Search PubMed⌕ Search

Biomedical subjects

E Ackerman

Publications and source records attributed to E Ackerman.

At least 19 recordsLinked to original sources
PubMed1992

Iontophoretic delivery of morphine for postoperative analgesia.

Iontophoresis is a method of transdermal administration of ionized drugs in which electrically charged molecules are propelled through the skin by an external electrical field. This was a prospective, randomized, single-blind study to determine the effectiveness of iontophoretically delivered morphine HCl for the control of postoperative pain. Thirty-eight patients who underwent total knee or hip replacement completed this clinical trial. Informed consent was obtained before surgery and patients were instructed on the use of a patient-controlled analgesia (PCA) device. Postoperatively, pain in the recovery room was initially controlled with IV meperidine, and thereafter with PCA therapy using meperidine, 2 mg/cc, with a dose of 10 mg IV and a lock-out period of 15 min. The dose was adjusted as necessary and the lock-out period remained the same. The number of patient requests and the dose (mg) administered was recorded hourly. On the morning following surgery, iontophoresis devices were attached for 6 hr to patients who received either morphine HCl or lactated ringers solution. During this period and for 12 hr following completion of iontophoresis, PCA analgesia remained available to patients. Venous blood samples for determination of morphine levels were obtained every 30 min during iontophoresis, then every 60 min for 2 hr following iontophoresis. Of the 38 patients, 17 received iontophoresed morphine, and 21 received iontophoresed lactated ringers. The morphine group utilized the PCA device more than the control group during the baseline period. However, following the institution of iontophoresis and continuing up to 12 hr following completion of iontophoresis, the morphine group used significantly less PCA meperidine to maintain analgesia than the control group (p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Pancreatitis induced by mesalamine.

Sulphasalazine is an active agent in the treatment of chronic inflammatory bowel disease, but there are a number of well-known side effects, including pancreatitis. The newer 5-ASA agents are thought to be equally effective but less toxic. Here we describe a patient who developed a pancreatitis due to mesalamine; this was confirmed at rechallenge.

Acute Disease↗
PubMed1991

Polychotomous multivariate models for coronary heart disease simulation. I. Tests of a logistic model.

Stochastic compartmental modeling techniques have been employed to simulate coronary heart disease morbidity and mortality. In the current paper, polychotomous logistic models are used to describe the relationship between risk of disease and multiple risk factors, effect modification and confounding variables. The process of estimating the parameters for two risk factors and three types of outcomes is described for a population followed for five years. A Statistical Analysis System (SAS) procedure was used to estimate risk factor coefficients based on two partial periods and on the entire five year epoch. Most of the estimated coefficients were found to be statistically significant. The model performance was evaluated by comparing the observational data with simulated outcomes using a micropopulation and Monte Carlo techniques. Two different tests of goodness of fit were used. Satisfactory fits were obtained both for the risk coefficients based on two partial periods and those based on the entire epoch. This indicates that the model is suitable for simulation of the effects of intervention strategies. The use of the entire epoch involved estimates of one half as many parameters as did the use of two partial periods. Accordingly, it is concluded that only the entire epoch need be considered for future studies of this population.

Adult↗
PubMed1991

An expert system for simulation of coronary heart disease risk factor interventions.

The feasibility of using an expert system to support intervention studies within CRISPERS was investigated. A prototype expert system named CRISPERT was designed to accept user inputs, adjust the values to CRISPERS requirements, start a sequence of simulations, and analyze and interpret the results. The rule-based system was implemented using the expert system development language OPS5 combined with FORTRAN, as well as SAS procedures and DEC VMS system service routines. Results of initial tests suggest that using an expert system as an interface between users and CRISPERS is a viable approach. The development of CRISPERT facilitates the usability of CRISPERS for intervention studies of coronary heart disease.

Computer Simulation↗
PubMed1990

LINKERS: a simulation programming system for generating populations with genetic structure.

Significant features are described of a Monte Carlo simulation system, LINKERS, that generates nuclear family data conforming to one locus and two loci genetic models. Software engineering techniques help to produce a user friendly environment for studies of genetic ascertainment. LINKERS' 39 code modules are maintained and optimized using VAXset. Within a VAX/VMS workstation environment LINKERS generates a useful population of 10,000 families in 1 min. An example is presented to illustrate the use of LINKERS. Generated data were analysed using the segregation program POINTER. Likelihood ratio tests showed the effects of multiple alleles, gene frequency and incorrect specification of disease prevalence.

Computer Simulation↗
PubMed1990

Cardiovascular effects of large doses of pentamorphone in the dog.

The cardiovascular effects of large doses of pentamorphone were evaluated in nine mongrel dogs basally anesthetized with sodium thiopental, 25 to 30 mg/kg, intravenously. All dogs were mechanically ventilated with 100% oxygen, and the PaCO2 was maintained between 35 and 40 mm Hg. Mean arterial pressure (MAP), central venous pressure, heart rate (HR), cardiac output (CO), pulmonary artery pressure, and pulmonary artery occluded pressure were measured, and stroke volume and systemic and pulmonary vascular resistances were calculated. Baseline measurements were obtained, then pentamorphone, 10 micrograms/mL, was given as an intravenous infusion at 2.5 micrograms/kg/min. Additional data were obtained after infusion of 25, 50, 75, 100, 125, 150, 200, 250, 300, and 350 micrograms/kg of pentamorphone. The inspired gases were then changed to 50% nitrous oxide in oxygen, and after a 20-minute equilibration period, an additional set of data was collected. Pentamorphone, 25 micrograms/kg, decreased HR 50%, MAP 65%, and CO 54%. No further changes in any measured or calculated variables were observed with additional doses of pentamorphone. The addition of 50% nitrous oxide to the inspired gas mixture had no effect on any measured or calculated hemodynamic variable. The minimal hemodynamic effects of pentamorphone in the dog suggest that further investigation into its use as an anesthetic is warranted.

Analysis of Variance↗
PubMed1990

Simulation of mechanisms of viral interference in influenza.

Biological interference among viral agents might have significant implications for disease prevention and therapy. Field data for influenza yield conflicting evidence concerning the independence of infection rates, or disease severity, for two co-circulating viruses. To examine the effects of several assumed modes of interference for influenza, simulations of a Monte Carlo micropopulation model of influenza epidemics have been performed. Model parameters were selected so that the simulated attack rates for each of two different viral strains matched actual field data. Rates of infection were compared for single agents and for two viruses with only behavioural interference. Other simulations included temporary immunity to the other virus for the duration of the infection, and/or reduced shedding of viral particles for dual infections. Simulated viral competition had little impact on epidemic severity, duration, or size distribution. Under the conditions studied, viral interference in natural populations would be difficult to infer from field observations of attack rates. Other simulations extended a partial immunity and/or reduced viral shedding during an infection with a second virus. These indicated that interference might be suggested by field data, but it could not be demonstrated conclusively. Still other simulations showed that for epidemics with much higher attack rates for both viruses, it would be relatively easy to demonstrate interference. However, in order to observe interference between influenza strains, it would be necessary to monitor on an almost daily basis, using a method of viral detection which would have to be both highly specific and also very sensitive.

Adolescent↗
PubMed1988

Latin hypercube sampling and the sensitivity analysis of a Monte Carlo epidemic model.

Discrete, algorithmic simulation and Monte Carlo methodologies are currently used in population biology, connectionist cognitive modeling, and physics. However, little is typically known about the sensitivity of such models to changes in the values of the model features. Traditional methods of sensitivity analysis for systems of differential equations do not apply. Sometimes, one or two parameters are modified at a time in an ad hoc fashion in an attempt to assess sensitivity. To include more model features and their interactions in a sensitivity study, while limiting computer utilization, various sampling methods have been suggested. In this article, a sensitivity study based on a Latin hypercube (LH) sampling design is compared with a similar study using a full factorial (FF), fixed-point sample. A discrete, Monte Carlo model of epidemics of influenzavirus infections in a human community is used for illustrative purposes. Although the FF scheme used over 14 times as many samples as the LH sampling one, both provided comparable predictive ability and comparable information about simulation sensitivity to model features.

Adolescent↗
PubMed1988

Order of response surfaces for representation of a Monte Carlo epidemic model.

Response hypersurfaces for two selected outcomes and for 6 model features were generated for Latin Hypercube (LH) samples of the parameter space of a discrete, micro-population, Monte Carlo model of an epidemic of an infectious disease agent. SAS stepwise, multivariate regression routines were used to generate response hypersurfaces of first, second and third order in the model features for each outcome. These are used as illustrative examples to examine the appropriateness of the order of the polynomial describing the response hypersurface. The response hypersurfaces are very dependent on the model outcomes and also on the selected ranges of the model features. Results indicate that there is little reason to prefer any particular order for the response hypersurfaces. Further, it is suggested that apparent interaction terms found when using quadratic and cubic response hypersurfaces may represent artifacts of the choice of a particular order for the response hypersurface. Nonetheless, the comparison of the 3 orders of response hypersurfaces can, under some circumstances, reveal basic characteristics of the sensitivity of the outcome to the model features.

Computer Simulation↗
PubMed1988

Measles: clinical and laboratory observations in young adults during an epidemic.

We describe the spectrum of clinical and laboratory findings in 130 young nonvaccinated adults who had measles during an epidemic, and give special emphasis to liver involvement. The data from these cases are compared to those of other selected groups of hospitalized young adults. Since measles seems to cause severe morbidity in adults, active measures should be taken to identify and vaccinate vulnerable nonimmunized individuals.

Acute Disease↗
PubMed1979

Immunonephelometric assays.

Nephelometry, the measurement of scattered light, determines the size, shape, and concentration of the scattering particles (at least in theory). For the applications of nephelometry in immunoassays, the scatterers are the antigen-antibody complexes formed. The rationale for using nephelometry includes the advantages of greater simplicity and improved precision as compared to other assay methods. There are, however, other factors which limit the immunological assays in which nephelometry is employed, most notably its sensitivity to noise due to dust and occasional large aggregates of antigen-antibody complexes. Nephelometers commercially available for immunoassays use a variety of light sources; most measure the scattered light at a single angle, and several incorporate microcomputers. A review of the theory of light scattering by small spheres is introduced to indicate fashions in which future developments may make nephelometry the method of choice for an even wider range of immunoassays.

Humans↗
PubMed1978

Investigation of statistical decision rules for sequential hematologic laboratory tests.

A statistical data processing program for identifying patients who are likely to have abnormalities on various hematologic laboratory tests is described. The prediction of abnormal levels of serum vitamin B12, serum folate, transferrin saturation, and reticulocyte counts is based on a statistical analysis of the patient's age, sex, and routine blood cell measurements. The program was developed using data from normal-value studies and data from patients who had these laboratory abnormalities. The sensitivity and specificity of the program were evaluated in a controlled prospective study of about 5,000 ambulatory adult patients. The program's predictions also were compared with the laboratory tests requested by the patients' attending physicians. The program was most sensitive for predicting low serum vitamin B12 (74%) and low transferrin saturation (78%). In the prospective evaluation, the predictive values varied from 11% for predicting low serum folate to 65% for predicting low transferrin saturation.

Adult↗
PubMed1978

Relative merits of two electrophoretic and two column-chromatographic kets for determining serum creatine kinase isoenzyme MB activity.

Prospective analysis (by use of commercially available kits) of 339 validated admission specimens from patients consecutively admitted to a cardiac monitoring unit revealed sensitivities of 68 and 63% for two electrophoretic assays (Bioware and Helena) and up to 73 and 77% for two chromatographic assays (Roche and Worthington). Specificities were 94.8, 96,6, 90.2, and 89.7% and efficiencies were 90.2, 90.7, 87.0, and 87.0, respectively. Although these results differ from early reports, they agree well with several recent studies. However, 86 (25%) of the specimens gave at least one discrepant result based on clinical evaluation of the patients, and 68 (20%) gave at least one discrepant result between methods.

Chromatography, Ion Exchange↗
PubMed1977

Economic impact of a computer-based centralized organization in a clinical laboratory.

The Department of Laboratory Medicine, University of Washington, has explored various management of organizational approaches over the past seven years. The Centralized Processing Area supported by a computerized information system has evolved from these efforts. Despite a decrease in U.W. hospital usage since 1968-69, laboratory volume has steadily increased. The cost of these services is shown in relation both to three successive management systems and to the impact of inflation on laboratory costs. Chemistry and hematology costs per procedure, including administration and computer costs, are compared with microbiology cost per procedure, where the management system was not used. There is growing acceptance of the intangible benefits of computerization in the laboratory. Economic benefits are often presumed but have not been proven. Favorable economic effects of the Centralized Processing Area together with the computerized information system are demonstrated.

Autoanalysis↗
PubMed1976

An influenza simulation model for immunization studies.

A stochastic simulation epidemic model based on discrete time intervals and appropriate for any infectious agent spread by person-to-person contacts is presented. The population is highly structured, allowing for five age groups and for subgrouping mixing in families, neighborhoods, schools, and preschool playgroups as well as total community mixing. With proper choice of relative susceptibility by age, length of latency and infectivity periods, pathogenicity and withdrawal patterns, and the relative infectiousness of silent infections, the model becomes highly agent-specific. The model includes flexible immunization routines and variable vaccine response patterns. The model is applied to the 1957 Asian and 1968 Hong Kong pandemic strains of influenza A. The results of several schedules of immunization of school children are presented and compared for the two strains.

Adolescent↗