic or obligatory. Previous histopathological studies reported findings in skin and hair; no autopsy studies have been published. We report the clinical and autopsy findings of a 7-year-old boy with severe CFC syndrome and malnutrition of psychosocial origin. Manifestations of CFC, reported previously, included macrocephaly and macrosomia at birth; short stature; hypotonia; global developmental delays; dry, sparse thin curly hair; sparse eyebrows and eyelashes; dilated cerebral ventricles; high cranial vault; bitemporal constriction; supraorbital ridge hypoplasia; hypertelorism; ptosis; exophthalmos; depressed nasal bridge; anteverted nostrils; low-set, posteriorly-rotated, large, thick ears; decayed, dysplastic teeth; strabismus; hyperelastic skin; wrinkled palms; keratosis pilaris atrophicans faciei; ulerythema ophryogenes; hyperkeratosis; gastroesophageal reflux; and tracheobronchomalacia. Additional findings, not previously reported, include islet cell hyperplasia, lymphoid depletion, thymic atrophy and congenital hypertrophy of peripheral nerves with onion bulb formations. Although the islet cell hyperplasia, lymphoid depletion, and thymic atrophy are nonspecific findings that may be associated with either CFC or malnutrition, the onion bulb hypertrophy is specific for a demyelinating-remyelinating neuropathy. These findings implicate congenital peripheral neuropathy in the pathogenesis of the developmental delays, feeding difficulties, respiratory difficulties, ptosis and short stature in this case. Additional studies of other cases of CFC are needed.

Causes of death in sickle cell disease: an autopsy study.

More precise analysis of causes of death is needed to focus research efforts and improve morbidity and mortality in sickle cell disease. In this study, the morphological evidence of the cause of death was studied in 306 autopsies of sickle cell disease, which were accrued between 1929 and 1996. The most common cause of death for all sickle variants and for all age groups was infection (33-48%). The terminal infection was heralded by upper respiratory tract syndromes in 72.6% and by gastroenteritis in 13.7%. The most frequent portal of entry in children was the respiratory tract but, in adults, a site of severe chronic organ injury. Other causes of death included stroke 9.8%, therapy complications 7.0%, splenic sequestration 6.6%, pulmonary emboli/thrombi 4.9%, renal failure 4.1%, pulmonary hypertension 2.9%, hepatic failure 0.8%, massive haemolysis/red cell aplasia 0.4% and left ventricular failure 0.4%. Death was frequently sudden and unexpected (40.8%) or occurred within 24 h after presentation (28.4%), and was usually associated with acute events (63.3%). This study shows that the first 24 h after presentation for medical care is an especially perilous time for patients with sickle cell disease and an acute event. Close monitoring and prompt aggressive treatment are warranted.