Dominic Klyve

Malpractice claims for endoscopy.

AIM To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities (

Measuring Habits of Mind: Toward a Prompt-less Instrument for Assessing Quantitative Literacy

54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest (

Longitudinal assessment of colonoscopy quality indicators: a report from the Gastroenterology Practice Management Group

374  794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment (

Using a Media-Article Approach to Quantitative Reasoning as an Honors Course: An Exploratory Study

70  730  101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.

An Empirical Approach to the St. Petersburg Paradox

In this study, we offer a new “prompt-less” instrument for measuring students’ habits of mind in the field of quantitative literacy. The instrument consists of a series of questions about a newspaper article the students read. The questions do not explicitly solicit quantitative information; students’ habit of mind is assessed by their use of quantitative reasoning even when it is not asked for. Students’ answers were graded according to a modified version of the Quantitative Literacy Assessment Rubric (QLAR) published in this journal (vol. 4, issue 2). We applied the instrument and rubric to assess preand post-intervention habits of mind in opportunistic samples of two cohorts of students: the general (non-STEM) student body and (non-STEM) honors students at Central Washington University. The intervention was a QL course designed around a collection of newspaper articles to provide authentic context. The preand post-course assessment showed no statistically significant improvement in either group. We close with a discussion of practical aspects of using the rubric based on our experience of using it in this QL class.

Spare your arithmetic, never count the turns: A Statistical Analysis of Writing about Shakespeare, 1960–2010

BACKGROUND There is increasing demand for colonoscopy quality measures for procedures performed in ambulatory surgery centers. Benchmarks such as adenoma detection rate (ADR) are traditionally reported as static, one-dimensional point estimates at a provider or practice level. OBJECTIVE To evaluate 6-year variability of ADRs for 370 gastroenterologists from across the nation. DESIGN Observational cross-sectional analysis. SETTING Collaborative quality metrics database from 2007 to 2012. PATIENTS Patients who underwent colonoscopies in ambulatory surgery centers. INTERVENTIONS Colonoscopy. MAIN OUTCOME MEASUREMENTS The number of colonoscopies with an adenomatous polyp divided by the total number of colonoscopies (ADR-T), inclusive of indication and patients sex. RESULTS Data from 368,157 colonoscopies were included for analysis from 11 practices. Three practice sites (5, 8, and 10) were significantly above and 2 sites (3, 7) were significantly below mean ADR-T, with a 95% confidence interval (CI). High-performing sites had 9.0% higher ADR-T than sites belonging to the lowest quartile (P < .001). The mean ADR-T remained stable for 9 of 11 sites. Regression analysis showed that the 2 practice sites where ADR-T varied had significant improvements in ADR-T during the 6-year period. For each, mean ADR-T improved an average of 0.5% per quarter for site 2 (P = .001) and site 3 (P = .021), which were average and low performers, respectively. LIMITATIONS Summary-level data, which does not allow cross-reference of variables at an individual level. CONCLUSION We found performance disparities among practice sites remaining relatively consistent over a 6-year period. The ability of certain sites to sustain their high-performance over 6 years suggests that further research is needed to identify key organizational processes and physician incentives that improve the quality of colonoscopy.

Darwin, Malthus, Süssmilch, and Euler: The Ultimate Origin of the Motivation for the Theory of Natural Selection

In this study, we investigate student performance on a basic skills assessment of percentages and ratios in two cohorts of students: the general (non-STEM) student body (cohort G) and (non-STEM) honors students (cohort H). Both cohorts used a media-article approach to the study of quantitative reasoning. A preand a post-intervention assessment were administered with a two-week intervention period consisting of critical analyses of the use of percentages and ratios in media articles. Using non-parametric techniques, no statistically significant improvement was measured in cohort G while cohort H students showed statistically significant improvement on several items.

A pilot study of endoluminal US for stool liquefaction.

Summary The St. Petersburg game is a probabilistic thought experiment. It describes a game which seems to have infinite expected value, but which no reasonable person could be expected to pay much to play. Previous empirical work has centered around trying to find the most likely payoff that would result from playing the game n times. In this paper, we extend this work to the distribution of all possible values which could result from this experiment. We use this distribution—with a surprising fractal-like pattern—to examine the unlikely nature of the most famous experiment on this game, the results of the Compte de Buffons playing the game 2048 times.

Generalized Collatz Functions: Cycle Lengths and Statistics

By taking a quantitative approach to Shakespeare studies, this paper reveals patterns in how and what we write about Shakespeare. Using statistics from the World Shakespeare Bibliography (WSB), we track publications about individual plays from 1960 to 2010. In addition to reporting descriptive statistics that offer a bird’s-eye view of Shakespeare studies over the last half century, we identify trends in relation to particular plays, such as The Tempest’s growing popularity and Julius Caesar’s relative decline. We demonstrate temporal trends in relation to genre and non-English Shakespeareana. This paper concludes by suggesting the value of further quantitative analyses of Shakespeare studies.

Tu1399 Colonoscopy Quality Indicators From a Nationwide Consortium of GI Practices

It is fairly well known that Darwin was inspired to formulate his theory of natural selection by reading Thomas Malthus’s Essay on the Principle of Population. In fact, by reading Darwin’s notebooks, we can even locate one particular sentence which started Darwin thinking about population and selection. What has not been done before is to explain exactly where this sentence – essentially Malthus’s ideas about geometric population growth – came from. In this essay we show that eighteenth century mathematician Leonhard Euler is responsible for this sentence, and in fact forms the beginning of the logical chain which leads to the creation of the theory of natural selection. We shall examine the fascinating path taken by a mathematical calculation, the many different lenses through which it was viewed, and the path through which it eventually influenced Darwin.